Ethical Musculoskeletal Therapy and Myofascial Pain Specialists

Articles Back Pain

MSK Back Pain Treatment


Back Pain an age-old problem

Back Pain an Age old problem

Unfortunately, Back pain (backache) is something that the vast majority of the population will experience at some point in life and with an ever-increasing prevalence. Research suggests that up to one-third of the adult population is affected by back pain each year in the UK alone. Many direct and indirect costs are associated with back pain management, not just the medical aspects. There are also a variety of expenses related to treating the consequences for the individual, family members, work colleagues, society, and the economy, which can run into billions. Hence, there is a massive demand for back pain treatment. Backache is not purely a modern-day problem and has been a condition or, rather, a collection of associated symptoms that have affected humanity throughout history and since records began. There is also documentary evidence of treatments for back pain relief dating back to ancient records from China, Egypt, Greece and Rome, to name a few.


Back Injuries, Inflammation and Pain

Back Pain injury inflammed disc

As with many Musculoskeletal / MSK-related conditions, pain in the back can occur for many reasons and create vastly differing symptoms, levels of severity, types of pain and disability. For example, pain symptoms may vary from mild localised back soreness to agonising radiating pain depending on what is injured. Many forms of back pain have direct links to injury mechanisms, including historical and unresolved trauma resulting in functional biomechanical changes and tissue adaptions. A vital aspect of the human body's response to injury involves the inflammatory process, which serves multiple purposes and is a necessary part of healing. In brief, the inflammatory process consists of the body sending fluids to the area of injury to fight infection, remove debris, and stabilise the area for repair. How long it takes for fluids to reach the site of injury can depend on factors such as the severity of the injury, body temperature, external environmental temperature, vascular supply (blood) to the injured tissues/structures and more. Bodily tissues and structures have differing properties, which partially affect how they respond to types of force or injury mechanisms. There are also differences in vascular supply and the number and type of bodily sensors within different tissues and structures. Such differences can impact our interpretation of the type of pain, the intensity, and even where we feel pain. However, other factors can impact our interpretation of pain. The vascular supply to tissues and structures affects how soon one notices inflammation in the area of injury and the speed at which tissues can heal. The article on Soft tissue healing goes into far more detail.

Muscle tissues are highly vascular, and one may visibly notice swelling, bruising and pain in the case of a substantial muscle tear. On the other hand, intervertebral discs have a poor blood supply, meaning that the inflammatory response takes longer to reach the site of injury, with the pain often worsening after a night's sleep. However, injury mechanisms typically directly or indirectly affect a combination of tissues and structures, which is relevant to the noticeable inflammatory response, healing and pain perception. The inflammatory process also results in pressure on sensors within affected tissues and structures, restricting movement and further affecting pain perception. Further injury to already injured tissues and structures during the healing process can interrupt the normal healing process, resulting in an inferior repair, further inflammation, pain and prolonged healing times.


What can cause back pain and stiffness

Causes of back pain

Much like any piece of machinery, correct functioning requires a combination of cogs and moving parts to work seamlessly. Parts also require lubrication and maintenance to prevent breakdowns, and the human body is not hugely different. However, the human body does operate many self-maintenance functions, which have limits as covered in the soft tissue healing article mentioned earlier.

The spine consists of complex joint structures and soft tissues, enabling normal pain-free movement when no issues exist. Direct or indirect injuries to soft tissues and joint structures can result in restricted mobility and pain. The section on injury mechanisms provides further details about direct and indirect injuries, which can both result in back problems . Back injuries typically involve injury to a mix of soft tissues and functional unit structures, varying primarily due to the injury mechanism and how long the injury has been present. However, pain referral can also occur due to other forms of injury resulting in inflammation, such as infections or diseases. For example, urinary tract infections (UTIs) are commonly seen in women, resulting in referred kidney pain and lower back pain, which would require medical practitioner assistance rather than manual therapy. Common reasons for back pain may involve a combination of the following tissues and structures:-

  • Intervertebral Discs
  • Zygapophyseal Joints
  • Zygapophyseal Joint Capsules
  • Muscles
  • Ligaments
  • Tendons
  • Vertebral Bodies
  • Vertebral Elements
  • Hip joints
  • Sacroiliac Joints (SIJ)
  • Nerves
  • Organs - Visceral tissue
  • Fascia

