What is Back Pain and Why is it so Common?

Back pain is one of the most common issues that we assess and provide treatment for at Sunup Physiotherapy. This is not surprising considering that the majority of our patients are office workers.

A few reasons why back pain has become so common among Canadians include:

  • High volumes of sedentary desk work
  • Poor postural habits
  • Low activity lifestyles
  • High proportion of social and recreational activities that involve sitting
  • Too much screen time starting at younger ages
  • Heavy Snow shoveling during winter season

Pain felt in the low back, buttocks or even the legs can all be attributed to issues stemming in the lower back and pelvis. The nerves that control the strength and sensation in the legs originate in the low back (lumbar spine) and are most vulnerable to compression, angulation or irritation as they exit the spine. If this occurs, your lower back issue may also develop into leg pain/tightness or symptoms of sciatica.

Back pain can be debilitating and influence not only your ability to work but can also impact all aspects of life. If back pain is not managed appropriately in the early stages, it can turn into a more chronic condition with repeating re-occurrences and ongoing discomfort. It is important that you have your back pain assessed by a medical professional be it a Physiotherapist or Chiropractor. It is important to seek treatment for your back at the onset of pain or stiffness. Early intervention can lead to a faster recovery, can prevent worsening of symptoms and will limit compensations strategies from taking over and leading to a more stubborn, chronic condition

What Makes the Lower Back Unique?

The back takes on heavy loads across a lifetime and it’s also an area where there is a decent amount of movement (forward bending, backward bending, sideways bending and twisting). The lumbar spine does have some unique features that help to protect it:

  • Size of the vertebra and intervertebral disc are designed to take load- the bones are larger and denser and the disc tissue has an intricately designed pattern so it can take loads in multiple planes of movement. Also, the joint architecture limit end ranges of twisting movements which can strain the disc.
  • Its relationship with the pelvis- The lumbar spine is closely related to movements of the pelvis and hips. These areas have a close relationship to one another. If one area fails other areas can compensate and take the load, create stability or offer flexibility. In the long term, these compensations can lead to secondary damage/injury but in the short term, this can be quite protective for the low back.
  • Its natural lordosis or curvature- the spine in our low back anatomically has a concave curve forward to which transitions to a convex spine in the midback. These curves are important for proper weight bearing through the disc and vertebrae but often become reversed or changed with poor postural habits.

The lumbar spines movement is influenced by many areas of the body from feet to shoulder. It is the commonly considered the core or power house that drives movement. We all hear the buzz word “core strength” but to truly understand what the core is a lot of us need the guidance from a knowledgeable professional or trusted physiotherapist. It’s important that we recognize that core deficits can be different in each of us and the best core exercises are very individual and unique to each person’s body and demands.

What are the Causes of Back Pain?

Back pain due to muscle strains or joint sprains (Mechanical back pain)

Mechanical back pain is a general term and describes when muscles, ligaments and joints of the low back get injured. When excessive demand is placed on one or more of these structures they can become strained/sprained and an inflammatory response will ensue. A strain/sprain more commonly occurs with a sudden demand is placed on the tissue and fibers tear. Proper rest and gradual rehab exercise can lead to a favorable recovery.

Back pain due to the facet joint dysfunction

There are two paired joints on either side of a vertebra that connect the vertebrae above and below. These joints are called facet or zygapophyseal joints. These joints glide, gap and rock as the back moves. They can have variations in how they form from birth or can be damaged or sprained with trauma. Extension or leaning backwards (arching your lower back) causes compresses at these joint surfaces and is one of the most common ways to injure this area. If you are having pain coming from the facet joint it will be localized to that specific area in the back and may also impact the exiting nerve root causing leg symptoms. It is important you get proper diagnosis and treatment for this injury to resolve it and prevent future occurrences.

Back pain due to the intervertebral disc bulge or disc herniation

The interverbal disc is a commonly injured area of the spine that can lead to nerve compression and associated symptoms down the leg when it involves the discs of the low back. It is injured with compression and rotation which will occur with a bend and twist movement or can also occur with prolonged sitting in poor postures. Pain with a cough or sneeze is another common sign that a disc had been injured. There are different levels of severity with disc herniation’s ranging from a bulge, prolapse to a sequestered disc. The most common is a bulge but as the injury progresses it may become larger and advance towards a sequestered disc lesion. It is important to seek treatment from a trusted physiotherapist or chiropractor right away to prevent any further damage and promote resolution of symptoms.

