Spinal Physio Brisbane | Back, Neck & Rib Pain

Spinal Rehabilitation

Spinal pain is one of the most common concerns presenting to GP's and physiotherapists in Australia and worldwide. With a range of presentations such as neck pain, low back pain, rib pain, and a range of varying time lengths from clients who have experienced pain for one week all the way through to clients who have experienced pain for years.

Physiotherapy for spinal injuries or spinal pain requires targeted assessments to determine as accurate of a diagnosis as possible. A thorough subjective assessment must be completed to determine a range of things such as:

The mechanism of injury
Aggravating movements, positions, or functional activities
Easing factors such as comfortable positions, heat, cold, rest
Your previous history of pain or injuries
Whether you have any referred pain such as pins and needles, tingling, sensation loss
If there is any motor strength loss

A woman receives a leg massage from a physio.

Without a thorough subjective assessment, determining what structures and potential pain sources to assess during an objective assessment becomes much more difficult. A physiotherapist should have determined a few likely culprits for the cause of your symptoms, whether that be a facet joint, a particular muscle, or whether they believe there is a neural or disc component to your pain.

After your subjective assessment I will then perform a targeted objective assessment to assess the particular structures. During this process I will be aiming to provoke your pain and your symptoms. Determining that they are truly your symptoms is important, differentiating between your pain that you experience and just "that's a bit sore but it's not the pain that I feel" is very important. Commonly for spinal pain an objective assessment will include:

Range of motion assessment potentially including assessment of the shoulder, cervical spine, thoracic spine, lumbar spine, or the hip joint.
Palpation of the muscles surrounding the area to assess for areas of increased muscle tone or tenderness to touch.
Palpation and assessment of facet joints and/or rib joints to assess for increased stiffness, tenderness to touch, or recreation of referred symptoms.
Special tests of specific structures such as a testing battery for the SIJ - In the Laslett cluster 2/4 tests are required to be confident in a diagnosis of SIJ pain.
Neurodynamics to assess the mobility of the neural system - these are vital for clients experiencing referred pain, pins and needles, tingling, or sensation reduction.
Neurological assessment - these aren't commonly required but are necessary in certain situations such as a client who is experiencing a numb foot or sensations of weakness that are wholly independent of pain inhibition. This test will include an assessment of light touch, two point discrimination, myotome assessment (strength), as well as assessment of your reflexes.
Functional assessment - often this will include an assessment of activities of daily life, whatever that may be for you. This could include posture during sitting or standing, squatting, walking, lifting. If there are any particular activities or movements that recreate your symptoms, these should be key assessments for us.

A man is receiving sports physiotherapy for his back.

Common Causes of Spinal Pain

Lumbar Facet Joint Sprain

Facet joint injuries are probably one of the most common presentations for lower back pain. Often pain is quite localised and able to be recreated with extension and compression based movements or positions. This could often include laying on the affected side, reaching up for something or reaching back in the car.

Lumbar Discogenic Pain

Discogenic pain carries a bit of a stigma that is a bit overplayed. Discogenic pain is far from the problem it is often made out to be. Findings of disc bulges or protrusions are far more common than you would believe and in asymptomatic people they become more common as we get older. Discogenic pain often presents with pain with flexion based activities such as picking things up from the ground, some aspects of self care, and a lot of daily activities such as playing with your children. Some clients with discogenic pain may also experience referred pain.

SIJ Pain

SIJ pain is not overly common and requires specific assessment criteria to come to a confident diagnosis. SIJ pain can be common in pregnant women due to the effects of hormonal changes during this time resulting in a loosening of the ligamentous structures supporting the SIJ. Often clients will respond to either distraction or compression of the joint which can assist in developing a targeted treatment pathway.

Lumbar Neural Irritation

Neural irritation often occurs when there is increased tension on a nerve structure but not a source of compression. Often this may present as sciatica with a common source of irritation being the gluteal muscles. This presentation is often referred to as piriformis syndrome. A source of irritation could also be the lumbar spine where there may be an increase in joint stiffness or muscle tightness.

Lumbar Nerve Root Compression

Nerve root compressions often presents with numbness and altered muscle strength. Following a thorough neurological assessment we will hopefully be able to determine a likely level of the lumbar spine that the compression is occurring at. This is through the assistance of dermatomes and myotomes, a range of sensation areas and movements that correlate with a certain spinal level. Reflexes are also supplied by certain lumbar spinal levels also.

Lumbar Muscle Strain

Whilst not overly common, muscle strains certainly do occur in the lumbar spine. They often fit the pattern of most other muscle strains, that is, they are painful to contract, stretch, and touch. You may be sitting there telling me that all back pain presentations do that. This is often where the description of symptoms while doing these movement patterns is crucial.

Thoracic Facet Joint Sprain

The thoracic facet joints operate slightly differently to the lumbar and cervical facet joints. This is largely due to the presence of the ribs. An innate understanding of how the joints operate is crucial to understanding thoracic or mid-back pain. Understanding the stressors of combined flexion and rotation or combined extension and rotation and what movements create which is crucial.

