Within each type of back pain there is no ‘one size fits all’ treatment approach. Back pain is a complicated, personal experience. As you may already know through personal experience, back pain can be uniquely complex and difficult to diagnose and treat.The intensity and manageability of pain are very different for every person.

There are many types of back pain, and a wide range of treatments that may or may not work for the same condition. Here we outline several insights that you may find helpful in your journey to finding and participating in a treatment approach that works for you.

Below are some of the more common types of back pain, and many of you may recognize your own symptoms in the descriptions. These are followed by key elements and strategies that should be included in a treatment plan for that particular pain pattern

5 Types of Back Pain

1. FLEXION DOMINANT BACK PAIN

Often, this type of back pain is described in terms of injury to the disc (though this is not always the case). More importantly, the pain and symptoms tend to follow a familiar pattern:

Symptoms are made worse by sitting, bending, lifting

Symptoms improve after standing and walking for short durations

May include spine pain, leg pain or both

May experience tingling/numbness

Can progress to leg weakness

Often has pain with cough/sneeze (but not always)

Loss of range of motion (difficulty straightening up after rising from sitting)

CARE & TREATMENT

Effective care for Flexion Dominant pain includes a directional exercise/stretch that you perform at intervals throughout the day to maintain your spinal range of motion and to reduce pain. After performing this stretch, you should have less pain and your back should feel more flexible. The exact stretch that is right for you is best determined by a trained physiotherapist, but often passive, repeated extension of the lumbar spine is a good place to start.

2. EXTENSION DOMINANT BACK PAIN

Extension Dominant pain is often described in terms of the joints at the back of the spine called the zygapophyseal joints (or Z-joints). Again, this is often part of the problem, but not always. Extension Dominant pain has a tendency to follow an identifiable pattern:

SIGNS AND SYMPTOMS

Pain after standing for long periods

Temporary relief from sitting or bending

Range of motion is typically stable and does not change in short periods of time.

The back may be stiff, but it is always stiff in the same way

Pain after high impact activities (running or gymnastics movements)

Usually includes localized spinal pain

May include leg pain, tingling, or even numbness in severe cases

CARE AND TREATMENT

Care for Extension Dominant pain is guided by finding ways to reduce pressure on the spine in extension. People who suffer this type of pain often stand with their low backs arched. Specific abdominal stabilizing exercises and hip mobility stretches (specifically hip flexor stretches) can be effective. Intermittently using flexed postures to relieve pain is also helpful. Pain relieving treatment techniques such as acupuncture or manual therapy may also play a temporary role. Longer term care focuses on spinal/core strength and stability with good hip mobility. Once your pain is under control, the treatment program can be more aggressive. It will be aimed at building muscle around the spine while gaining length in shortened hip muscles.

3. NEUROGENIC CLAUDICATION

Neurogenic Claudication is a specific type of Extension Dominant back pain that tends to affect older individuals (60+). It’s caused by the nerves being compressed when the patient is standing and walking, and can significantly limit a patient’s ability to walk for long distances.

SIGNS AND SYMPTOMS

Typically no symptoms when sitting

Upon rising and walking: pain, numbness or weakness in the legs begins after a predictable amount of time (length of time depends upon severity)

Many of these patients have no local spine pain

After symptoms begin, the patient must sit or bend forward to reduce symptoms

Some patients are seen leaning over a shopping cart, for example, so they can walk without leg symptoms

When patients with Neurogenic Claudication have an acute flare-up, their walking tolerance is greatly reduced and they must take frequent breaks to allow their nerves to recover. These patients should be given a variety of flexion-based stretches and strategies to use throughout the day, and temporarily reduce walking distances. As symptoms decrease, training and exercises to reduce pelvic anterior tilt in standing may be effective. These patients should not try to ‘fight through the pain’ or ‘train’ themselves to walk further, which tends to be like throwing fuel on the fire.

Restorative care for someone suffering from bouts of Neurogenic Claudication should be aimed at two main priorities: First, abdominal strength must be adequate so the individual can walk without the spine falling into an arched or extended position; second the patient’s hips must be mobile enough that the pelvis isn’t pulled into an anterior tilt when standing and walking.
The stronger and more mobile a patient can keep themselves the more likely they are to avoid a decompression surgery to make room for the nerves. 

4. INFLAMMATORY BACK PAIN

Inflammatory back pain is less common than mechanical back pain, but is often misdiagnosed. This type of pain is caused by excessive inflammation in the spinal joints, secondary to a medical condition causing the immune system to attack the joints of the spine. An example of a condition that causes inflammatory back pain is ankylosing spondylitis. However, there are a number of conditions that can result in inflammatory back pain.

SIGNS AND SYMPTOMS

Onset of pain is usually in patients under 35 years of age, and not due to trauma

Pain persists for more than three months

The back pain and stiffness worsen with immobility, especially at night and in early morning

The back pain and stiffness tend to ease with physical activity and gentle exercise

Anti-inflammatory medications (NSAIDs, such as ibuprofen or Naproxen) can be effective in relieving pain and stiffness in most patients.

There is some evidence to suggest that turmeric can serve as a natural way to help to reduce inflammation without the side effects of anti-inflammatory medications. Click HERE for an informative post on the use of turmeric.

 

Patients should be given a management plan that teaches them positions of relief, as well as activities to avoid when experiencing a flare up. Unfortunately there’s no way to alter the natural path of this condition with physiotherapy, but a gentle exercise program is useful to maintain mobility and reduce pain. When symptoms are well controlled and pain levels low, a patient can use a more aggressive restorative program, designed by a skilled physiotherapist. In addition, some low impact functional strength training can be helpful.

5. CHRONIC PAIN DISORDERS

A Pain Disorder involving back pain is one of the more challenging conditions for medical professionals to treat. The nervous system is interpreting stimuli not normally painful or harmful to the body as dangerous, which the brain then treats as painful. It’s a complex issue requiring a profound understanding of the patient, and what has led them to this place.

The usual treatments don’t help these patients. They are best served by working with a multidisciplinary healthcare team, including a physiotherapist with a strong understanding of pain science.

SIGNS AND SYMPTOMS

Vary widely

Pain does not follow typical anatomic boundaries

Location of pain may migrate to include other parts of the body

Pain can be made worse by a state of anxiety or depression

Increases and decreases in pain are not necessarily linked to mechanical trauma or physically stressful events