As one can imagine, the spine is extremely complex – it takes considerable understanding of the anatomy to decipher sources that could be causing a person spinal pain. What am I talking about when I say spinal pain? In a general sense, I am talking about the NECK, or the cervical region, the MID-BACK, or the thoracic region, the LOW BACK, or the lumbar region, as well as the transitional zones between these regions – the cervicothoracic, thoracolumbar and lumbosacral junctions (see below).
The picture above does a great job of showing the regions of the spine, but it neglects the depiction of the extensive vascular (arteries/veins), neurological (nerves) and muscular systems. These other systems are highly integrated with any region of spinal pain, and thus MUST BE considered in a physiotherapist’s list of differential diagnosis in order to treat all areas of dysfunction and give the client the best clinical outcome.
Clear anatomical differences exist between the various regions of the spine – i.e. shape of the bones, orientation of the joints, vascular supply to the region, size of the space containing the spinal cord, innervations to musculature, etc. Understanding these differences is imperative in diagnosing and thus, treating spinal pain.
Common reasons for having spinal pain include:
– History of/or recent motor vehicle collision
– Improper posture
– Aging spine WITH or WITHOUT nerve root compression
– Sleeping position
– Laxity or instability issues causing too much movement in a spinal segment and/or stiffness or restricted movement in a spinal segment
– Bony malalignment (scoliosis, congenital defects, systemic conditions)
Like any area of the body, a person’s clinical picture can vary immensely. For example, an acute whiplash from a car accident will present differently than a flare-up from a degenerating neck. There is a whole gamut of considerations when evaluating spinal pain – a person’s age, co-existing medical conditions, previous medical history, medications, mechanism of injury, timeline of symptoms, pattern and location of symptoms, other symptoms other than pain (dizziness, headaches, weakness, numbness, tingling, etc.) More objective considerations include ligamentous stability, muscular influences, joint involvement, ruling in or out neural compromise, and then fitting all these different pieces into a puzzle to make the diagnosis and thus, treatment plan make sense.
Where the picture can get muddied is during the discussion of referred pain from joints or muscles or nerve roots. This is when a client can point or be specific in locating an area of tenderness or dysfunction, but has trouble making sense of other pain areas that may be down an arm or a leg, or in the hand or the foot. An example of this can be illustrated using the upper trapezius muscle. You can see in the picture below that a person may complain of marked tenderness across the muscle, but they also may only describe pain away from the muscle at the base of the skull and spreading up and onto the lateral or temporal aspect of the skull.
Another example is noted when you hear the common phrase “sciatica” to describe pain that shoots down the leg. There can be misinterpretation about that diagnosis as MANY different structures can cause the sensation of pain shooting down the leg – various nerve roots exiting from the spine, muscular referral from gluteus medius or minimus, compression of peripheral nerves (sciatic, tibial or common peroneal, etc.) It is the physiotherapist’s job to decipher the true source of the referred pain through their assessment skills.
The common message to be received when discussing spinal pain is there is no simple answer to explain it. A thorough assessment from an experienced physiotherapist is recommended to determine the source of the spinal pain. Once the clinical picture has been evaluated and diagnosed, you can expect a treatment plan that includes individualized exercises to help improve mobility, endurance and strength, manual therapy to correct muscle, joint and nerve influences, as well as tailored education of do’s and don’ts to help speed up the recovery process. Current research shows that the most successful physiotherapy treatment plans have a combination of exercises and manual therapy, so that’s how I treat clients.
If you’re experiencing spinal pain, give us a call today at 403.295.8590. I would be happy to help you resolve your spinal pain, and get you moving faster and feeling better. ☺
Lisa Sametz, Physiotherapist
MScPT, FDN, BScPhysiology