Some injuries and medical conditions may result in pain referral and the feeling of a painful back, and yet there is nothing wrong with the back, such as hip pathologies. Hence, successfully treating back pain symptoms requires a holistic approach to gain a detailed understanding of each patient's unique circumstances leading up to symptom formation. Gaining a detailed understanding of what is at fault requires time, experience, knowledge and the ability to assess. Just guessing what is at fault means that any treatment is also guesswork, likely leading to poor outcomes. Poor outcomes may result in prolonged healing time, increased treatment costs, worsening symptoms, the formation of additional conditions and unnecessary stress. Many structures and tissues within the back have direct or indirect relationships with other body parts. Hence, one commonly sees patients with neck and back pain or other seemingly unrelated issues within an MSK Therapy clinical setting.


Back Injury Mechanisms

Back Pain injury mechanisms Rowing

Many musculoskeletal conditions can arise for one of four reasons, though some notable exceptions exist. The Osteopath (Leon Chaitow) frequently spoke of lack of use, misuse, overuse and abuse as injury mechanisms. However, specific diseases and congenital (birth-related) conditions can also affect the correct functioning of the musculoskeletal system and would not be related to the previous four categories. These possible injury mechanisms can lead to chronic pain if left unaddressed or if further injury occurs. Chronic Pain can be much harder to treat and resolve due to a combination of factors, and the articles on the human stress response cover some of these. By understanding the reasons for the onset of back pain, one can identify what's injured, how to treat and provide pain relief, rehabilitate the injury and prevent, avoid or limit the chances of future injury. It is essential to understand how remarkable the healing capabilities of the human body are and how much trauma it can heal from, given the right opportunity and still perform at a high level.

More in depth Back Pain Injury mechanisms

Lack of use

The phrase "use it or lose it" is highly relevant in back soreness and pain cases. Many functions within the body require movement to help move fluids around the body, e.g. venous return (deoxygenated blood supply), lymphatic flow (lymphatic fluid relevant to immunity) and synovial fluid (related to cartilage). Many joints within our body and spine include cartilage, and squeezing type action of movement helps maintain this. In some respects, cartilage is a bit like a "sponge" and nutrients and waste products are transferred in and out via a squeezing action and movement. There is also evidence that cerebrospinal fluid is pumped around the body as part of normal respiratory action (breathing) movement. There is growing evidence of the benefits of activity on musculoskeletal health, immunology and other bodily systems. Evidence suggests that a lack of use of the musculoskeletal system results in earlier degenerative changes, which is highly logical. Tissues and structures will also adapt to a lack of use, and thus, they may not be able to cope when needed for a particular function, such as lifting something.

Misuse

There are multiple ways to misuse joint structures and soft tissues of the spine. Misuse can also create adaptive changes, which affect the back directly or indirectly. Again, such adaptive changes can lead to injury at a later stage. One can misuse our body in many ways, e.g. poor exercise technique when rowing or at the gym, habitual behaviours (laying on the sofa watching television, poor computer work setup, sitting in a slumped position for hours on end, not taking breaks), (see the article creating an ergonomic computer setup guide). Equally, one could combine a misuse activity with a lack of use type activity or vice versa

Overuse

An overuse activity does not necessarily have to originate from physical activity and could easily result from a misuse activity. Quite often, a misuse activity can lead to the overuse of joint structures, soft tissues or a combination thereof. Overuse injuries arise from doing too much of something, be it a sport, social activity, habitual behaviour, etc. Tissues and joint structures need time to adapt to new levels of demand. Hence, why serious athletes go through a training process which develops throughout the training schedule. Rowers are quite susceptible to lower back-related problems, as the repetitive rowing motion can lead to overuse injuries. However, adaptive changes will likely have already placed additional loads on the lower back when the issues finally become apparent.

Abuse

In some cases, there could be elements of misuse and overuse with some "abuse" type injuries. Generally, one could view any form of physical trauma, unintentional or otherwise, as an "abuse" type of injury. Equally, consciously doing something likely to cause a spinal injury would certainly fit within this category. Some sports and pastimes have developed protective clothing, such as helmets, neck collars, and even protective jackets, to help reduce the chances of spinal injury, as with horse riding. Many back injuries will also affect the neck and other structures as they are connected and forces travel. Hence, neck pain is common with back injuries. Furthermore, all of the possible mechanisms mentioned above can lead to "adaptive" changes within the body. Having a good "self-body awareness" can help prevent many types of misuse and overuse injuries. One then knows when something is wrong and can address it before it becomes more problematic.

