Back pain assessment
If you have pain in your neck or back which does not appear to be resolving by itself or is causing you significant levels of pain and impacting on your ability to function, you would be recommended to see a healthcare professional, such as a physiotherapist. They will carry out a full assessment, obtain a diagnosis and advise you on the best treatment and management strategies to resolve your pain and get you back to full function as soon as possible. At Complete Physio, our physiotherapists have vast experience in the assessment and treatment of a wide range of back pain presentations from elite sport, dance and performance through to the management and rehabilitation of complex and chronic spinal pain disorders.
Your treatment and management will be based on the findings from your initial assessment, which will help to form the diagnosis for your condition. For successful management and treatment of back pain, as with all musculoskeletal conditions, a clear diagnosis and understanding of the mechanics affecting your back is key.
1. History taking
Your clinician will undertake a thorough history identifying potential causes and contributing factors, looking at movement patterns, assessing your function and understanding your movement and functional ability from before and after the onset of your back pain.
2. Clinical assessment
Your physiotherapist will undertake a detailed clinical assessment of the area, which will generally involve asking you to perform a number of movements and standardised activities. It may also include a detailed functional assessment, whereby they will help to break down and analyse the particular movements that are causing pain. This will involve your physiotherapist performing a detailed assessment and analysis of the painful movements. They will also take a detailed neurological assessment to assess for any evidence of neurological deficits. They will also perform specialised and specific tests, which help to form a diagnosis and assess the severity of back pain. This will also help determine the next steps, such as whether further scans or investigations are required, or indeed possible onward referral.
3. Functional assessment
A functional assessment will include assessment of a number of functional movements. This may be tasks or even sports specific activities, which consistently brings on a person’s symptoms or, in the case of someone with more severe symptoms and physical limitations, this may involve looking at basic functional activities of daily living, such as getting on and off a chair or the ability to go up and down stairs.
Referral for scans, further investigations, or specialist opinion
At the end of your assessment, your physiotherapist will discuss with you whether there is any indication that a scan may be necessary or indeed helpful in the overall treatment and management of your condition. They will also discuss other treatment and management options, such as the need for onward referral for surgical opinion, should this be relevant, based on the assessment findings.
Screening for red flag signs and symptoms, such as cauda equina syndrome
Whenever a patient presents with lower back pain the physiotherapist, or other healthcare professional, will ask a number of questions to help screen for possible underlying serious or sinister pathology, such as cauda equina syndrome (cauda equina syndrome relates to compression of the cauda equina in the spinal cord, which can result in bladder or bowel dysfunction or loss of sensation around the crotch area). This is classed as a medical emergency and if any such findings are detected on the day of your assessment your physiotherapist will discuss onward management.
If you would like to discuss your back pain before booking, or feel that you may need referral for a scan, please do not hesitate to contact us by email on firstname.lastname@example.org and one of our senior clinicians will reply to your questions or arrange a call.
Types of back pain
There are different categories of back pain. Below we have summarised some of the main presentations. Sometimes more than one presentation may co-exist. It is useful to categorise the type of back pain that someone is suffering, as this can help to guide overall treatment.
Mechanical back pain.
Mechanical back pain refers to pain that is associated with movement. Many back problems will hurt when people move and there will be particular movements that will hurt more than others. Part of your assessment will be analysing which particular movements cause you pain and the relevance of these movements to your overall clinical presentation. Mechanical back pain can be a high level or complex movement associated with sport for example, which consistently brings on pain or discomfort when performing that specific movement, or repetitions of that movement. Equally, mechanical low back pain could relate to a particular direction of movement, such as bending down to touch toes or to put shoes and socks on, which can be extremely painful, whilst other movements, such as walking, might be far less painful. The analysis of what aggravates and eases your pain often forms a core part of your overall diagnosis and treatment plan.
