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Why is physiotherapy so important for spinal pain?

Physiotherapy based exercises are very important for patients with back (and neck) pain. The spine or ‘back bone’ is a complex structure that is made up of a large number of small bones (known as ‘vertebra’) that allows people to walk upright rather than on all four limbs like other animals. The spine contains nerves that carry pain signals from the rest of the body to the brain. The spine is supported by muscles and tough ligaments, which keep it strong and yet allow us to bend in different directions so that we are able to carry out complex physical tasks or engage in different sports. Any of the different parts that make up the spine can become injured or become affected by age related wear and tear, sometimes referred to as degeneration or osteoarthritis.

As with any other part of the body, injury to the back causes pain, but this usually goes away over time as the injury heals. Maintaining an active lifestyle can help the healing process and so can daily gentle exercises and stretches for the back. It was previously thought that bed rest and time off work was the best way to help people recover from back injuries, however, this is no longer the case. The back is an active structure and needs to remain active otherwise it can stiffen up and actually increase and prolong the pain. In order to provide stability to the bones of the spine, the muscles need to be kept strong and active. Without the support of the muscles, more pressure is placed on the spine itself and back pain can be increased or prolonged. The muscles are also very important for posture and bad posture itself can cause back pain or make existing pain even worse. The only way to reduce pain in the long-term is to keep active and carry out regular specific exercises to strengthen and stabilise the back. In this way, people can achieve the best quality of life even if they are not pain free and also take the least medications. Back exercises if performed as directed by a specialist physiotherapist are safe and will not damage the back in any way even if they can cause temporary discomfort. In the long-term, the most dangerous approach is to avoid exercising the back.

It is very important to note that people who have had back pain for a long period of time may also have increased sensitivity of their back. This means that even normal movements or light touch can become painful. In these instances, it is still very important to carry out daily gentle exercises and stretches, however, the exercises should only be for very short periods of time initially and until they start to increase the pain each time. They should be repeated each day so that the person becomes used to them and then over time they should be increased in time and also force. By taking this slow and steady approach, people will get the best result in the long-term, but they will have to be patient in order to see the benefits. It is very easy to fall behind with exercises, but it is also very easy to overdo it as well. Aggressive exercises, massages or manipulations are likely to make the situation much worse and these types of therapy should be reserved for athletes who do not have chronic conditions and are used to tolerating high levels of pain.

In summary, the general aim of physiotherapy in pain management is to restore function and improve strength and stability through focused exercise programs. They can advise which exercises or activities to choose and which ones to avoid and guide the patient with regard to the optimal intensity. They can assess what the current level of function is and recommend how quickly to increase the workload in accordance with the principles of pacing (i.e. avoiding the boom-bust pattern of activity).