Notable Exceptions

Many diseases and infections may present with back pain at different spine levels. Common examples may include urinary tract infections, shingles, and other visceral (organ) related pain. Such notable exceptions may present in an MSK clinical setting, though require a general medicine approach with a medical doctor or specialist for further investigations and treatment.


The shear complexity of spine

The following section briefly explains how complicated the human spine is. Backache can originate from several areas due to the vast array of structural and functional components. Numerous other structures run between various spine sections, including ligaments, muscles, fascia, nerves, veins, arteries, and lymphatics, complicating matters further. Trauma can result in injury or irritation to any of these structures, which the brain interprets as various types of pain, which may be localised to the area of injury or referred to other areas. As one can see from the image, there are a vast number of moveable joint structures within the spinal column. Furthermore, human movement requires the correct functioning of multiple joint structures or units (coupled motion) and tissues simultaneously. Issues causing restrictions in movement at one structural unit level have a knock-on effect on other units above and below, impacting overall movement.

The human spine consists of four broad sections and many vertebrae within each section:- cervical (7), thoracic (12), lumbar (5), sacral (5 fused), and coccygeal (4 fused). The image on the left illustrates these structures, including the skull, ribs, sternum, and pelvis, but no soft tissue structures exist. The shape of vertebrae within each section of the spine differs, which has connotations for function and movement. It is also noticeable from the image on the left that the spine has three distinct and natural curvatures. The lumbar (lower back) section and cervical (neck) section of the spine both have "C" shaped lordotic curves. However, the thoracic portion of the spine has the opposite shape, a reversed "C" shape or kyphotic curvature. Although there are differences between the general population concerning the degrees of curvature in these spine sections, this is perfectly normal. A combination of structural (bone and joints) and functional soft tissues (ligaments, muscles, tendons and fascia) maintain the spine's natural curvatures. Such differences in the individual components help explain why there is no such thing as a "correct", "perfect", or "Gold Standard" posture. However, one can still place a "postural" related load on the spine and, in effect, increase forces on the tissues and structures that maintain the spine's natural curvatures. In some respects, the term "postural fatigue" might be more descriptive, as muscles only have a finite capacity to cope with any given load. Multiple variables affect a muscle's capacity to deal with any given force, including the type of muscle (size, condition), load (type, duration, angle), muscle nerve supply, nutrients, oxygen, etc. Once muscles fatigue, other structures and soft tissues start taking additional loads, which can, in turn, affect other muscles and so on. The spine's natural curvatures are functionally relevant to bodyweight distribution, movement, shock absorption, etc.

Back Pain structures - 3d4medical.com image

Image produced with kind permission of 3d4medical.com from Essential Anatomy 5

(Copyright © 2018 - 2024 3D4Medical. All rights reserved.)

If one were to isolate each of the portions of the spine, then one would find that the amount of functional movement decreases as one moves from cervical to lumbar. Hence, one can usually rotate one's head to around ninety degrees to the left and right, and cervical vertebrae are relatively narrow in height, as seen in the following image. As one moves from the top of the spine to the bottom, the compressive load-bearing capacities of the vertebral bodies of the spine increase, as does the shape width and height. Although the human head is relatively heavy (around 10 lbs), the cervical portion of the spine does not need to carry vast amounts of weight, just the head. As any engineer will know, there are always tradeoffs between structural and functional capabilities. Hence, different sections of the spine are more susceptible to certain types of injury mechanisms than others, and this explains the typical grouping of conditions within medicine, such as lumbar back pain. The cervical spine is highly mobile yet incapable of taking large loads/forces and is more susceptible to various injuries.

Cervical neck bones - 3d4medical.com image

Image produced with kind permission of 3d4medical.com from Essential Anatomy 5

(Copyright © 2018 - 2024 3D4Medical. All rights reserved.)

