Back Pain
Back pain is one of the most common musculoskeletal complaints, affecting individuals of all ages. It can arise from various etiologies, including mechanical issues, inflammatory conditions, infections, neoplastic processes, and trauma. The clinical presentation of back pain can vary depending on the underlying cause, but the primary signs and symptoms often share certain features.
The main sign and symptoms associated with back pain are:
Localised pain
- Back pain is most commonly felt in the lower back (lumbar spine), although it can also affect the upper back (thoracic spine) and neck (cervical spine).
- Lumbar back pain is typically associated with mechanical issues such as muscle strain, disc herniation, and degenerative changes.
- Pain may radiate into the buttocks, thighs, or lower legs in cases of nerve compression (e.g., sciatica). Referred pain is when pain originating in structures such as the kidneys, or gastrointestinal system may present as back pain, and requires careful assessment.
Pain characteristics
- Can be acute (last less than 6 weeks) or chronic (last more than 3 months), and range in intensity.
- Mechanical back pain tends to worsen with certain movements or activities.
- Pain that worsens at night may indicate a more serious pathology, such as a spinal malignancy or an infection.
Stiffness and Decreased Range of Motion
- Reduced flexibility can be experienced in both acute and chronic back pain.
- Acute back pain is often associated with muscle spasms. Patients may adopt abnormal postures or gait patterns to avoid pain.
Neurological Symptoms
- Can include Radicular pain, numbness or tingling, weakness and bladder/bowel dysfunction (in severe cases of nerve compression).
Postural and gait changes
Impact on function
Interventions
Physical therapy and exercise are common interventions for treating back pain.
Conservative treatments can include cold and heat therapy, massage therapy, and taping or bracing.
Acupuncture has been shown to be effective for both acute and chronic back pain by reducing inflammation and enhancing the body's natural healing mechanisms.
There are a variety of Medical and Surgical Modalities that can be used to treat back pain including (but not limited to), NSAIDs, Corticosteroid and nerve block Injections, Platelet-Rich Plasma (PRP) Therapy and TENS (Transcutaneous Electrical Nerve Stimulation). Surgery is a consideration for Severe or Structural Issues.
HIGH INTENSITY PBMT and SHOCKWAVE THERAPY
Where research now is pointing us is to combine interventions like Shockwave therapy and Photobiomodulation Therapy (PBMT) with our conventional physical therapy. The research results show superior outcomes with this combination therapy compared to using either intervention on its own. The therapeutic effects of PBMT and Extracorporeal Shockwave therapy (ESWT) in improving pain and function have been widely supported in research studies.
This study (de la Barra et al 2024) clearly demonstrated that High Intensity PBMT has a positive effect on pain and function in a variety of neck disorders
Another systematic review with meta-analysis by Abdildin et al (2023), showed us that HI PBMT may also have a positive impact on pain and disability associated with chronic low back pain
An intervention that has gained in recent popularity is Shockwave therapy. It is widely used in the management of tendinopathies. While not having a direct influence on nocioceptors it has been shown to improve pain and function by expediting the healing process. More and more uses for shockwave therapy are being revealed by contemporaneous research, including back and neck issues.
A study by Wu et al (2023), reviewed research using both Focused Shockwave and Radial Shockwave devices and concluded that shockwave therapy has been shown to improve pain and function in low back pain patients with long term efficacy.
Learn more about the therapeutic effects of PBMT and Extracorporeal Shockwave therapy in improving pain and function.