Recent Upper Back Injuries
For any of these back problems, contact us for an assessment
Occasionally, thoracic disc bulges may occur following a trivial movement involving bending forward such as picking up a small object or sneezing. In these instances, the disc has normally been subject to repetitive or prolonged bending, slouching or lifting forces leading up to the incident.Signs and symptoms of a thoracic disc bulge
Patients with a thoracic disc bulge may experience a sudden onset of back pain during the causative activity, however, it is also common for patients to experience pain and stiffness after the provocative activity, particularly the next morning.
Symptoms are typically felt in the mid back, sometimes between or around the shoulder blades and may be located centrally, on one side or on both sides of the spine. The patient may experience pain radiating around the ribs and into the chest, or sometimes down the arms. Muscle spasm, pins and needles, numbness or weakness may also be present.
In some cases, patients may appear to stand with their spine noticeably out of alignment as a result of the disc bulge. Symptoms are generally exacerbated with activities involving rotation, side bending, activities using your arms in front of your body, lifting, bending forwards, or prolonged sitting (especially if slouched). Breathing, coughing, and sneezing may also aggravate symptoms.
Patients with a thoracic disc bulge often experience pain that is worse first thing in the morning.
Diagnosis of a thoracic disc bulge
A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose a thoracic disc bulge. Investigations such as an MRI or CT scan may be required to confirm diagnosis.
In patients with the perfect balance of activities, the thoracic disc may be pushed into position in as little as three days. Typically, however, patients take approximately 2 to 3 weeks to push their disc back ‘in’. Once the disc is ‘in’, the patient should be pain free and have full movement. However, the torn connective tissue at the back of the disc only begins to heal from this point. It takes approximately six weeks of consistently keeping the disc ‘in’ to allow the torn tissue to heal to approximately 80% of its original strength.
Contributing factors to the development of a thoracic disc bulge
Several factors may contribute to the development of a thoracic disc bulge. These need to be assessed and corrected with direction from the treating physiotherapist and may include:
• poor core stability
• a sedentary lifestyle
• being overweight
• muscle tightness
• muscle weakness
• joint stiffness
• poor lifting technique
• poor posture
• a lifestyle involving large amounts of sitting, bending or lifting
Physiotherapy for a thoracic disc bulge
Physiotherapy treatment for this condition is vital to hasten the healing process and ensure an optimal outcome and may comprise:
• soft tissue massage
• electrotherapy (e.g. ultrasound)
• postural taping/bracing
• the use of a lumbar support for sitting
• dry needling
• exercises to push the disc back ‘in’ and to improve strength, core stability and flexibility
• activity modification advice
• biomechanical correction
• ergonomic advice
• clinical Pilates
• a gradual return to activity program
Other intervention for a thoracic disc bulge
Despite appropriate physiotherapy management, a small percentage of thoracic disc bulges fail to improve and may require other intervention. This may include further investigations such as an X-ray, CT scan or MRI, pharmaceutical intervention, assessment from a specialist or sometimes surgery. The treating physiotherapist can advise if this is required and will refer to the appropriate medical authority if it is warranted clinically. In cases of persisting or worsening neurological symptoms (pins and needles, numbness and weakness), surgery may be indicated. When a loss of bowel or bladder control is present due to the disc bulge, this is considered a medical emergency and immediate surgical intervention is usually required.
• soft tissue massage
• joint mobilization
• advice on rest from aggravating activities
• dry needling
• protective padding
• exercises to improve posture, flexibility and strength
• activity modification advice
• taping techniques
• a graduated return to activity plan
In fact, back muscle pain is the most source of back pain. The good news is that is also one the quickest to heal and rehabilitate.What Causes Back Muscle Pain?
Most causes of low back pain are muscle, ligament or joint related. Most commonly, these back injuries are caused by muscular strains, ligament sprains and joint dysfunction, particularly when pain arises suddenly during or following physical loading of your spine. Muscle fatigue, excessive loads, high speeds or poor lifting postures are the most common causes.
The causes of simple back pain are numerous but roughly fall into the following categories.
Inefficient, weak, or back muscles that lack endurance or normal contraction timing can lead to poor joint stabilisation and subsequent injury to your back muscles, ligaments, joints or even spinal discs.
Poor posture when sitting, standing and lifting at work can place unnecessary stress upon your spine. With muscles fatigue or overstretch, your ligaments and discs can stretch and this places spinal joints muscles and nerves under pain-causing pressure or strain, that results in back pain.
Ligaments are the strong fibrous bands that limit the amount of movement at available at each spinal level. Stretching ligaments too far or too quickly will tear them with subsequent bleeding into the surrounding tissues, causing swelling, muscular spasm and pain.
Awkward lifting, sports injuries and motor vehicle accidents are very common causes. Just as in other regions of the body, physiotherapy hastens ligament healing and relieves pain so that you can enjoy life again as soon as possible.What are Symptoms of Back Muscle Pain?
