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The Ins & Outs of Back Pain

By Alan Williams, PT, OTR/L, ATC, CSCS

In the course of my work as a physical therapist, I get to hear a lot of stories. Even when I’m not at the clinic, if I meet a person for the first time, they often start to tell me about the time they dislocated their shoulder while on rock climbing trip, or broke their toe learning to line dance, or threw their back out wrestling with the dog. I get that last one a lot. It seems that here in America, our backs are always “out.” I’m not sure where they’ve gone out to (lunch, maybe?), but it’s perhaps the number one information request I receive – “My grandma’s neighbor’s back is out. Should she see a doctor?”

First off, let me dispel this myth. Your back is not “out.” It hasn’t gone anywhere. This misleading phrase is merely a slang descriptor of back pain, not an actual condition or diagnosis. Back pain can have a multitude of origins, and unless the underlying cause is identified and eliminated, the pain will not get better. And remember that regardless of the cause, any back pain that is accompanied by difficulty breathing, loss of bowel/bladder control, loss of coordination, fever, headache, or chest pain should be addressed with emergency medical care.

Back pain (officially called dorsalgia) is so common that 90% of Americans will experience it at some point in their lifetime. It usually falls into two categories – neuropathic (caused by nerve damage) or nociceptive (caused by damage to the bones or musculature). Some people may even experience a combination of the two.

Additionally, back pain is classified as acute, subacute, or chronic. Acute back pain is usually caused by injury or other trauma; the onset is sudden, and the pain may be intense, but with treatment, most sufferers of acute back pain recover in less than 1-2 months. Subacute pain is essentially acute pain that, for whatever reason, takes a little longer to heal; it should be carefully monitored so that it does not progress into a chronic condition. Chronic back pain, however, is most often due to a disease or degenerative condition (such as arthritis or osteoporosis) or an injury that was not treated properly and therefore did not heal properly. Depending on its cause, chronic back pain can be an ongoing struggle for pain management and functional improvement; it demands the highest level of professional attention.

The causes of back pain are numerous. They can be muscular in nature (such as a strain, tear, spasm, etc.), skeletal in nature (fracture, bone spur, herniated disk, etc.), or related to the joints (sprain, dislocation, etc.) or nervous system (sciatica or other impingement syndrome, etc.). They can be due to injury or trauma (whiplash, a fall, injury from lifting or bending improperly, etc.), disease or other condition (stroke, cancer, infection, myopathy, rheumatoid arthritis, osteoporosis, etc.), lifestyle (poor posture, obesity, stress, etc.), or age (as in normal, age-related degeneration).

My intention in writing this article is not to overwhelm you with everything that can go wrong with your back. Rather I believe increased awareness and education can aid you in obtaining the proper treatment for your back pain. Your physician will work with you to achieve a diagnosis and can order any necessary x-rays, MRIs, CT scans, or other tests to rule out serious medical causes. They may also recommend that you see a specialist, such as a physical therapist, to help expedite your recovery through exercise and stretching. Your physical therapist will also be able to educate you about preventative techniques.

It is very important that you employ a medical professional to help you determine the right course of treatment for your back pain. Remember, identifying the cause of your back pain is key to successful treatment.

Don’t let back pain keep you down. Call 463-0022 today for your FREE Back Pain Assessment!

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