If you experience back pain, you are not alone. In fact, 8 out of every 10 North Americans suffer from back pain at some point in their lives (NIH,2012). Chronic back pain is a major public health issue which affects not only you, but also your family, the health care system, your work, and society as a whole. It can cause absences from work or social activities and even lead to a loss of a job. Chronic pain can also be associated with anxiety and depression.
Research shows that two out of every three people that experience back pain cannot even identify any specific mechanism of injury, “it just happens”.
But WHY does it happen? Can it be controlled, managed, or prevented?
As a physiotherapist, back pain is by far the most common complaint I treat, and yet, I find that the general population knows very little about simple back health. We have been taught how to brush and floss our teeth to maintain good oral health and we even know how to maintain our vehicles so they run efficiently and safely. But somewhere along the line, basic back care education for our own bodies is missed.
There are many factors that play a role in back pain, many different ways it manifests and many different ways that it can be addressed. We can’t discuss this all in one article. However, in my experience, I feel that the majority of cases can certainly be better managed, and potentially even prevented all together. Here are 6 helpful tips to keep in mind to help manage and prevent your back pain:
1) frequent position changing: prolonged sitting or forward flexion puts the most load on the low back and can contribute to disc problems. Prolonged standing or repetitive movements in any one direction can also place unfavourable strain on the spine. Frequently changing your position or taking mini-breaks throughout the day may seem ‘time consuming’ and unproductive at the time, but it can save you from debilitating pain in the long run.
2) use correct body mechanics: most people seem to understand they need to “use the legs when lifting or bending, strengthen the back and abdominal muscles, and exercise”. Unfortunately, most back pain patients I see are commonly performing exercises unsafely or incorrectly, or not at all. I rarely witness optimal posture or correct use of body mechanics with activities such as getting in/out of bed, bending forward to tie your shoes, reaching, lifting and carrying. These are just a few of the activities we do daily that can eventually cause back pain if not performed correctly. It is simple to learn, but accurate instruction and even demonstration from your physiotherapist can be helpful.
3) optimizing postural alignment: positioning your spine so that it maintains its 3 natural curves is key to a healthy back. When these healthy curves become too flattened or too arched, it can compress the vertebrae and the discs in between, causing pain or irritation of the nerves coming out of the spine. Whether you’re sitting, walking, lifting, exercising or sleeping, your spine should primarily be in its optimal position. Proper instruction and training from a qualified professional is essential in finding your ‘neutral spine’. When taught correctly and safely, Pilates, Yoga, and Physiotherapy exercises are great ways to attain and maintain optimal postural alignment.
4) proper footwear: back pain can result when your optimal alignment is compromised by improper footwear because certain muscles can become tight, shortened and overused, causing an imbalance. A consult with a pedorthist to assess whether or not orthotic inserts are required may be beneficial for some people.
5) overall physical health: maintain a healthy diet and body weight. Perform regular stretches, strengthening, and spinal stability/mobility exercises in a safe and effective manner. Many people with low back pain have poor core stability (or rarely know what true core stability means) and tight lower extremity muscles that both play a role in back pain. Numerous studies have shown that both Pilates and Yoga (performed safely and correctly) can help reduce low back pain. Consultation with a certified nutrition and health counsellor that focuses on the mind-body connection may also be beneficial.
6) manage your stress: many scientific studies have shown that stress is one of the MOST influential factors in back pain. Find effective ways to manage your stress. If your current coping strategies are not working for you, find support and resources that can lead you to better management. There are numerous approaches that are not within the scope of this article. CREATING time to mindfully unwind and participate in life activities that truly bring you joy, as well as participating in a regular exercise regime (performed correctly and mindfully) has been shown to assist in stress reduction. Often times there is no quick or magical ‘fix’ to stress management. It takes an ongoing active approach on your part to find healthy and sustainable coping strategies!
Unmanaged back pain warrants a visit to your doctor to rule out a serious medical condition. Your physiotherapist has the skills to assess and treat a variety of back conditions and knows when to refer back to your doctor if further investigation is required.
Incorporating healthy back habits into your daily life is another way you can take an active approach to your overall health and well being!
Headaches. If you’ve had one, you understand how debilitating it can be. Did you know that migraine headaches alone are estimated to cost the Canadian economy $500 million annually in lost productivity and absenteeism? (Angus Reid Poll, 1990). This doesn’t even include other types of headaches such as sinus, cluster, or tension. If headaches are so common, why do they appear to be so poorly managed?
Chronic headache sufferers frequently do not receive the proper treatment and education on management because it can be very challenging for a health care practitioner to determine the root cause of the pain. Paying close attention to your headaches, including location, how long they last, quality of the pain and what reduces or triggers the pain, will help your doctor identify the type of headache you are experiencing, which will result in better overall treatment.
Headaches can be caused by a number of triggers such as hormone imbalances, sleep disturbances, foods, odors, smoking, alcohol, light or temperature sensitivities, weather sensitivities, sinus problems, poor postural alignment, muscle tension, and the most common trigger, STRESS.
One of the most effective ways to manage your headaches is to avoid or address these triggers. This is easier said than done.
