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Spine Physiotherapy

Lower back pain

Lower back pain is a complicated, painful and frustrating condition. The anatomy of the lower back consists of muscles, joints, discs, and nerves, all of which play their own vital role in our daily activities. An injury of any type; acute, chronic, overuse, or stress, will disturb the normal functioning of all these anatomical structures. Due to the disturbance of normal functioning, determining the underlying cause of your pain can be a complicated process. 

Physiotherapy for lower back pain is a complicated science, requiring attention to detail. Due to lower back pain being a daunting and frustrating experience, getting to the bottom of your underlying cause is vitally important. Our expert back pain Physiotherapists take the time to get to know you and your individual situation to determine the underlying cause of your back pain. 

 

Symptoms of Low Back Pain
  • Pain local to the lower back (muscles, joints, disc, nerves)
  • Pain radiating into the legs, or other parts of the back (muscles, nerves, both)
  • Tension through the lower back (muscles)
  • Stiffness through the lower back (joints)
  • Difficulty getting around (standing up from a chair, walking, or even moving in bed)
  • Increased pain with a cough or a sneeze (red flag)
  • Problems with bladder or bowel control (red flag)

Due to the complexity of lower back pain & the symptoms, there can be no “one size fits all” approach. Having a “cookie cutter” approach leads to poor outcomes, increased pain, and potentially long-term complications. 

Causes of Low Back Pain

  • Poor Biomechanics
  • Fatigued/weak muscles 
  • Neural irritation 
  • Disc irritation
  • Stress
  • Joint irritation
Common Questions

Everyone has questions;

  • Do you need surgery?
  • Will I have pain forever?
  • When will the pain go away?
  • Is it my disc?
  • Was it the way I moved?
  • Was it when I lifted that couch?

One of scariest parts about low back pain is the uncertainty, having so many questions and not getting the answers you’re after. Our experienced Physiotherapists take the time to answer all your questions, no matter what they are, to make sure that you have a full understanding of what is going on with your injury and physical rehabilitation. 

The best thing you can do when you are experiencing back pain is to head in and see your Physiotherapist. Your Physiotherapist will be able to give you the best advice in terms of movements that you should be doing to help improve your pain, movements that currently might be aggravating your pain, things that you can do at home to help with the pain, work environment tips, whether you should be at work at all, and if you should be seeing your GP, or getting imaging. 

Headache and Migraine Management

Around 90% of all headaches and migraines are managed with medications, and long-term use of those medications. More recently research has shown headaches, including cervicogenic headaches, share a common pain pathway – the lower brainstem. 

Research has also shown that upper cervical joint manual therapy (joint mobilisations), provided by a trained professional, can have a significant impact on reducing the pain pathway, and reducing the overall symptoms and severity of those headaches. 

Leaders Sports & Spine Physiotherapy is Brisbane’s most experienced headache specialty physiotherapy clinic for headache and migraine treatment. Call us today and see how we can help you with your headache and pain management.

Headache Types

While there are over 300 different types of headaches that have been clinically diagnosed, these are some of the more common types that we treat at Leaders Sports & Spine Physiotherapy. 

Cervicogenic Headaches

Generally speaking cervicogenic headaches are the most commonly treated type of headache at Leaders Sports & Spine Physiotherapy. A cervicogenic headache is a secondary headache, meaning the root cause of the pain is not coming from the head, but coming from an external source. Cervicogenic headaches are caused by some form of dysfunction in the cervical (neck) area; joint irritation, disc irritation or injury, muscle spasm, etc. 

Cervicogenic headaches generally have the same two symptoms; neck stiffness, and increased pain/pressure in the head when certain areas around the neck are pressed. Some of the less common symptoms of cervicogenic headaches are; 

  • Nausea
  • Vomiting
  • Poor concentration
  • Dizziness 

Cervicogenic headaches are generally best treated with a combination of manual therapy (joint mobilisations), muscle releases (soft, deep, and trigger point therapy), & exercise. The combination of these therapies will result in determining the underlying cause of the headaches, along with fully addressing the underlying cause while reducing overall pain.