The lumbar spine can cope with much higher loads/forces, particularly compressive, though it is relatively immobile compared to the cervical spine. Unlike the cervical spine, the lumbar spine has to cope with the weight of everything above it, not just the head. One can see the difference in size and shape of the lumbar vertebrae in the following image.

lumbar back bones - 3d4medical.com image

Image produced with kind permission of 3d4medical.com from Essential Anatomy 5

(Copyright © 2018 - 2024 3D4Medical. All rights reserved.)

The thoracic section of the spine also has additional rib attachments. Ribs have several functions, including protecting organs and aiding respiration. The ribs are attached to the thoracic spine via ligaments, cartilage, other soft tissue structures and to the chest's sternum. The following image demonstrates the difference in the shape of the thoracic vertebra.

thoracic back bones - 3d4medical.com image

Image produced with kind permission of 3d4medical.com from Essential Anatomy 5

(Copyright © 2018 - 2024 3D4Medical. All rights reserved.)

The sacrum and coccyx (tailbone) are fused bones below the lumbar spine. The sacrum (5 fused bones) carries a great deal of load for the spine, and a common disc injury (slipped disc, prolapsed disk) site is between lumbar vertebrae L5 and the start of the sacrum S1. One finds the coccyx (tailbone) (4 fused bones) below the sacrum. There is also a joint structure between the sacrum and coccyx (tailbone), which can be another origin of back, hip or leg pain. Two further joints on either side of the sacrum attach the two halves of the pelvis. The Sacroiliac Joints (SIJs), as they are known, can also be a source of back, hip or leg pain.

sacral or coccyx bone - 3d4medical.com image

Image produced with kind permission of 3d4medical.com from Essential Anatomy 5

(Copyright © 2018 - 2024 3D4Medical. All rights reserved.)

Although there may be four distinct spinal sections, various soft tissues, muscles, fascia, ligaments, and tendons cross over the multiple sections. Equally, soft tissues from other body parts can impact the spine directly due to physical attachment(s) or indirectly via associated tensional and compressive forces (see biotensegrity article). Trauma of any kind usually impacts soft tissues and fascia, which can result in myofascial pain and restricted mobility. If left unaddressed or ineffectively treated, such pain can develop into more complicated conditions such as myofascial pain syndrome.


Pain and back symptom onset

As a musculoskeletal therapist, the author has lost count of the number of patients he has seen with varying degrees of back-related pain and with differing origins. Typically, one can split patients into one of two groups based on symptom onset.

A Direct trauma/event:-

Back pain origin direct trauma

Typically, a distinct associated event relates to the patient's symptom onset, such as a traumatic event (car crash, bike accident, horse riding fall, etc.). Before the specific incident, the patient may have had no pain or symptoms. Equally, pain or symptoms could be made worse or even better after a traumatic injury event. However, sometimes a patient may go to lift something innocuous or turn in a particular fashion and then suddenly "feel their back go". This type of injury would equally appear to have an undeniable "direct trauma" injury mechanism and pain onset. However, in many respects, such an injury may fit better into the second group, "gradual onset".

Gradual onset:-

Back pain in pregnancy and biotensegrity

Back pain symptoms can appear gradually over time, and frequently, the patient is unaware of any specific or related injury event. It usually takes time for symptoms to appear, worsening until patients finally seek help. The author has found that the majority of people wait until symptoms are extremely painful or otherwise debilitating before seeking treatment. Sometimes, people hope symptoms will resolve with no intervention, hence the delay in seeking assistance. In other cases, symptoms may appear to resolve on their own, only for further or different issues at a later date. Based on the author's clinical experience, he has often noted contributory "indirect" factors relating to those patients who have just "felt their backs go". Some patients have had a previous history of unresolved trauma, and others have never had an episode of backache . That said, the author has always noticed adaptive or compensatory changes in both sets of patients. Adaptive changes can lead to restrictions in 'normal" structural mobility and function, increasing the loads placed on spinal joints and other soft tissue structures (see the article on tissue adaptation for more details). Hence, the spine's ability to cope with specific loads or forces diminishes or becomes compromised over time and in part due to these dysfunctional adaptations. Habitual behaviours can also play a part in some types of back and neck pain . Relatively simple changes can have a hugely beneficial impact, such as creating an ergonomic work setup for home or in the office. Pain in the lower back is relatively common in pregnancy, especially as the pregnancy progresses. The natural ligament laxity caused by pregnancy, the change in centre of gravity and other noticeable changes to soft tissues and structures all can have an impact. Pregnancy involves many adaptive changes, which equally affects biotensegrity (see the article about Biotensegrity and how everything is connected). Pregnancy also increases the degrees of curvature in each of the sections of the spine. The changes become more noticeable as the pregnancy develops and lead to changes in loading.