Back muscle pain symptoms may range from a mild ache to sudden debilitating back pain.
Typical back muscle pain symptoms include:
• Localised back pain, with no radiation into your buttock or leg.
• Back muscle tenderness and/or spasm.
• Protective back stiffness.
• Sudden back pain onset.
You will usually feels better when resting, and may find change of position painful eg sit to stand, rolling in bed, walking or bending.
Warning Signs of a More Serious Back Injury?
In these instances, or you have constant and severe back pain, please urgently consult your nearest hospital, doctor or physiotherapist.
• pins and needles (paraesthesia),
• numbness (anaesthesia),
• leg muscle weakness,
• altered reflexes,
• difficulty walking,
• loss of control of bladder or bowels.
How is Back Muscle Pain Diagnosed?
Differentiating a back muscle strain from a ligament sprain can be difficult, as both injuries will show similar symptoms. In general, it doesn’t significantly matter what you call the problem because the treatment and prognosis for both back muscular strains and ligament sprains is similar. Most spinal practitioners refer to both injuries as a category called a “Back Strain” or “Musculoligamentous Strain”.
X-rays do not identify muscle or ligament injury. MRI scan is probably the best diagnostic test to specifically identify muscle or ligament structures are injured and to what extent. CT scans may also assist.
What is Back Muscle Pain Treatment?
Seek a Professional Diagnosis!
All back pain sufferers should be thoroughly examined by a spinal health practitioner eg physiotherapist. Back pain can be caused by numerous injuries and the treatment does vary significantly depending on your diagnosis. Physiotherapy treatment for simple back pain is designed to protect your injury, while hastening your muscle and ligament healing, and then look at strategies to prevent a recurrence.
Your physiotherapist has some nifty tricks for quickly relieving your back pain so that you can enjoy life again as soon as possible.
Back Pain Treatment Aims
PHASE I – Pain Relief & Protection
Managing your back pain is the main reason that you seek treatment for low back pain. In truth, it was actually the final symptom that you developed and should be the first symptom to improve.
Your physiotherapist will use an array of treatment tools to protect your back and reduce your pain and inflammation. These include: ice, electrotherapy eg tens, acupuncture, taping techniques, soft tissue massage, back braces. Your doctor may also recommend a course of non-steroidal anti-inflammatory drugs such as ibuprofen.
PHASE II – Restoring Normal ROM, Strength
As your back pain and inflammation settles, your physiotherapist will turn their attention to restoring your normal back motion, muscle lengths and resting muscle tension, muscle strength and endurance, proprioception, balance and gait (walking pattern).
Your physiotherapist will commence you on a lower back core stability program to facilitate your important muscles that dynamically control and stabilise your low back and pelvis. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for you specific to your needs.
PHASE III – Restoring Full Function
Depending on your chosen sport, work or activities of daily living, your physiotherapist will aim to restore your function to safely allow you to return to your desired activities. Everyone has different demands for their backs that will determine what specific treatment goals you need to achieve. For some it be simply to walk around the block. Others may wish to run a marathon.
Your physiotherapist will tailor your rehabilitation to help you achieve your own functional goals.
PHASE IV – Preventing a Back Pain Recurrence
Recurrence of low back pain can and does regularly occur. The main reason it is thought to recur is due to insufficient rehabilitation. In particular, poor deep abdominal core muscle exercises have been shown to render your back more vulnerable to instability and therefore re-injury.
To prevent a recurrence, you should continue a regular series of these exercises a few times per week. Think of your exercises as your anti-back pain pill! Your physiotherapist will assist you in identifying the best exercises for you.
Back Pain Treatment Options
There are many treatment options that your Physiotherapist will discuss with you in the treatment of your pain. Treatment varies based upon the source of your individual symptoms.
A back brace or corset can provide excellent relief for most sciatica sufferers. Those who gain the most benefit are those who find their pain eases when they wrap/bind a towel or sheet (folded-lengthwise) tightly around their stomach and back. If this simple test eases your pain, you should use a back brace in the short-term. Back braces and strong deep core muscles help to avoid a recurrence in the future.
Back braces are available from CARE Institute/Sabga Physiotherapy.
Acupuncture has been an effective source of pain relief for over 5000 years. While we do not fully understand how it works, acupuncture can assist you pain relief. Ask your physiotherapist for advice as most of our physiotherapists have acupuncture training.
Massage always feels wonderful, plus it has wonderful muscle relaxation benefits. Massage is particularly useful when muscle spasm or chronic muscle tension is present. Regular remedial massage is also a very handy low back pain prevention strategy.
Massage Therapy is available at CARE Institute/Sabga Physiotherapy.
TENS machines are an electronic pain relieving device that will reduce your pain and your need for pain relieving drugs.
TENS Machines are available from CARE Institute/Sabga Physiotherapy.