Author: admin

Ice or Heat for Back Pain?

There is a lot of conflicting information as to whether ice or heat is better for back pain.

Amongst modalities, even amongst practitioners within the same modalities there is conflicting views and opinions.

Whilst there is great benefit in both approaches what is absolutely integral is that the back pain patient and or the practitioner have a clear goal of what they are trying to achieve in using either heat or ice.

We will attempt to remove biases and instead focus in on both the different sources of back pain, and the different approaches to alleviating back pain and how either ice or heat can help or hinder.

Ice treatment is dedicated to achieving:

• Reduction in swelling (anti inflammatory)
• Pain relief (analgesia)

Heat treatment is dedicated to achieving:

• Promotion of blood flow
• Muscle relaxation
• Pain relief  (analgesia)

In the event of an acute back flare up ice treatment can provide effective pain relief until the area settles down.

In the event the practitioner is trying to reduce inflammation of the back, ice treatment can assist following the treatment and is frequently prescribed by practitioners for this reason.  

In the event of a back spasm, heat can assist by relaxing the muscles, promoting blood flow which can provide pain relief and ease the symptoms.

With chronic back pain, the vast majority of sufferers use heat as a form of relief either through intuition or trial and error.  

If you are suffering from back pain, it is imperative that you get an accurate diagnosis from your doctor or practitioner and seek their guidance as to what is the most appropriate approach at that specific time.  If you are unsure, then listen to your body, the is no definitive right or wrong answer to whether heat or ice is better for back pain, however you will feel better using one or the other, so let that be the guide.

Are heat ointments good for your back pain

Find out if heat ointments could be beneficial to you.

Heat creams, ointments and heat patches contain skin irritants. The active ingredients present in the ointments create a reaction that results in blood rushing to the applied area.

The blood rushing to the surface of the skin, along with the irritation create the hot sensation. Muscles will also warm up in the process of blood rushing to the area, which is why the use of heat ointments are so prevalent in sporting change rooms.  

Whilst these ingredients are not overly harmful to the body, continuous daily use is not ideal.

As the smell of liniment or deep heat often brings comments of a football change room, the use of heat ointments regularly to assist with the symptoms of back pain is not ideal, especially if you work in an office or are in direct contact with clients.

Alternative options to heat ointments:   

1. Hot shower first thing in the morning
2. Really hot bath prior to activity
3. Use of hot water bottle
4. Use of wheat bag heated in the microwave
5. Sports massage prior activity

Heat ointments are terrific for getting through a sports activity, or a day’s work after waking up with a stiff back. However if you do suffer from an ongoing achy back, forming a habit of using a wheat bag placed in the microwave with a small cup of water is most optimal.

The steam held in the wheat penetrates deep into the muscles of the lower back often reaching the areas where people experience discomfort. Hot baths are even better as the entire back and hip region is immersed in hot water which has a greater benefit on the restricted connective tissue of the lower back which is another common source of discomforting back pain.

So in conclusion, if you need to get through an activity or can’t take the day off work, heat ointments are a great method of assistance. However if you find you are requiring heat as a form of pain relief on a daily basis we definitely recommend looking for a preferable alternative.  

And if pain your back pain is persistent, seek out a practitioner who can address the cause of your pain and offer you lasting relief.

Standard physio and chiro does not strengthen your back, hence why the pain continues to return

There are two core elements to chronic back pain

Standard physio and chiro does not strengthen your back, hence why the pain continues to return

As chronic back pain specialists we see countless patients who have spent years receiving standard physio and chiro treatments in the hope of finding a lasting solution to their condition.

The treatment techniques and the exercises (if even prescribed) do not address the fundamental underlying cause of chronic debilitating back pain.

There are two core elements to chronic back pain

1. Tight, restricted structures such as joints, muscles and connective tissue
2. Weakened/ non functioning postural muscles integral to the support of the back

The typical cycle for chronic back pain is as follows

1. Postural muscles weaken over a period of time rendering the person vulnerable to a back injury  
2. An innocuous action or movement sends the back into a painful spasm.
3. Restriction during and after the spasm further weakens the muscles that support the back
4. The painful back spasm typically eases on average after 1-3 days.
5. Standard physio or chiro sessions are sought out to ease the residual pain causing tension.
6. Compensatory movement patterns follow as the back suffer now attempts to protect the back to prevent recurrent spasms.  
7. Any follow up physio or chiro continues to address the tight, restricted structures while completely overlooking the underlying cause of the back spasm.