Clinical experience has taught the author that one is likely to find a combination of adaptive changes in patients who present with either "direct trauma" or "gradual onset" type symptoms. The level and severity of these changes will usually relate to multiple variables, some of which may include:-

  • Severity of injury
  • Recency of injury
  • The tissues or structures involved and thus healing duration
  • Previous injury history
  • Unresolved trauma
  • Adequate Injury healing environment
  • Age
  • Other medical conditions
  • How soon after injury one seeks treatment
  • Effectiveness of treatment given
  • Time for dysfunctional adaptations to occur
  • Overall fitness
  • Diet

Such variables all have a bearing on how well tissues can heal, what adaptive changes occur and the effect that all of these factors have on biotensegrity. Pain can also have physiological and psychological impacts, and not purely due to the initial injury. There is a great deal of evidence concerning the relationship between long-term pain and the impact this can have on psychological health. Equally, physiological changes can occur as a result of psychological aspects. The articles about stress and wellbeing help explain some of the links between the physiological and psychological aspects of the human body.


Self-help back pain relief considerations

Back Pain relief considerations

Although there is a tendency for members of the general public to have good intentions by seeking self-help options in the first instance to resolve back pain, doing so can often end in poor outcomes. As with any form of treatment, whether self-treatment or by a professional, good outcomes are only possible when one knows what is injured and needs treatment. The author has seen many patients who have gone down the internet self-diagnosis and treatment route before seeking professional help. In some cases, the patients have resolved issues to some extent and got pain relief. In other cases, they have made things far worse or scared themselves into thinking they have some life-threatening condition. Other individuals have managed to resolve their pain and yet keep encountering seemingly unrelated injuries over time. Unfortunately, the internet only provides lists of symptoms for various conditions, including back pain, and knowledge of symptoms and differential diagnoses are just some aspects of understanding the cause of symptoms. Furthermore, lists of internet symptoms and a diagnosis based on such details do little to identify the actual cause, hence why some can appear plagued with seemingly unrelated injuries. Although the internet may provide some ideas, it cannot perform other important aspects of understanding what is going on with a patient, such as detailed questioning, examining tissues (palpation), and performing neurological and orthopaedic tests. It is also worth noting that there are huge differences within the field of manual therapy relating to the breadth and depth of education and training around such assessment, testing and diagnostic techniques. Ethical practitioners will work within their scope of practice and the confines of their training, knowledge and experience. Sadly, many work beyond their scope of practice and effectively rely on complete guesswork to treat. Hence, it is worth doing some due diligence around actual qualifications and professional memberships rather than attractive low-cost special offers, marketing blurb and hype. Influencers posting content online may have zero training or knowledge about what they say and yet have a good following.

Sleeping position and pillow height

Generally speaking, the human body is clever at finding positions that relieve pain for each person's unique injury situation. Hence, just because people post on social media about getting back pain relief from lying or sitting in a particular fashion does not mean such a position suits others. How our bodies are positioned and supported can make a huge difference in loading tissues and structures, which is particularly relevant when dealing with injuries. How we sleep also has a bearing on how tissues are loaded and can have relevance to healing from injury and, in other cases, the onset of musculoskeletal problems affecting the shoulders, neck and back. Correct pillow support and height, along with sleeping position can assist in creating an optimal healing environment by reducing further injury irritation.

Stretching a painful back

Although stretching may relieve back pain in one situation, it may worsen things when misapplied. Muscle strains or tears tend to have a dull ache, soreness and a sensation of tightness, which is why people often feel the urge to stretch the area. Stretching an already damaged muscle tear will likely create further damage, inflammation affecting the muscle and back pain, which may not be immediately apparent. Equally, stretching a protective muscle spasm will likely create further problems, either at the time or later, resulting in further muscle and back pain . One issue is that stretching may make things feel better at the time and yet cause further injury, increasing the chances of developing chronic pain.

