Back pain can often start after doing something completely ordinary like bending down to put your socks on, lifting a heavy bag into the boot of the car or spending an afternoon in the garden. Because we notice the activity we’re doing, it’s easy to conclude that’s the cause.
One of the things that often surprises people when they come for physiotherapy to treat back pain, though, is how much time we spend looking beyond the painful area.
Of course, we’ll want to understand exactly where your back hurts, what it feels like and how it’s affecting your day-to-day life. But we’ll probably also ask you to walk across the room, watch you perform different actions, assess how your hips move and ask whether you’ve had any previous injuries, even if they seem completely unrelated.
Patients will sometimes ask, “If my back hurts, why are you looking at my hips?”
The answer isn’t that we think the pain is “all coming from your hips” or that your back doesn’t matter. It’s simply that the body doesn’t work in isolated parts. Every time you bend, lift, twist or reach, different joints and muscles share the workload. If one area isn’t contributing as much as we’d expect, another often steps in to help.
That doesn’t necessarily cause a problem straight away. Our bodies are remarkably good at adapting so that we can carry on with everyday life. But there tends to come a time when the back starts doing more than its fair share. Our job as physiotherapists is to spot this and identify the root problem.
Looking beyond the painful area
Take something as ordinary as unloading the dishwasher. We regularly see people whose back pain began when they bent down to empty the bottom shelf. It’s easy to understand why they connect the two, particularly if the pain was sudden.
What we’re interested in, though, is why that particular bend caused a problem when all the others didn’t.
That’s usually the question we’re trying to answer.
Rather than assuming the last thing you did must be the cause, we’re interested in everything that led up to it. What has your body been dealing with over the past few weeks or months? Have you been feeling more tired than usual? Has your routine changed? Have you been moving differently because another joint has been bothering you? Have you suddenly spent an entire weekend decorating after months of office work?
Understanding the answers to those questions often tells us far more than simply knowing where the pain is.
Looking for patterns, not just pain
As we’ve already mentioned, every movement you make relies on different parts of your body working together.
When you bend down to pick something up from the floor, for example, your ankles, knees, hips, spine and the muscles around them all have a role to play. They don’t each work in isolation; they share the job.
If one part of that chain isn’t moving as well as we’d expect, your body rarely gives up and refuses to bend. Instead, it usually finds another way of achieving the same movement.
Most of the time, that’s exactly what we’d hope it would do. If your body couldn’t adapt, even relatively minor injuries would make everyday life much more difficult. The ability to find another way of moving is one of the reasons most of us can carry on walking, working and looking after ourselves while something settles down.
The difficulty comes when one area repeatedly ends up taking on more work than it was designed for.
Looking for clues
Imagine someone has stopped going for their regular runs because they’ve developed heel pain. A few months later, they’re moving less, their hips have become a little stiffer and they’re no longer as strong as they used to be. None of those changes automatically leads to back pain, but they may help to explain why bending, lifting or spending a day in the garden suddenly feels much harder than it did before.
Equally, somebody might have recovered from an ankle sprain years ago without ever thinking about it again. They’ve been walking perfectly well ever since, but perhaps not quite in the same way as before. It’s not something they’d notice in everyday life, but it may be one of several factors contributing to why their back has gradually become overloaded.
This is why physiotherapy assessments are rarely about finding one dramatic cause.
More often, we’re piecing together lots of small clues. On their own, they may not seem particularly important. Together, they help us understand why a person’s back has started to hurt.
Once we’ve gathered all those clues, we begin to build a picture of how your body is moving.
We might ask you to squat, balance on one leg, bend forwards, twist from side to side or even recommend a full biomechanical assessment. None of these tests is about catching you out or proving that you’ve been moving “wrong”. They’re simply helping us understand where movement feels comfortable, where it becomes restricted and whether another part of your body is working harder than we’d expect.
We’ll also want to know how your symptoms behave. Is the pain worse first thing in the morning? Does it ease once you’ve been moving? Does sitting for long periods make it worse than walking? These patterns can be just as informative as the movement itself.
By the end of the assessment, we’re not simply looking at a painful back. We’re looking at the person standing in front of us and trying to understand why their back has become painful.
Why there isn’t a single “best” treatment for back pain
We’re frequently asked, “What’s the best exercise for back pain?”
It’s an understandable question, but it’s a difficult one to answer because back pain isn’t a single condition. It’s a symptom, and the reasons behind it vary enormously from one person to the next.
Take two people with pain in an identical part of their lower back. One may benefit from improving hip mobility because their back has been compensating for restricted movement elsewhere. Another may need to rebuild strength after spending several months avoiding activity because they were worried about making the pain worse.
They’ve both arrived with back pain, but they haven’t necessarily arrived there by the same route.
That’s one of the reasons we don’t believe in handing everybody the same sheet of exercises or assuming the same treatment plan will work for everyone.
Instead, the assessment guides the treatment.
If we identify movement that’s become restricted, restoring that movement may become one of the priorities. If pain has led to changes in the way you move, building confidence in those movements again may be just as important. In other situations, improving strength, reducing irritation or helping your body move more efficiently may have the biggest impact.
The treatment itself matters, but choosing the right treatment matters even more.
What your treatment for back pain might look like
Once we’ve identified what’s driving your symptoms, we can decide which combination of treatments is most likely to help.
For some people, hands-on therapy is the best place to start because it can reduce pain and restore movement, making it easier to return to normal activities. Others benefit more from targeted exercises that improve strength, mobility or the way they move. Sometimes, we combine these approaches with medical technology such as shockwave therapy or laser therapy to support the healing process or help calm irritated tissues.
At The Physio Box, we view our full range of treatment options as different tools that we can draw upon depending on what your assessment tells us and what you’re hoping to achieve.
Looking beyond where it hurts
If there’s one thing we’d like you to take away from this article, it’s that the place you feel pain isn’t always the place we need to focus all our attention.
That’s why a thorough physiotherapy assessment involves so much more than examining your back. By understanding how your whole body is moving, how your symptoms have developed and what matters most to you, we’re much more likely to identify the factors keeping the problem going.
Back pain can be frustrating, particularly when it seems to appear out of nowhere. But once you understand why it’s happening, the path back to moving comfortably often becomes much clearer.
If you’re struggling with back pain or recurring episodes that don’t seem to make sense, we’d be happy to help you understand what’s really going on and create a treatment plan that’s tailored to you.
Contact The Physio Box today to book a consultation.