However, finding and knowing what your triggers are is an essential step to successful management. Once you have identified your triggers, you are more capable of avoiding or addressing them. Sometimes this may result in different choices or even lifestyle changes you need to make. Other times, it may appear that there is nothing you can do to avoid your triggers. If this is truly the case, then at least your physician can still use your triggers as a guide for a more successful treatment outcome.
The most common type of headache pain is due to tension (Blanda, 2012) and is the most common type of headache we treat as physiotherapists. It is often associated with tightened muscles of the head and neck and can feel like a dull pain or pressure encircling the head, or at the base of the skull. It will likely be no surprise to you that the most effective way to treat tension headaches is to find out what is causing the muscle tension, and then address it. There could be many reasons as to why your head and neck muscles are tense. Here are just a few:
Muscular imbalances: weak and/or shortened postural muscles from poor postural habits or ergonomics can cause inappropriate head position. This places undue strain on the muscles of the head and neck, causing chronic tension and lack of blood flow to these muscles.
Joint Dysfunctions: If the joints in your neck or your jaw are not moving properly or are stiff, they can cause the surrounding musculature to become tight or guarded.
Vision problems can cause your eyes to strain and as a result, your facial muscles become chronically tense (when is the last time you had your eyes checked?)
Poor STRESS management. Even mild, daily stress can cause chronic tension in the head and neck muscles if you do not have effective stress management techniques. The most common cause of headaches is prolonged tension or stress (MediResource, 2012). Finding effective stress reduction methods that work for you in your daily life are essential in fighting the battle against tension headaches.
When you can give your physician valuable details about your headaches, he or she can then recommend an appropriate treatment approach which may include a referral to a specialized health care professional (neurologist, physiotherapist, pain specialist, massage therapist, yoga therapist, counsellor) to help educate and empower you to take an active role in the management of your headaches!
This article is not intended to diagnose or treat. Please consult with your physician if constant headaches persist.
Do you experience pain in your jaw? Perhaps radiating to your ear, face, neck, and even your shoulder? Does this coincide with difficulty opening or closing your mouth while talking, chewing, laughing or yawning, or your jaw locking? You may be experiencing a dysfunction in your temporomandibular joint (TMJ). The TMJ joins the lower and upper jaws and is the joint responsible for opening and closing your mouth, as well as any side to side movement of the lower part of the jaw (which is important for chewing and articulation of speech). You have a right and left TMJ. You can actually feel the movement of the joint by palpating just in front of the ears as you open and close your mouth. There is a disc that is in between the joint that enables a
smooth gliding motion. If this disc does not glide properly, you may experience clicking or popping sounds.
There are a variety of factors that can cause TMJ disorders, and often times it is a combination of factors that need to be
addressed in order for treatment to be effective. Some of the common causes include the following:
1) Poor postural alignment.
If you have habitually poor posture over time, this can greatly affect the position of your head and neck, creating chronic muscle imbalances, which in turn can affect the mobility of your TMJ.
2) Behavioural habits that create muscle tension around the jaw muscles such as grinding or clenching
your teeth, excessive gum chewing or biting your nails. A common underlying cause of poor habits can be stress related.
3) Trauma to the joint.
4) Arthritis in the joint.
5) Dental problems such as abnormal alignment of the teeth when the upper and lower jaws are
brought together (malocclusion).
6) Hormonal changes. Research suggests that estrogen levels can also play a role in TMJ pain (Craft, 2007.)
Treatment of your TMJ disorder may require more than one health care professional due to the nature of the potential causes.
Dentists, orthodontists, ear/eye/nose/throat specialists, physiotherapists, massage therapists, physicians, psychologists, and
endocrinologists may be some of the professionals involved in your treatment. It is essential to ensure your health care professional determines the cause(s) of the origin of your TMJ disorder before effective treatment can begin. Treatment may include the following, depending on the cause:
Addressing your postural dysfunctions by prescribing specific strengthening or stretching exercises specific to your deficits. This also includes education about your alignment and movement patterns at work, whether you sit at a desk or have a more physical job. A physiotherapist can assist you with this. Addressing any unhealthy behavioural habits (grinding, clenching, nail biting) can be challenging. It is helpful to look at the underlying cause, which frequently is related to stress. Learning how to effectively
manage your stress levels is important not only for your TMJ disorder and the muscle tension surrounding the joint, but is also important for many other systems of your body. Relaxation methods, breathing methods, appropriate exercise, regular yoga practise or perhaps some small changes in lifestyle choices can all contribute to improving the way you handle your stress. Physical Therapy can address any TMJ instabilities, inflammation, or stiffness in the joint by manual therapy methods, electrotherapeutic modalities, and prescriptive exercises to address the specific dysfunction. A visit to your dentist is
important to ensure you have a thorough assessment of your teeth/mouth alignment and to determine the need for night splints or guards or any other treatment option. Occasionally, there may be a more serious problem where you need to be referred to another specialist. Symptoms that include loss of hearing, nerve involvement, weight loss, or
persisting pain and immobility despite ongoing treatment indicate a visit back
to your physician for a referral to an appropriate specialist.