Exercising with back pain

Exercise can also aggravate symptoms, primarily when one performs the wrong exercise or at the wrong time. Sometimes, patients have been attending group classes such as yoga or pilates and inadvertently performing exercises, worsening symptoms. In some cases, the individuals thought that pain was doing them good at the time, or they were encouraged to feel pain and think that it was good or that the class felt good. However, significant differences exist between discomfort during a treatment or while performing exercises and actual pain. Pain indicates that the tissues are not yet ready for the particular activity for various reasons. Contributory factors may still need addressing, or the original issue requires identification.

The author has encountered multiple patients suffering from disc-related back pain who had found exercises online and made symptoms worse. Disc pain usually has a sharper type of pain, which may travel or radiate to the extremities. However, disc injuries will likely press on other soft tissue structures, meaning symptoms may vary somewhat. Repeated motions involving the discs, prolonged loading (sitting) and even activities like coughing and sneezing tend to irritate disc-related symptoms. The author has encountered patients performing kettlebell swings with either cervical (neck) or lower back disc problems because "it felt good at the time", only for symptoms to be considerably worse the following day. The process would then repeat until the patient reached a point where they had to seek professional help. Such a situation can easily result in repeated trauma and lead to avoidable damage requiring surgical intervention.

Massage ball use and painful backs

Another example of where self-help can go wrong is finding an area of pain and then using a massage ball to apply trigger point therapy or a myofascial release technique. Pressing a massage ball into an area of pain can irritate the area and create additional inflammation, yet a massage ball may be helpful in other situations. Pressing a massage ball into an area with a muscle strain, ligament sprain, or inflamed disc is likely to make things worse, regardless of how it feels at the time. Hence, knowing what one is dealing with or treating is crucial to a good treatment outcome. The article on trigger point therapy provides some hints, tips and limitations of self treatment with a massage ball.

Heat and cold use with a sore back

Using heat and cold to relieve back pain is another area that can make things better or worse. Although there is no hard and fast rule, in a nutshell, heat increases the flow of fluids and blood to injuries (vasodilation) and cold decreases the flow of fluids and blood to injuries (vasoconstriction). For example, applying heat to a muscle spasm may provide some relief and feel soothing, yet using cold may worsen symptoms. Equally, applying cold to a muscle tear within the first 72 hours of injury may reduce pain and limit overall levels of inflammation, whereas applying heat may increase inflammation and pain levels. However, inflammation is integral to healing, so cold can negatively impact overall healing if used excessively.

Movement vs rest with a painful back

General medicine has moved a long way since the days of advising weeks or months of bed rest for backache or foam neck braces for whiplash as in the 1980s. Research has shown that prolonged immobility can negatively create adaptive changes to tissues and structures, affecting healing and longer-term outcomes. Movement, such as walking, tends to be a beneficial method of relieving pain for many back problems and aiding healing, though there are cases where movement can worsen symptoms. Hence, the takeaway is listening to the body rather than what somebody on social media tells you. Even if two people have the same diagnosed back-related condition, no two injuries are the same due to various unique person-specific factors impacting biomechanics. Such unique factors can help explain why a given activity may make one person's symptoms worse and another's better. If walking is painful, the injured tissues are not currently ready for this level and type of activity. However, other movement-based activities, such as swimming or walking in a swimming pool, may be fine. However, there may be occasions where rest is the only option and in cases of severe trauma and medical advice.

A note from the author:-

Even with all of the treatment knowledge, experience and skills the author has, he cannot effectively treat his own back, neck or shoulders, and there are limits on what is achievable elsewhere on the body. His clinical training and experience, combined with a highly developed sense of body awareness, may enable him to self-diagnose without all the testing but not apply effective treatment. Hence, we all need outside help sometimes.


