Back Pain and What It Means

We get asked by patients on a daily basis what injury or joint we see the most.  Back pain is high on the list, no question.  Back pain spans the lifespan and doesn’t discriminate between age, sex, or activity level.  We have many patients with a wide array of back pain symptoms.  For those of you that want to know what’s possibly wrong, here’s a collection of some common things we hear and what to do about it.  The orthopedic physical therapists at SSOR are astute at figuring out your problem and helping you fix it, not just put a “band-aid” on it with medication, heat/ice, or pain creams.

Back Pain Symptoms

1.  Symptoms: A fairly constant ache that’s not too severe but is always there annoying you.  No matter what, you can’t get comfortable.  You feel good for a few minutes and the pain returns.  Hurts to return from bending or any sudden movement transition.  Pain is typically across the whole low back when it happens.  You may have a long history of chiropractic manipulations, a history of dance/gymnastics, or are generally hypermobile/very flexible.  You tend to feel best in the morning and worse as the day progresses, you might be most miserable at the very end of the day.  You can be any age.
Diagnosis:  It’s likely that you are dealing with some sort of instability/hypermobility.  You need stabilization exercises.
2. Symptoms: Your back aches on either or both sides when sitting too long.  Maybe you work a job that requires you to sit a lot, drive long distances, or spend a lot of time in airplanes.  You can be any age.  Pain is typically achy and gets uncomfortable towards the end of the work day.  You typically feel best when not sitting or in the morning.  Moving around feels really good.
Diagnosis: It’s highly possible you have a postural syndrome from your job demands.  Your body doesn’t like any position too long, which explains the aching.  It’s letting you know that it’s time to get up and change position.  Think of it as a “reminder” that you need to move around or take a break.  The problem is that this is a cumulative condition.  The more hours/days/weeks/years you sit, the worse this tends to be.  We can help you with education on posture, ergonomics at your work station, exercises and stretching.  Try not to waste your time with MRI’s or anything with this.  Physical therapy is very successful for this.
3. Symptoms: You bent over, lifted something, or possibly twisted and felt  a sharp pain in the low back that may have caused shooting pain down the leg.  Pain may go from the hip, down the hamstring, in the calf, all the way to the toes.  Pain is typically very sharp and can take your breath away.  Bending, sitting make you worse and you tend to be worse in the morning.  Sitting on deep couches or recliners make you miserable.  You may be “shifted” one way if it’s bad enough.  You may or may not have a history of this.  You are likely at least in your 20’s.
Diagnosis: More than likely, you have some sort of disc pathology.  Could be a bulge or a herniation.  Word of caution: careful on immediately asking for an MRI.  Several studies have shown that many asymptomatic people have disc bulges.  Unfortunately, sometimes health care providers end up treating MRI’s and not the patient.  Exercises and education on posture and lifting mechanics will really help.  The McKenzie Approach, as practiced by our staff, is a useful method to treat herniations.
4.  Symptoms: You’re likely some sort of athlete, possibly in a rotational sport or a kicking sport.  You have unilateral low back pain that is aggravated by activity.  Pain is typically achy, but can be sharp if you move too fast or kick a ball really hard for example.  You may or may not have pain throughout the day, but specific things bother it.  You typically feel best in the morning, although you may be a little tight.  You don’t have any pain in your legs.  You don’t have numbness or tingling in your legs.
Diagnosis:  You may have what’s called spondylolysis, which is degeneration of one side of the vertebrae.  Can be easily helped w/ exercises and stretching.  Now, if you do have pain with extension and occasional pain down the leg, you may have a more severe version of this, which is called spondylolisthesis.  There are various grades of this that may or may not be managed by surgery or exercise.  Every case is unique.
5.  Symptoms: You’re likely at least in your 30’s.  You feel stiff in the morning, better as the day progresses, and tend to hurt at the end of the day.  Standing too long, walking too long, sitting too long all aggravate you.  Pain is mostly across the low back.  It may or may not radiate down your legs. Pain is usually achy and never really that sharp.  You know it’s there often.  You tend to get relief laying down.
Diagnosis:  You likely have some degenerative changes going on in your back, otherwise known as arthritis.  Like all other arthritic conditions, you treat this with activity modification, stretching, exercises, and posture/body mechanics.
6.  Symptoms: You are likely at least in your 40’s.  You have pain and possibly numbness/tingling going down BOTH legs and likely pain across the low back.  Seem to only get relief when you are resting your elbows on your knees or possibly when leaning on a shopping cart.  Standing and walking hurts your back and reproduces your symptoms.  You can get relief laying on your back with your legs up.
Diagnosis:  You may have central stenosis.  This leads to spinal cord compression, which causes the bilateral symptoms.  If the symptoms are only on one side, you may have what they call lateral recess stenosis.  Here, the foramen (“hole” to the layperson) on the side of your condition may have a bone spur or scar tissue that is pressing on the nerve causing your symptoms.  Depending how bad it is, you may need surgery to decompress the nerves.  However, you should try traction first.  You don’t need “Teeter Hang Ups” or fancy “decompression units” per se.  Your physical therapist can do this manually.  If you have lateral recess stenosis issues, there is another technique that can be done.  Give us a call and we’ll show ya what to do…
7.  Symptoms: You have a deep, boring ache in your back that isn’t relieved or worsened by anything. It’s there all the time.  Tends to be worse at night when you sleep.  You may have recent weight loss, feel nauseous, or sweat more often than normal.  You may have altered organ functions that are also associated with your back pain.
Diagnosis:  Not sure because it could be a lot of things, but it is not likely a physical therapy problem.  More than likely you have some sort of medical condition that needs evaluation by your primary care physician.
8. Symptoms: You have a throbbing, pulsating pain in your abdominal region that is not worsened or relieved w/ anything and is there all the time.   You may also feel nauseous as well.
Diagnosis:  You may have an abdominal aneursym.  This is a really big deal and needs immediate attention.
These last two are pretty complicated because so much may be going on, but the bottom line is this:  if your pain isn’t worsened or relieved by anything and is fairly constant, you likely don’t have a PT problem and need to see your physician.
The physical therapists at SSOR have seen it all so to speak.  We know how to figure out what’s the problem, how to fix it, and how to maximize your pain relief and function.  Give us a call – remember, in Kansas, you can see a physical therapist without having to see the doctor first.  Don’t wait any longer to get the relief you desire.

Tags: Kansas City, Overland Park