Rib Joint Sprain

Rib joints sprains and injuries are often quite painful, and they can take some time to settle down. Fortunately, they can be pretty easy to spot, pain on deep breaths, coughing, and sneezing coupled with a pain location a little further to the side of the spine is close to a dead giveaway. The onset of symptoms isn't easy to always pick up, I woke up one morning earlier this year with rib pain with no cause of onset, luckily for me the symptoms settled quite quickly.

Cervical Headaches

Headaches can have a wide range of causes and contributing factors. Determining what will respond to physiotherapy and what may need other more specialised interventions from the medical side of treatment is crucial. Cervicogenic headaches often present with patterns of where the headache occurs as well as the types of symptoms. Cervicogenic headaches can respond fantastically to physiotherapy involving hands on treatment and an exercise program.

Whiplash

Motor vehicle accidents are the most common cause of whiplash, though it can occur during sporting events as well. It often involves a quick change from cervical flexion to cervical extension, think of what happens to your head when you are hit from behind in the car and that's what the most common movement is. Presentations can vary widely, ranging from symptoms onsetting days later and minimal symptoms to immediate onset that continues to build. For any client who has had a motor vehicle accident I would always recommend booking an appointment with your GP or physiotherapist to ensure you aren't suffering from any latent whiplash symptoms.

Cervical Discogenic Pain

Cervical discogenic pain is often very similar to discogenic pain in the lumbar spine. There will often be movement patterns such as flexion or lateral flexion that are aggravating movements with or without referred pain. It's always important to remember that discogenic pain is just as likely as every other form of spinal pain to recover, you are not defined by your scan findings. Hands on treatment from an experienced physiotherapist, along with a targeted exercise program to strengthen the shoulder and cervical muscles is often highly effective.

Cervical Facet Joint Sprain

Facet joints in the cervical spine are most commonly put under stress during rotation, lateral flexion, and extension. These compressive forces often increases pain in these types of presentations. But things change a little bit for upper cervical facet joint issues changes slightly. An experienced physiotherapist who is able to differentiate and bias movements and positions to improve the accuracy of diagnosis is necessary in these presentations.

Cervical Nerve Root Compression

Cervical nerve root compressions will often present with referred pain to the upper limb as well as the potential symptoms of numbness, sensation changes, or weakness and altered reflexes. Through the assistance of dermatomes and myotomes, a range of sensation areas and movements that correlate with a certain spinal level. Reflexes are also supplied by certain lumbar spinal levels also.

Cervical Neural Irritation

Neural irritation often occurs when there is increased tension on a nerve structure but not a source of compression. Often this may present as pins and needles, or pain down the forearm or upper arm, or even into the hand. Common sources of irritation could be the cervical spine, rotator cuff, thoracic outlet, or through the neural pathways in the upper arm and forearm.

Postural

Posture is one of the most hotly debated topics in physiotherapy. Is there an ideal posture or should we not really care about it, is there one "best posture" or do all postures carry their own set of pro's and con's. Currently no research has been able to link a specific posture with pain, so "text neck" is not a thing as catchy as the name is. In my opinion, posture is all about adaptability, being able to change postures and adjust as needed to comfort, ergonomics, and the task you are completing is necessary.

Steps to Success for Recovering from Spinal Pain

Hands On Treatment

Manual therapy is a necessary component for recovering from an episode of spinal pain whether that be acute low back pain, whiplash, headaches, or rib pain. Hands on physiotherapy could include massage, soft tissue release, trigger point release, joint mobilisations, or joint manipulations. These treatment techniques often result in a short term reduction in symptoms, an increase in functional capacity, and an improved ability to complete an exercise program. It's always important to remember that hands on physiotherapy isn't going to "fix" the issue. A complete rehabilitation program including an exercise program is needed to resolve an issue in the long term.

Physiotherapist treating a client's lower back and hip while they lie on their side

Adjunct Treatments for Spine Pain

Dry Needling

In conjunction with hands on treatment, adjunct treatments can provide improved results immediately, or prolong the effects of the hands on treatment. Dry needling is one of the most commonly utilised adjunct treatments in physiotherapy regardless of which body part you are having treated. Whilst I do believe it is a bit "in fashion" at the moment and may be utilised a little bit more than I think it is clinically indicated or recommended, in the right subset of clients it can provide great results. In my opinion, dry needling creates a short term effect via stimulation of the nervous system, and a longer term effect by creating a small, very localised inflammatory response. However, I cannot definitively say this is how the process works. Dry needling differs from acupuncture, they are quite different treatments even though they both involve needles. In my opinion, acupuncture is based upon Eastern Medicine principles, whereas dry needling is more so based in Western Medicine principles.

Taping

Taping techniques are one of the most commonly utilised interventions for physiotherapists. We are able to offload or support certain structures in an effort to provide short term pain relief, cue habits or positions we want to reinforce, or promote contractions of certain muscles. For spinal pain taping is often utilised in the early stages, a box taping is often utilised for the lumbar spine to reduce muscle spasm. For clients suffering from neck pain or postural concerns, K-Tape or RockTape can provide a deloading effect to the muscles and allow symptoms to settle as well as providing postural cues.