Painful backs, treatment, healing and relief

Painful back treatment and relief

Although there is a vast industry based on offering quick fixes and back pain relief, there is not currently a magic pill or any specific treatment that instantly heals. There are decades of well-established research concerning the healing processes for various soft tissues and structures and the time taken. The absence of pain may not indicate that everything has healed correctly and may be due to tissue adaptions or medications masking the pain. The lack of pain can also impact a patient continuing with a treatment plan. In some cases, the author may resolve a patient's pain within a single treatment, though suggest a further one or two treatments. The additional treatments and aftercare advice are to treat resulting tissue adaptions at the time of injury and after the injury and to rehabilitate tissues to prevent further issues. Not only do initial injuries cause tissue adaptions affecting movement patterns, but changes in movement patterns also create further tissue adaptions. A single treatment is not likely to address or resolve such aspects of movement and tissue adaptations. Aftercare advice and prescriptive exercises build on the physical treatment work and address such aspects of tissue adaptation. Hence, the reason for recommending a course of treatments. Some patients purely wish to gain pain relief and so only seek treatment when in pain. However, there are also bad actors within the manual therapy field who utilise scaremongers and create excessively long treatment plans, which patients can feel pressured to sign up for. Personally, the author would never sign up for treatment plan blocks, especially if feeling pressured to do so by way of a discount or other means.

Given the correct healing environment, many patients are often surprised to hear that even bulging discs of varying severity can heal or reabsorb. Equally, although imaging can be helpful in terms of diagnosis, the evidence suggests that it is not the "be-all and end-all". Evidence indicates that imaging can be overused, with the imaging results frequently having no bearing on the end treatment given. Imaging does not necessarily explain the reason for the symptoms, as only some things may be visible. Research shows a high percentage of asymptomatic (symptom-free) patients who have routine imaging for symptoms not relating to back pain and have disc bulges within the spine or other such pathologies [1, 2]. Other patients may have symptomatic back pain, disc bulges, or other relevant pathology, which appear on imaging results. Historically, there has been a tendency to assume that just because something is present on an X-ray, CT scan or MRI, it must be the reason for the presence of the symptoms, often leading to surgery.

The fastest way to heal from injury is by providing the best healing environment, which prevents further injury. The correct environment largely depends on the type and severity of the injury, which may require treatment ranging from manual therapy through surgery and hospitalisation. Key aspects of providing the body with the best healing environment include:-

  • Identifying what is injured and why.
  • Preventing further injury while healing.
  • Rehabilitating, as is tolerable.

Manual therapists come in various forms and can effectively treat back problems, though there can be significant differences in how professionals work within the same profession. Hence, it is best not to hire all professionals from any profession with the same brush because of a good or bad experience. Some may think that seeing various professionals may speed up healing. Seeing multiple professionals can be beneficial in some cases, but only when there is a coordinated approach. Without coordination, one professional's work may prove counterproductive to another, extending overall healing times.


References

The article was written by Terry Davis MChiro, BSc (Hons), Adv. Dip. Rem. Massag., Cert. WHS.

The Morningside clinic occasionally runs promotional treatment rates for new and existing patients, which are available via the online booking calendar. If you liked this article or found it interesting, feel free to share the content with others. There are lots more articles available via the TotalMSK main Health, Wellness and Sports Injury blog page, which has a brief description of all the articles to date.


About the Author

As of December 31st 2020, the author chose to leave the Chiropractic profession due to a planned move back to Australia, where his training and education are not recognised. Terry no longer works as a Chiropractor and works as a Myotherapist in Morningside, Brisbane. He developed an early interest in soft tissue therapy techniques and advanced myofascial release methods in 2006 for treating various conditions. Terry's interests in human performance and trauma have naturally led to him developing a specialism in treating work and sports-related musculoskeletal injuries and Chronic Pain symptoms.

The author possesses an unusual background for somebody who trained in the McTimoney Chiropractic technique. His education, training, and practical experience span over two decades and relate to health's physical and mental aspects. He also needed to push his body and mind to the limits of physical and psychological endurance as part of his time serving in Britain's elite military forces. His education includes a bachelor of science degree in Business Management, with a specialisation in psychology and mental health in the workplace, an Integrated Masters in Chiropractic, MChiro and a multitude of soft-tissue therapy qualifications (see the about section for more details). His soft tissue qualifications range from certificate level right through to a BTEC Level 5 Advanced Diploma in Clinical Sports and Remedial Massage Therapy. He has also taught as a senior course coach at the Advanced Diploma level (Myotherapy / Musculoskeletal Therapy) in Australia, both theoretical and practical aspects, including advanced Myofascial Release Techniques and has certification in training and assessment. Terry will have taught many of the first students to train as Myotherapists in Brisbane. Terry's combination of knowledge through education, training, elite military service, and personal injury history has paid dividends for the patients he sees and has treated over the last 16 years. Terry is still extremely active and enjoys distance running, kayaking, mountain biking and endurance-type activities.