Is Your Back Pain Really Coming from Your Back?

Have you ever had pain in the base of your spine, going into your buttock, pelvis, or leg? Everyone says it’s your back, but is it? How do you find out?

The key to resolving your symptoms is an accurate diagnosis. Let me walk you through the in-depth evaluation that you will receive at our office. We start with the McKenzie Method of Mechanical Diagnosis and Treatment by taking a thorough history of your pain and any other issues such as numbness, tingling, unsteadiness, and falls or trauma. We then look at your sitting, standing, walking, and sleeping posture to see if your upper body, legs, or pelvis are shifted or tilted. We next check your sensation and your reflexes. While standing, we assess your ability to bend forward, backward, rotate and side bending to each side, once and up to 10 repetitions while carefully assessing the effects on the location and level of your symptoms. Then, while lying down, we check your spine flexion and extension motion, strength, and joint mobility. We may perform a prone instability test if we suspect you have weak core muscles that are not properly stabilizing your spine.

Next, we move on to check the flexibility and strength of your hip in all 6 directions as well as your hamstring flexibility and dural tension. If your symptoms are in the sacrum, we may add sacroiliac joint testing.  We also fully assess your motion and strength in your knees, ankles and even your toes.  We will check for any tenderness in the regions where you have symptoms to determine the status of the back and hip muscles and tendons.  If you have X-rays or MRI results, we do integrate those tests into our assessment; however, our full evaluation is the key to knowing what motions cause and what motions will improve your symptoms.

We then combine your personal history with your full evaluation results, to arrive at your specific PT diagnosis and custom treatment plan. We start on the first day with hands-on treatment for soft tissue and joint mobilization, education in proper posture, and instruction in a home exercise program. Often, we find that patients that have back symptoms that peripheralize or move into the leg with the repeated motions have symptoms caused by lumbar or lumbosacral discs protruding on the nerves.

Sometimes we find that patients have a large imbalance in the strength and flexibility of hip rotator muscles, such as the piriformis muscle. A tight piriformis muscle can cause piriformis syndrome where the sciatic nerve gets compressed under a tight piriformis muscle. Other times, we see the pelvis tilted forward making it difficult to stand straight, and find that the patient has a tight iliopsoas muscle. The iliopsoas muscle is a hip muscle that originates on all the lumbar vertebrae and a tight iliopsoas can create a lot of back pain! You may have weak core muscles that are not properly stabilizing your spine and your PT might work on your transverse abdominal muscles and other core muscles to stabilize your spine. Bottom line, you may have pain originating from your lumbar spine, sacrum AND/OR your back or hip muscles.

Your personalized one-on-one evaluation at Excel will let you know what is causing YOUR pain and get you the most effective treatments such as the McKenzie method, stabilization, Graston Technique or Active Release Therapy. Our mission is to get you BACK to doing what you want to do pain-free! 

Jean Scott, PT, DPT, OCS, Cred MDT, Graston Cert, ART cert

Excel PT: Is Your Back Pain Coming From Your Back? 

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