Tension Headaches – acute & chronic

Tension headaches can be either acute (episodic) or chronic. The difference being the number of occurrences within a month, episodic being less than 15, & chronic being more than 15 occurrences within one month. 

 

A tension headache can be described as a tight band of tension around your head, kind of like wearing a headband. This tension comes on slowly and gradually, and generally doesn’t get too sharp with the pain staying around that mild to moderate intensity. 

 

The symptoms of an acute or chronic tension headache are relatively the same, due to the increased occurrence of the headaches, they can also have negative impacts on other aspects of your life. You may find;

  • Difficulty sleeping
  • Chronic fatigue
  • Difficulty concentrating
  • Muscle aches through the shoulders and neck 
  • Mild to moderate light and noise
Migraine Headaches

Migraines are a little more complicated than tension headaches in that they have more variability within the symptoms. Generally migraines are divided into two categories; a migraine with an aura, or a migraine without. An aura is referring to symptoms an individual may experience prior (10-30mins) to the beginning of the migraine. These Aura symptoms may include; 

  • Being less mentally alert or having trouble concentrating
  • Seeing spots or flashing lights
  • Feeling sensations of tingling or numbness through the face or hands
  • Having unusual sensations of touch, taste, or smell

Along with the normal headache-type pain, migraine sufferers also experience symptoms such as; 

  • Nausea
  • Vomiting
  • Pain behind one eye or ear
  • Seeing flashing lights or spots
  • Pain in the temples
  • Sensitivity to sound and/or light

Migraine sufferers generally also report various factors they relate to their migraines. These associated factors are called “migraine triggers”, and may include; 

  • Menopause
  • Emotional anxiety
  • Contraception
  • Alcohol 
  • Hormonal changes
Thunderclap Headaches

Thunderclap headaches are severe headaches that develop within 60 seconds. Generally speaking these headaches are actually a symptom of a subarachnoid hemorrhage (a bleed in the brain). If you experience anything like this, please go to the emergency department at your closest hospital – they are not headaches that you want to “leave and see how it feels”, every minute matters!

Acute & Chronic Neck Pain

Acute Neck Pain

Acute neck pain is generally caused by an unexpected force on the neck area resulting in a muscle, ligament, or joint sprain. This unexpected force can be either a large force acting quickly on the neck, such as whiplash from a car accident or a fall, or a smaller force acting on the neck for a prolonged period, such as sleeping in a strange position at night or having poor workplace ergonomics. 

The good news is that because the neck area is so highly vascularised (blood flow), it heals and recovers relatively quickly. Physiotherapy can be used to hasten the healing process through the neck, by determining the exact cause of the neck pain and treating that area specifically, rather than using heat/ice to treat the neck in a more general manner. 

Chronic neck pain

Chronic neck pain is defined as pain that lasts longer than the time that an acute injury would take to fully heal. The generally accepted length of time is around the 12week mark, where things generally tend to move towards the chronic neck pain area. 

The causes behind chronic neck pain are a little more complicated than those of an acute neck injury, however, they generally are only concerned with the passive structures in the cervical spine (bony anatomy, discs, & nerves). 

A disc injury or irritation is usually due to one of two seperate reasons; degeneration of the disc, or a herniation of the disc. Throughout life we are placing different pressures and stresses on the joints and discs in our spine, meaning that we are slowly degrading them – this is a normal process of aging. However, sometimes we will have excessive wear and tear on the discs in the spine, resulting in “abnormal” disc degeneration. This abnormal degeneration of the discs can result in pain through irritation of the joints in the area, or an irritation in the nerve in the same area – both of which can be quite painful. A herniated disc is usually caused by some form of trauma to the neck, resulting in the outer layer of the disc tearing and the inner layer of the disc protruding into the thecal space – causing irritation or compression of the nerves in the area. 

A cervical joint irritation or injury is slightly different to a disc injury. A joint irritation generally affects the nerves a little more closely, but only in certain positions or directions. The reason joint injuries affect the nerves more closely is due to the anatomical proximity they have to the joints, and the lack of available space. 