We literally see thousands of chronic back pain patients each year who fall into the above category and are looking for an alternative approach to their condition.

The techniques carried out with standard physio and chiro focus on the symptoms of chronic back pain, not the underlying cause. No amount of spine or joint manipulation, mobilisation or soft tissue treatment will address weakened postural muscles and set in compensatory movement patterns.

The exercises prescribed in standard physio and chiro most typically focus once again on the symptoms. No amount of stretching tight painful muscles, joint mobility work will ever strengthen weakened postural muscles.

Yet countless people come into our clinic confused and frustrated after spending countless hours stretching each day in an attempt to overcome their back pain and prevent further muscle spasms.

If the postural muscles that support the back were strong and functional then excess load would not be placed on the back muscles, completely avoiding painful tension to the back muscles, joints and connective tissue. Which would completely avoid pointless hours spent each week on muscle stretching and joint mobilisation.

Weak postural muscles are the true underlying cause of lower back pain. Strengthening these muscles and restoring postural symmetry is the solution to ending chronic back pain for good.

Should I play golf with a sore back?

The repetitive action of swinging a golf club can be either the best thing or the worst thing if you a suffering from back pain.

After treating hundreds of passionate golfers for back pain, one of the most common forms of feedback we receive is that sometimes golf makes you feel better, whilst other times it leaves you in terrible pain for days.

In this article we will clarify why this is the case, and hopefully give you some guidance to know when is good to push through the pain and stiffness and when it is best waiting for your symptoms to settle down before hitting the fairways.

The most common cause of back pain is an excessive lordotic lumbar curve (or an overly arched lower back/ swayback to keep it simple).  photo required

The excessive curve compromises the joints and shortens the muscles of the lower back as both the joints and the muscles are jammed closer together.  

Muscular imbalances create the excessive curve and the severity of the curve or jamming of the lower back frequently changes. Hence why sometimes you are in pain, and other times you are fine.  

Why all of this information is important to the golfer is due to the importance of lumbar (or lower back) freedom of movement required in the hip and back rotation of a golf swing.

If the back is severely jammed to the point where the facet joints are touching – the repetitive action of a golf swing is not going to end well. Whereas, if the back is not too jammed and the facet joints can still function, even if the muscles of the back are stiff and sore, the action of the golf swing can progressively stretch out the painful muscles leaving you feeling better than before your 18 holes.

So if you suffer from back pain, however you find golf to alleviate your symptoms, your condition is most likely muscular, so getting out there as regular as possible is the best thing for you.

If you fall into the category where sometimes you feel better, sometimes you feel worse, it’s time to start tuning into the signs and choose your battles wisely.

The following are some great tips or guidance for when it may be best to leave your round until your back settles:

1. Back arches or extensions feel more painful than usual (a sign that your facet joints are compromised)
2. Lower back rotation, after a hot bath or shower feels no better than before. (a sign that your pain is not purely muscular)
3. Hips are extremely tight. (the deep muscles of the hips, when tight cause the pelvis to tilt forward, which increases the excessiveness of the lordotic curve.)      

So if you suffer from lower back pain and love golf, we strongly recommend you become more familiar with the constant changes that occur to your hips and lower back. Forming habit of stretching and carrying out range of motion exercises will provide you with accurate insight to the days where playing golf will help you, however more importantly identifying the day’s best suited to meeting your friends at the 19th hole.

Who should I see for my back pain?

With so many different options for back pain patients, it is imperative to address what kind of back pain symptoms you have, what the source of your pain is and which modalities will be best suited to helping you overcome your back pain.

The following list are the most common sources of pain for back sufferers

1. Joint pain, such as sacroiliac pain and facet joint pain.  
2. Nerve pain
3. Muscular pain

Identifying the source of your pain and the length of time you have been suffering from it will assist you in making an informed decision on who to see for your back pain. Seeing the wrong practitioner at the wrong time can delay your rehabilitation period, so it’s important to get it right from the onset.  

