Back pain is one of the leading causes of disability worldwide. It’s estimated that 80% of the population will experience back problems at some point in their lives. The back is composed of a complex structure of bones, joints, ligaments, and muscles that embody the cervical, thoracic, lumbar, and sacral regions of the spine. Any strain to your ligaments, discs, or joints can lead to the feeling of spinal pain. Most cases of back pain aren’t caused by conditions such as inflammatory arthritis, infection, fracture, or cancer. The simplest of movement patterns, such as sustaining your postural alignment, can be the source of your back pain. Since most people spend a majority of their time sitting at the office, it’s estimated that 54% of Americans who experience back pain spend most of their workday in a sitting posture. The majority of back pain is the result of muscle and ligament strain or weakness which can be prevented by having proper posture. If your spine isn’t balanced, you will inevitably have problems all across your back, including the neck and shoulders.

Symptoms & Causes of Back Pain

Generally, the lower back is the area of the spine that will elicit the most pain symptoms. The number of people experiencing lower back pain is gradually on the rise, with 29% of Americans feeling symptoms of lower back pain. Improper posture due to poor spinal alignment commonly causes your lower back to compensate while taking on more load. This misalignment could place more strain on your upper back as well as along the neck region.

Generalized Symptoms Of Back Pain:

• Persistent aching or stiffness anywhere along your spine, from the neck to tailbone
• Sharp, localized pain in the neck, upper back, or lower back
• Chronic, deep, and dull ache anywhere along the back
• Pain when moving from sitting to standing
• Pain rolling over in bed
• Issues squatting, bending, sitting, or standing for long periods of time

Symptoms of back pain could also be the result of a condition such as inflammatory arthritis, sciatica, infection, or a fracture. If you’ve suffered a fall or accident that’s directly injured your back, make sure to contact a medical professional immediately in case of a herniated disc or fracture to the spine. If you have any radiating numbness, weakness, or pain to your groin, arms, or legs it may be a sign of spinal cord damage.

Postural Causes Of Back Pain:

Sustained maladaptive posturing can lead to increased tension in the muscles along your core and spine. The misaligned spine can no longer support you in a sustained position, leading to symptoms of pain. Since the spinal muscles are fatigued and in a weakened state, you’ll see loss of normal function throughout your day. More than 1 in 3 adults report that back pain impacts everyday activities including sleep. Factors contributing to postural issues that cause restricted spinal muscles could range from:

• Lack of awareness of correct postural techniques
• Lack of core stability
• Genetic issues, such as a history of scoliosis
• Occupational demands, such as consistently sitting in an office space
• Poor ergonomic workstations

Almost 9 in 10 patients never know the primary cause of their pain. Once the cause of the postural issues causing back pain is found, treatment can be designed to relieve a patient’s specific condition.

Physical Therapy Treatment

Since most cases of back pain are non-organic, it’s difficult to see the cause of the issue in diagnostic imaging such as an X-ray or MRI scan. For example, if you experience chronic lower back pain on a daily basis, you may have increased stress applied to the muscles along your lumbar spine. This excessive stress can lead to inflammation, tightness, and strains around the muscles that surround your spine and this stress is difficult to detect on a scan. Most cases of back pain need to be treated by using a full-body approach to finding the source of the pain. If you need further testing and diagnostic imaging such as an X-ray or MRI, your physical therapist can differentially diagnose your condition and can lead you in the right direction, which may be to your physician.

Manual Therapy

Manual therapy is used as both an assessment tool and as a treatment technique. A physical therapist will physically assess your muscles and joints at each spinal segment including the cervical, thoracic, lumbar, and sacral regions. These assessment areas could be above and below the site of your pain which could include the upper and middle spine, the pelvis, and the hips. The physical therapist will determine which areas around the spine may have misalignment. For example, these areas might include misalignment along the rib cage, the pelvis, and/or hip complexes. Additionally, they will determine if there are any translational misalignments such as positive step-off signs along your spine. Once they have an understanding of your tissue health, they’ll work to release any restrictions in the muscles with specific physical therapy manual techniques. These techniques might include both soft tissue and joint mobilization, myofascial release to connective tissue, and/or direct manipulation to a specific area. The goal is to use these manual processes to eliminate any restrictions or scar tissue that have developed within your muscles and/or joints due to repetitive, indirect, or direct trauma. Once those areas of strain or stress have been restored, the individual will experience less pain, more range of motion, flexibility, and better postural movement patterns along the back.

Movement Assessment

Another aspect of a physical therapy program to treat back pain is to observe and analyze the specific ways in which an individual moves. For example, a physical therapist can assess the way you sit, touch your toes, or bend to the side. A physical therapist observes your postural movement patterns while analyzing the ways in which your body rotates, flexes, and moves throughout specific postures. They can determine whether or not tightness in one region of your spine affects how you sit or bend to the side. They’ll also assess your overall spinal endurance in many ways including but not limited to plank and/or side plank testing, which gives the physical therapist an idea of how much strength is engaged in your core. Overall, your physical therapist will want to understand how your body is able to maintain postural alignment. They can then incorporate these static and dynamic pattern findings into their treatments and begin to understand where your weaknesses lie in order to develop optimal training plans.

Strength & Postural Training

Achieving mobility in your spine is one way to relieve pain caused by poor posture patterns. Physical therapists are trained to correct spinal alignment and apply stabilization along the spine to prevent future risk of back dysfunction. One aspect of this process is postural re-education for the patient to correct their current maladaptive posturing. When working to restore better posture, a physical therapist can direct you to train your body in ways that allow for the development of better spinal alignment. They’ll also take your daily habits, workplace design, and physical activities into consideration while designing your treatment plan for better posture. For example, if you spend a majority of your time at the workplace and have developed poor spinal alignment, your physical therapist will help you stretch and strengthen areas along the back and core to better support the spine. This might also include teaching you how to sit at your workplace while maintaining good neutral posture. You’ll need to learn how to keep your head upright without craning it forward which could be helped by keeping your computer screen at eye level. Leaning forward to stare at your computer screen could lead to a history of neck strain. It’s almost important to keep shoulders relaxed, your feet flat on the floor, and have a curve to your lower back by using a lumbar roll. Overall, they’ll show you exactly how to maintain proper posture for all the movements you may face on a daily basis.

When To Seek Help

If you’re unable to sit comfortably throughout your workday, sustain sitting, or sustain standing because of back pain, it’s necessary for you to seek treatment. It’s also necessary to seek the opinion of a medical professional if you feel like you can’t complete daily activities because of your pain. A thorough physical therapy evaluation can help determine the source of the pain. Afterwards, your physical therapist will work to design a treatment plan for your back pain that incorporates your daily postural habits. They’ll treat any restrictions and correct any misalignments in the spine while also reducing and/or eliminating the risk of it happening again in the future.