 

 

Chronic neck joint injuries are generally caused by osteoarthritis in the joints in the neck, with or without spinal stenosis. Osteoarthritis without spinal stenosis is abnormal growth within the joint space, while osteoarthritis with spinal stenosis is abnormal bone growth within the joint space that also expands into the foraminal space. The foraminal space is where the nerves exit the spinal column and move into their distributions. The abnormal growth within the foraminal space may or may not result in nerve root compression or irritation. 

Compression of the nerve root within the foraminal space is known as myelopathy. Myelopathy can be caused by either the stenosis (abnormal bone growth), or by disc compression through a herniation. Both of which narrow the foraminal space where the nerve exits the spinal column. Compression of the nerve roots may result in problems with coordination and strength throughout the distribution of that particular nerve root.

Physiotherapy has been a proven treatment method for many clients with chronic neck pain to avoid more invasive procedures such as steroid injections, nerve root ablation, & surgery. The main focus of Physiotherapy in chronic neck pain is to improve pain-free range of motion, and motion through the thoracic spine to alleviate some painful symptoms and movements.   

 

Thoracic Spine

The anatomy of the thoracic spine differs from the cervical and lumbar spine in the addition of the ribcage. There is a rib attached to each side of the thoracic spine, in multiple locations – the head of the rib articulates with not only its corresponding vertebra, but also the superior portion of the rib head also articulates with the inferior aspect of the vertebra above. 

Your costo-vertebral joints can be a common source of pain in the thoracic spine, as there is a mirriad of connective tissue, and mobile joints in a small space. An injury to a costo-vertebral joint is commonly referred to as a costo-vertebral joint dysfunction, this is due to the injury occurring through a complicated combination of movements. 

While the degree of movement at each of these joints is actually quite minimum, the amount of times each of these joints move everyday is quite high. Everytime you take a breath, the joints are forced to move in a “bucket-handle” pattern up and down around a fixed location. This movement allows for the expansion of the lungs, and entry of air into them. 

A costo-vertebral joint dysfunction occurs when there is significant enough load through the region to irritate, damage, or disturb the connective tissue. This load comes in one of two formats, strong and sudden – think car accident, or weak and prolonged – think strange sleeping position. Some of the other more common causes of a costo-vertebral joint irritation are; repetitive movements/lifting, lifting a heavy load with poor technique, or a muscle imbalance surrounding the spine. 

Generally speaking costo-vertebral injuries occur very quickly, resulting in sudden, sharp pain, that may take your breath away. In the hours following the initial injury, muscle spasm will begin to set in, with the peak generally being after some prolonged rest. This is why the day after the initial joint sprain and subsequent dysfunction will result in loss of mobility the next day.

Symptoms may include; 

  • Decreased range of motion through the thoracic spine
  • inability to stand upright
  • Increased pain on a cough/sneeze
  • Increased pain/sensation on deep breath
  • General tightness throughout the chest, or around one rib in particular

Physiotherapy is generally considered the best course of action for costo-vertebral joint sprains and irritations. During your Physiotherapy consultation you will be treated with a variety of modalities, including manual therapy, and soft/deep tissue release. Along with this your Physiotherapist will be able to provide you with some advice and education around ways to prevent re-aggravation and re-injury in the future. 

Thoracic Outlet Syndrome

Thoracic outlet syndrome is a term used to describe three related syndromes involving the compression of nerves, arteries, and veins in the lower neck and upper chest area. The compression of one or more of these structures can result in pain through the arm, shoulder and neck. Compression of these structures occurs in one of the narrow passageways leading from the base of the neck to the armpit and arm, most commonly in the subclavian space (area under the collarbone). 

The cause of the compression through these narrow passageways can vary greatly from person to person. Some of the causes may include; anatomical defects or variations, tumors within the narrow passageways, physical trauma, pregnancy, poor posture, & repetitive movements through the arm and shoulder.