The following list are the 10 most common modalities that address back pain.

1. Physiotherapy
2. Chiropractic
3. Osteopathy
4. Remedial Massage
5. Myotherapy
6. Exercise Physiology
7. Acupuncture
8. Dry Needling
9. Bowen therapy
10. Pilates

If you are suffering from an acute lower back flare up, as in you have only been suffering in pain for a few days or weeks maximum, then the following guide will help you make an informed decision on who to see.

If you have Joint pain, such as sacroiliac pain and facet joint pain the following modalities are best suited to your condition.

• Physiotherapy
• Chiropractic
• Osteopathy

If you have Nerve pain, as in sciatica pain or referred pain down the leg then we recommend

• Physiotherapy
• Chiropractic
• Osteopathy

If you have pain that is coming from the muscles and or the connective tissue of the lower back we recommend

• Remedial Massage
• Myotherapy
• Physiotherapy

For people who are suffering from chronic back pain, greater than 3 months and have not responded to any of the above listed modalities it is important to note that a different approach may be needed to address the underlying cause of chronic back pain.

The most common modalities that chronic back pain sufferers turn to after not responding to massage, physiotherapy and chiropractic are:

• Pilates
• Acupuncture
• Bowen Therapy
• Exercise Physiology

For many longer term back sufferers, they often turn to these alternative options out of desperation for a lasting solution to their pain.

If you are not responding to any of the listed modalities, you need to see someone who thinks outside the standard realms of the modality they have studied. Most modalities only focus on the symptoms of back pain, and if this is not giving you a lasting result, then you must seek a practitioner who will address the underlying cause.

We recommend reading articles on this site, that go deeper into our recommendations for chronic back pain sufferers who are not responding to the standard approach of lower back pain care.

There are 2 key elements to Chronic back pain – How Modalities fail to effectively address one of them.

ight, restricted joints, muscles and connective tissue create lower back pain. Tension present in the structures of the lower back produce pain through:

•  direct pressure on nociceptors (nerve endings) or by
•  inflammation placing pressure on nociceptors

Weak, elongated postural muscles integral to the support and structure of the lower back and pelvis create excessive tension on the lower back joints, muscles and connective tissue.

The weakened posture

• creates an excessive lordotic lumbar curve which comprises the joints, muscles and connective tissue
• The lack of support places too great a load on the lower back and creates a jamming effect to the area as movements compensate for the postural weakness.

All modalities focus on eradicating tension present in joints, muscles and connective tissue, whilst failing to provide an effective method to address and correct the postural muscles that created the tension and pain in the first place.

Let’s look at the most common modalities that treat back pain:

Physiotherapy – use techniques such as joint mobilisation, range of movement exercises, ultrasound, T.E.N.S, and stretching.  All of these techniques are dedicated to relieving joint and muscle tension and or reducing inflammation.

Chiropractic and Osteopathy – use techniques such as joint manipulation which release both joint and muscular tension.    

Remedial therapy and Myotherapy – use soft tissue manipulation techniques that are designed to release tension present in muscles and connective tissue.

So if you have acute back pain, in that it is only a few days of weeks old then the likelihood of you responded to standard treatment such as the above mentioned modalities is really high.

Whilst your pain is still derived from the same areas as chronic back pain, the chances of your postural muscles having sufficient strength to support your back is quite high at this stage. Your acute back pain symptoms are however a key warning sign that you need to start addressing your postural asymmetries to avoid future acute flare ups and or the potential to end up with chronic debilitating back pain.

If however you suffer from chronic back pain, you are most likely now aware that physio, chiro and massage only provide you with temporary short term relief from your pain. Hopefully now you are aware why this is the case, the treatment frees you of the tension present, however you walk away from your appointment still with a lack of support for the back. This lack of support places all the load back onto the back, it tires and fatigues and you end up right back the way you were before you received the symptomatic pain relief.   

If you fall into this category then you must address the underlying cause of your back pain. Seek a competent practitioner who specialises in restoring postural symmetry and strengthening your body so the pain does not return.

Anterior pelvic tilt and back pain.