It's always important to monitor for signs of an allergic reaction when you have taping done. If you have had an allergic reaction to taping in the past please advise me. If you haven't always be on the lookout for any signs of skin redness, itchiness, blistering, or any other abnormal signs around or under the tape.

Exercise for Spinal Pain

Exercise is almost always the long-term answer to any musculoskeletal injury. Without developing strength, endurance, or motor control in the areas that can support the area of symptoms, long-term, lasting relief is far from guaranteed. Hands-on treatments such as massage or dry needling are designed and implemented to have a short-term effect where we can push forward with an exercise program.

I often hear clients telling me they "want to develop a stronger core" for lower back pain. But what is a stronger core, you could ask a PT, a GP, a pilates instructor, and a physiotherapist and you would more than likely get four different answers. In my opinion, a strong core is a group of muscles including the abdominal group, the back, the gluteals, and the deeper core and pelvic floor muscles. All of this system is interlinked to provide a stable base that you can move and perform functional movements such as squatting, extending your back, bending your back, and twisting. Often this won't mean you will be doing 200 sit-ups every day, because really who has the time and who enjoys that? Ultimately we need exposure to these different movement patterns in a graded manner.

A good exercise program for lower back pain should incorporate all of these movement patterns, strengthen the appropriate muscles, as well as provide an appropriate stimulus for stretching and mobility work. An exercise program should work for you and fit into your lifestyle.

For clients suffering from mid back and upper back pain often an exercise program will revolve around optimising the movement and strength of the trunk and shoulder girdle, as well as neck mobility and strength. The thoracic spine plays an integral role in how the rest of the spine functions, if we have an increase in stiffness and a reduction in rotation and extension of the thoracic spine, we will begin to load up through other areas, such as the cervical or lumbar spine.

Physiotherapist assessing a client's lower back and hip movement as she lifts one knee

Your Questions About Spinal Conditions

What is spinal stenosis?

Spinal stenosis is a narrowing of the spaces in the spine that the spinal cord and nerves pass through, usually due to age-related changes such as thickened ligaments, disc changes and joint enlargement. In the lower back, it commonly causes pain, heaviness, pins and needles or weakness in the legs when walking or standing, which eases when sitting or bending forward. Many people find leaning on a shopping trolley helps. Physio focuses on improving walking tolerance, strength and flexibility, and many people manage well without surgery.

What does "degenerative disc disease" on my scan mean?

Despite the worrying name, degenerative disc disease is usually not a disease. It describes normal age-related changes in the discs, such as reduced height and water content, and these changes are very common in people with no pain at all. They are seen in a large proportion of adults by middle age and increase with age. Having these changes on a scan does not mean your back is fragile or that your pain will get worse. Most people with these findings respond well to exercise and staying active.

When is spinal surgery needed?

Spinal surgery is needed in a small minority of cases. Urgent surgery may be required for cauda equina syndrome, which causes loss of bladder or bowel control or numbness around the groin, and needs immediate emergency care. Surgery is also considered for progressive weakness, severe nerve pain that has not improved after several months of conservative care, spinal instability or fractures. For most back and neck pain, non-surgical care is recommended first. If I think a surgical opinion is worthwhile, I will help you organise it.

Can physio help after spinal surgery?

Yes. Physio after spinal surgery helps you get moving safely, rebuild strength and endurance, and return to work, sport and daily activities with confidence. I follow your surgeon's guidelines on what movements to avoid early on and when to progress. Rehab usually starts with walking and gentle movement, then builds into strengthening exercises for the trunk and legs. Because I come to you, home visits can be especially useful in the first few weeks when getting to a clinic is difficult. You can read more on my physio after surgery page.

Spinal Pain FAQs

Do I need a scan for back or neck pain?

Usually not. Most back and neck pain can be diagnosed with a thorough assessment. Scans often show disc bulges and wear that are common in people with no pain at all, so they do not always explain your symptoms. I will refer you to your GP for imaging if your symptoms suggest it is needed.

Should I rest when my back is sore?

Short periods of rest can help in the first day or two, but staying gently active is one of the best things you can do. Long periods of bed rest tend to slow recovery rather than speed it up.

When should I see a doctor instead of a physio?

Seek urgent medical attention if you have back pain with any of the following:
• loss of bladder or bowel control
• numbness around the groin or buttocks
• weakness in your legs that is getting worse
• fever or unexplained weight loss
• pain after a major fall or accident

Is a disc bulge serious?

In most cases, no. Disc bulges are very common, become more common as we age and often cause no pain at all. Disc-related pain can recover just as well as any other type of back pain. You are not defined by your scan.

Can physio help with sciatica?

Yes. Sciatica is usually caused by an irritated or compressed nerve, from the lower back or the gluteals. Assessment helps work out which, and treatment combines hands-on care with exercises to settle the nerve. You can read more on my Nerve Pain page.

How many sessions will I need?

Many recent episodes of back or neck pain improve significantly within a few weeks. Pain that has been around for longer usually needs a longer program. I will give you a realistic estimate after your first assessment.

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