The diagnosis of TOS can be complicated for all health professionals as there are many other injuries and conditions that have the same or similar symptoms, such as; rotator cuff injuries, cervical disc injuries/disorders, fibromyalgia, multiple sclerosis, complex regional pain syndrome, or tumors in the spinal cord. Along with the similarity of symptoms to other conditions, the symptoms of TOS can vary greatly in their severity – making the diagnosis even more complicated. To receive an accurate diagnosis, specialists will have to conduct nerve conduction studies, along with venous and arterial examinations under high-resolution imaging. 
Neurogenic TOS
Neurogenic TOS is the compression of the nerve supply running through the subclavian space, resulting in neurological type symptoms running down the arm or in the hand, such as; pins & needles, numbness (paraesthesia), discoloration or temperature changes in the hand, or dull aching pain in the neck, shoulder, or armpit.  Along with these symptoms, neurogenic TOS has one characteristic sign; the Gilliatt-Sumner hand. This is where there is severe muscle wasting through the thenar eminence (meaty part of the thumb).
Neurogenic TOS
Venous TOS Venous TOS is the compression of the venous blood supply running through the subclavian space, resulting in a weak or absent pulse through the affected arm, pale colouring of the arm (pallor), or being cool to the touch. Symptoms of venous TOS may include tingling, numbness, aching, weakness in the arm or neck, or swelling through the extremities – including the fingers. 
Neurogenic TOS
Arterial TOS Arterial TOS is the compression of the arterial blood supply running through the subclavian space, resulting in poor blood circulation in the arm, hand and fingers of the affected arm, along with changes in color and cold sensitivity through the hand and fingers. Along with this, symptoms may include paraesthesias, heaviness, or swelling in the affected arm. 

Sciatic Pain

Sciatic pain, or sciatica, is a blanket term used for ongoing leg and potential foot pain, originating from the lower back or glute area. In more severe cases the dull aching pain will be accompanied by neurological type symptoms, including pins & needles or numbness following a similar pattern. 

The term “sciatica” gets its name from the largest nerve in the body, the sciatic nerve. This nerve originates in the nerve roots in the lower back, in the spinal cord, and runs down through the glutes (buttock), through the lower limbs and into the bottom of the foot.

Symptoms
The symptoms of sciatic pain will vary between individuals, depending on the type of cause and the severity of the condition. The more severe the compression of the nerve the more severe the symptoms will be, and the greater chance the individual will suffer from multiple symptoms.  Symptoms may include; 
  • Intermittent or constant dull aching pain down the back or the outside of the leg. The distance down the leg the pain travels will vary depending on the individual; some people will only feel the pain into their glutes (bum), while others will feel the pain all the way through to the foot. 
  • Numbness through the leg, not always directly associated with the pain felt in the back of the leg. 
  • Some people will have feelings of a burning sensation, or tingling through their leg instead of the dull aching pain down the back of the leg that others may be feeling. 
  • For some individuals there will be certain movements, postures, or positions that make their symptoms worse. The most common position is sitting. 
Treatment for Sciatica

At Leaders Sports & Spine Physiotherapy we pride ourselves on preventing people from spending the rest of their lives taking medications, or even having surgery to potentially relieve their pain. 

After a thorough assessment of your condition and your symptoms, our Physiotherapy team will develop a treatment plan that may include manual therapy (joint treatment), soft and deep tissue mobilisations, trigger point therapy, and most importantly exercise prescription – to get you moving freely again. 

For some suffering from sciatic pain, they may have been recommended to undergo surgery to relieve their symptoms. For most people in this situation, a second opinion can be very valuable. The team at Leaders Sports & Spine Physiotherapy have extensive experience in sciatic, and other spine pain conditions, and understand where Physiotherapy can help, and when it is not the best option and it is more appropriate to refer for surgery. 

Scoliosis

A scoliosis is the lateral (sideways) curvature of the spine, most of which are mild cases with little to no symptoms. There are three different types or causes of scoliosis; idiopathic (unknown cause), congenital (passed down through genes), or neuromuscular. 

Some children develop these and other spinal deformities while they are growing, that gradually become more severe as they grow. Severe scoliosis can be both disabling and very painful. Severe scoliosis is usually treated with a brace, or sometimes surgery. 

The less severe cases of scoliosis can be treated, by a Physiotherapist. An assessment for scoliosis will involve assessing the movement and mobility of the spine, along with the surrounding musculature, and functional abilities. This assessment will guide the treatment, leading to potentially muscle releases, joint mobility work, strengthening of the paraspinal muscles, & improving the stability throughout the spine.