An anterior pelvic tilt is one of the most simple to understand yet most overlooked factor in the diagnosis of back pain. This is staggering given the influence the position of the pelvis has on the lower, middle and upper back, however is a clear indicator as to why most practitioners find the back the most complex area to treat.  

What is an anterior pelvic tilt:

An anterior pelvic tilt is where the pelvis in tilting forward. The front of the pelvis (both ASIS) tilts lower than its neutral position and the back of the pelvis (both PSIS) raise upwards

What causes an anterior pelvic tilt:

Internally rotated hips and shorted anterior muscles such as the hip flexors and quadriceps. Weakened/ elongated posterior muscles such as the glute max and hamstrings provide a lack of support to prevent the opposing force from the anterior muscles groups.

How is an anterior pelvic tilt related to back pain:

Think of the pelvis as the center of gravity, as the foundation of support for the upper body. If the support is solid and in the correct position, then the structures above the support will have every chance of functioning correctly. If the support is weak, unstable and tilting forward then all structures above the support will also be unstable with their function compromised.

The spine commences at the lumbosacral junction, therefore if the pelvis is tilted forward, so to is the position where the spine commences requiring compensation to occur. The spine will compensate to maintain a level eyeline. The spine holds a natural ‘S’ shape, so in order to compensate for the pelvic tilting forward and the eyeline maintaining a level position the excessiveness of the ‘S’ shape is increased.

The lordotic curve of the lumbar spine becomes more excessive or acute. The kyphotic curve of the thoracic spine becomes more excessive as does the lordotic curve of the cervical spine at the neck region.

So as we can see, the position of the pelvis plays a massive role in the health and function of the spine and the muscles, structures and joints that support it.

The vast majority of treatment focuses on the localised symptoms of the back; the restricted joints, damaged discs, painful muscles whilst completely overlooking the real reason why the back was affected in the first place.

For the majority of chronic back pain sufferers, they will go from physio to physio, try all kinds of different treatment options such as chiro, osteo, deep tissue massage only to experience short term temporary relief from their pain. The joints and muscles of the back are successfully released through treatment only for the tension to return soon after due to the anterior pelvic tilt not being addressed. The spine continues to compensate to maintain the level eyeline with the muscles and joints of the back becoming once again tight, restricted and in pain.    

What needs to be done to rectify an anterior pelvic tilt:

Address the cause of the anterior pelvic tilt and you will unlock a lasting solution to chronic back pain.

1. Effective treatment that lengthen the anterior muscles that are generating a constant downward force on the pelvis;
2. Effective treatment that lengthens the muscles that contra-laterally rotate the hip. To remove the constant internal force upon the hip joints.
3. Strengthen the major muscles of the hips to take the pressure of the deep muscles that are overloaded from compensating for the weakness.
4. Strengthen the posterior muscles that support the pelvis in its correct neutral position; hamstring and adductor muscles.

This treatment approach to addressing long term chronic back pain is not an overnight fix. It will take time and dedication by you and your therapist, however you will notice results along the way that will provide you with much longer lasting relief than they treatment that just focused on your back. Over time the pelvis will return to a neutral position providing you a lasting solution to your chronic back pain.

Why no amount of stretching will provide lasting relief from your back pain

In clinic it is not uncommon to see back pain patients for the first time who speak of their daily ritual of waking early before work for a hot shower followed with 30-60mins of stretching. Back pain sufferers speak of the relief they get from their stretching and that they could not get through the day without them.

Whilst stretching provides relief for some back pain sufferers, for others it does nothing more than create further pain. The most likely cause for this is pain derived from back structures other than just muscles, such as joints and fascia of the lower back.

For those who experience relief, stretching is a great option to aid them through the day however as most back pain sufferers clearly point out, the tension once again builds up throughout the day making them very dependent on doing them daily, often twice or more daily for some.

In this article we are going to address the reason why the tension builds up time and time again after effective stretching and more importantly what back pain sufferers can do to prevent the pain creating tension from coming back.

There are two elements to back pain:

1. Tight, shortened muscles that pull the body out of alignment which in turn comprises joints and other muscles creating pain.
2.  Weak, lengthened muscles that place too great a load on the tight shortened muscles.