Discogenic low back pain (a ‘slipped’ disc)
A common presentation with low back pain is a bulge or even sometimes a herniation of one of the intervertebral discs in the spine. Your intervertebral discs are relatively soft structures between the bones of your spine (bones = vertebrae). The discs can become damaged either as a result of age-related wear and tear or they can become damaged due to a one-off incident or trauma. If the disc bulges come into contact or compresses a nerve, this can cause severe pain which will often radiate into the buttock and down the leg, even as far as the foot. Discogenic low back pain is often associated with neurological disturbances. This can include pins and needles or numbness felt anywhere down the leg (including the foot), weakness in the muscles (again this can occur anywhere down the leg, as far as the foot), and absence of reflexes. Your physiotherapist will check for these neurological deficits as part of your standard assessment, particularly if disc involvement is suspected.
Postural back pain
A common cause of back pain can be related to posture. The most common scenario that we might see is someone who sits for prolonged periods of time at a desk. However, pain can also be related to other forms of sustained posture, often due to someone’s work tasks but can equally be related to someone’s sport or leisure activities, and even the result of prolonged relaxed sitting or sleeping positions. Part of the assessment will be to analyse and evaluate particular pressures and stresses that are being put on the back whilst the person is in their pain producing positions. The physiotherapist will also be able to advise you of pain-relieving activities, such as exercises, which can be used to alleviate pain and also prevent the pain coming on in the first instance when adopting certain postures.
Pregnancy related back pain
Pregnancy related Low Back Pain
Low back pain is common in pregnancy affecting around 50% of all pregnant women. It often occurs due to the anatomical and postural changes which affect the way you sit, stand, move and walk. As your tummy expands to make room for your growing bump, the muscles in your tummy and pelvic floor lengthen and become weaker which can put more strain on the joints in your back and pelvis.
The good news is, that back pain during pregnancy often responds very well to exercise. Simple movements to improve the mobility in your lower back can be helpful, as well as exercises to strengthen your postural muscles. A pelvic health physiotherapist will be able to assess and guide you through exercises that are safe for you to do. They may be able to provide hands-on treatment to help relieve your symptoms and will advise you on the best positions when sitting and sleeping, as well as tips for bending and lifting.
Postnatal Low Back Pain
Low back pain can occur after pregnancy. It can occur as a result of injuries sustained during childbirth, weakness in the abdominals and pelvic floor, and postural changes. Tasks such as prolonged sitting, feeding in poor postures, repetitive lifting and bending can also contribute to the development of low back pain. In a small number of cases, pregnancy hormones that remain in the body whilst you are breastfeeding can contribute to these symptoms.
If you experience low back pain after having your baby you may find it helpful to visit a pelvic health physiotherapist. They will be able to ask you questions to help identify the cause of your pain. They will be able to check the quality and strength of your pelvic floor muscles and abdominals and provide you with advice around appropriate exercises, techniques for bending and lifting, and provide hands on treatment if required.
Pregnancy related pelvic girdle pain
Pregnancy related pelvic girdle pain (PGP) is pain that occurs in the region of the pubic bone, groin, hips, buttocks or tailbone. It occurs in about 20% of all pregnancies and can develop during any trimester.
Women suffering from PGP commonly report pain while walking, pain with movements that require standing on one leg, for example; walking up or down stairs or standing to put your trousers on. Movements that require parting your legs are also often painful, for example; getting out of a car, rolling over in bed or during sex.
PGP often occurs because there is a change in the way the muscles and joints around the pelvis are working. Factors including postural change, weakening of your core muscles including your abdominals, pelvic floor and glutes can contribute to these symptoms. In a small number of cases, pain is due to pregnancy related hormones which soften the connective tissues in the body to prepare for birth.
Research suggests that women are more likely to develop PGP if they have experienced it in previous pregnancies, have had injury to their back or pelvis in the past, have a physical job or have gained a lot of weight during pregnancy.
If you think you have PGP, it’s important to seek help. Early diagnosis and treatment can significantly reduce your symptoms and prevent them from persisting. A pelvic health physiotherapist will take a thorough history of your condition, examine your posture and perform simple tests to help confirm a diagnosis. They will be able to examine the muscles around your hips and pelvis including your pelvic floor muscles. Your physio will then be able to advise you on the best movement strategies, and guide you on appropriate strengthening exercises.