Stretching is effective at focusing on the first element, releasing the tight and shortened muscles that pull the body out of alignment. However as the day progresses the tension soon but surely returns due the the second element, the weak and lengthened muscles placing too great a load on the tight dominate muscles causing them to shorten and contract, in turn creating pain.  

This pattern repeats itself for months, years even decades with the back pain sufferer knowing no other way than their daily ritual.

As simple as this sounds, if all the back pain suffer was to do was focus on the second element, then the first element would be removed out of the equation, completely breaking the chronic back pain cycle, completely eradicating the dependence on daily stretching.  

Strength is the key – not stretching. Shorten the weak postural muscles through an effective strengthen regime that would take less than an hour each week (the time most back pain sufferers spend stretching and applying heat packs to their sore backs).

By strengthening the weak postural muscles that support the back and pelvis you are ensuring that the excessive and constant load placed upon the muscles that once need to be stretched and lengthened will be removed. Once postural balance and symmetry is restored the weight and movements will be distributed evenly ensuring that your muscles are not tightening, not creating pain and more importantly not requiring you to set the alarm an hour early each day to wake up and stretch them out.  

Think stretching – short term results

Why do I have back pain?

You have back pain because the muscles that are designed to support your back have let you down. Or more accurately, you have let them down, gradually over a period of time causing them to weaken and weaken to the point where…. Bang, you have bent over to turn the bath tap off, or to pick up something you dropped on the floor. Something you had down a million times before without a worry in the world, and now through reading this you have learned why this time your back spasmed leaving you in a terrible mess for a few days and now you are stuck with a nagging back ache and a feeling a vulnerability when you bend forward.

Weaknesses and postural imbalances built up over a period of time lead to an innocuous action that causes your back to go into spasm, leaving you with nagging back pain. If we took one hundred chronic back pain sufferers, put them all in the same room and asked them one by one to recount their story, 97 of them would speak of a very similar experience.

What creates weaknesses and postural imbalances?

In one word – Inactivity! Is the main culprit for most.

However, for others it is constant repetitive actions or hours spent in the one fixed position.

Such as office workers seated in a fixed position for hours on end, or a manual labourer working forward of their midline for long periods of time. They same thing can apply to athletes who carry out similar actions in their sport; think golfers, cricketers etc.

These postural imbalances weaken the muscles integral to supporting us upright. The most significant muscles we define as postural muscles are the gluteus maximus muscles. When these muscles weaken, much of the load is placed on the deeper intrinsic muscles of the hips that are designed to internally/ externally rotate the hip.  Due to being placed under excessive load these muscles shorten and contract resulting the the hips remaining in a constant internally rotated position. This has the knock on effect of tilting the pelvis into a forward position. Once the hips are internally rotated and the pelvis anteriorly tilted all of your body weight is placed forward of your midline as you walk, sit, stand, jog etc. The muscles anterior of your midline compensate by taking more load than they are designed to, with the posterior postural muscles weakening even further due to the weight shifting off them and onto the anterior muscles.

As stated early, this patterns leads to the innocuous action that sends your back into a painful spasm, which is just a protection mechanism that kicks in to force you to rest the muscles of the back that over exhausted and fatigued.

The problem here, is that the spams leads to further inactivity, that leads to a further protection of your back to prevent further pain and spasms. Everything you do, you are either consciously or unconsciously moving in a way to protect your back. The muscles anterior to your midline over work in attempt to support you when you bend down. Your body gets caught in a compensatory protective pattern that must be broken in order to address the cause of your back pain.  

Muscular weaknesses created your back pain. Muscular weaknesses keep you in chronic back pain.

In order to address the true underlying cause of your back pain you must follow the following steps:

1. Address the compensatory patterns and gain confidence in positions that will strengthen your back
2. Reinforce corrective movement patterns that will override the protective compensatory patterns.
3. As the correct movement patterns become automatic/ second nature, add resistance to make them more challenging.
4. Continue to make the exercises more challenging keeping you out of your comfort zone.
5. As your neuromuscular pathways hypertrophy you will feel greater support and confidence in your back and body.
6. Continue to increase the resistance of the postural corrective exercises up and over your own body weight. This will restore muscular symmetry and strength to the muscles that support your back.

For more information on how to overcome your chronic back pain, please refer to the relevant articles with links below.