Back pain due to degenerative disc disease or Spondylolysis

Degenerative changes in the disc will occur across a lifetime. By middle age, the majority of the population will see some degree of degenerative change in their spine with imaging. It is a normal part of the aging process like the wrinkles that develop on the outside. However, a history of back trauma or pain will likely cause more symptomatic and earlier onset of degenerative changes. As we age, the disc becomes less fluid and when there is excess pressure pushes on it, it can start to wear down more easily. When the disc wears down, sometimes an inflammatory process ensues which can cause pressure around the nerve and ultimately cause symptoms down the leg. Often, individuals with symptomatic degenerative disc issues complain of stiffness and decreased load tolerance which results in regular flare ups. The good news is that many people that have radiographic evidence of degenerative changes do not have any symptoms and lead normal, active lives. The best part is that conservative management with physiotherapy or chiropractic can be very helpful at managing symptoms when and if they do exist.

Back pain due to Stenosis

Stenosis means narrowing of a pathway. The back has exit pathways for the nerves leaving our spinal cord travelling down to innervate our lower limbs. Depending on the extent of the abnormal narrowing of these passageways “stenosis” can result in compression around the exiting nerve and may result nerve like (sciatic like) symptoms. This narrowing is also part of the normal aging process but a previous injury or dysfunction will result in stenosis occurring earlier and with further severity. Physiotherapy and chiropractic interventions can be helpful at targeting the pain and improving function with this condition.

Back pain due to Spondylolisthesis

This injury occurs when one boney vertebra slips forward on the adjacent vertebra. It can happen in the lower back with a traumatic injury or in the case of repetitive strain (typically related to repeated extensions or over-arching). When this injury occurs, the ligaments become stretched/strained and a certain aspect of the vertebrae breaks down. This results in a forward slippage and ultimately the bony integrity of the spine bone can no longer maintain normal alignment. There are different types and varying severity of slippage. Thankfully, physiotherapy and chiropractic treatments can serve as an excellent conservative approach to treatment in most cases.

Back pain due to Scoliosis

Scoliosis is an abnormal veering of the spine in a sideways/rotational direction. There are different types of scoliosis, you can be born with scoliosis, develop it after an injury or develop it gradually over time due to postural habits. Our spines can accommodate for some mild angle changes but when they become significant this can change the biomechanics of the spine which can ultimately lead to discomfort. It is important that you seek advice from a health care professional on how to treat your specific case. Your trusted physiotherapist or chiropractor will guide you on an individualized prescriptive exercise program and healthy spine practices.

Back pain with Sciatica/Radiculopathy

Irritation of the sciatic nerve creates pain that can be sharp, burning, shooting or tingling down the side and back of the leg. The sciatic nerve is large nerve that exits at the lower back and travels through the buttock and along the back of the leg. It can be compressed or irritated by several structures which can include: disc herniation/degenerative disc disease,  spinal stenosis,  spondylolisthesis, tight piriformis muscle, adhesions in the hamstring muscle and fascia. A radiculopathy is another common issue and describes the situation when there is compression to a nerve root that is exiting the spine and causing pain, numbness, weakness or tingling along the course of that nerve. In both of these conditions, pain is likely to persist in the lower extremity but it is important to remember that the pain itself is originating in the low back and treatment must be directed there.

How can Physiotherapy, Chiropractic,  and Massage Therapy help your Back Pain?

A team of healthcare professionals can personalize your treatments to address your specific injury and help you return to your personal lifestyle goals. Each member of the team has its role. Treatments with a Physiotherapist and/or Chiropractor can include controlling pain with therapeutic modalities, shockwave therapy, acupuncture or dry needling. They will also help you regain full mobility of the joints by incorporating hands on manual therapy. Exercise therapy will also be a part of your care and individualized therapeutic exercises focused at improving mobility, strength and motor control will be taught as needed. Soft tissue release is also an important aspect of care and you may also require adjunct massage therapy treatment to address any soft tissue adhesions that exist. Education in regards to lifestyle modification, pacing, fear avoidance and other topics will also be addressed as required. Referral to a Physician will be made for further investigation and analysis if your treatment is not progressing as expected.

How Long Does it Take to Recover from Back pain?

The answer to this question is not simple as there are many factors to consider. In general recovery can take a few weeks up to a few months. In most cases back pain can resolve or be managed to appropriate levels so it does not impact your day to day life. In the severe cases a referral to orthopedic specialists who may choose to perform nerve blocks or surgery can be indicated. Only a small amount of chronic back patients require surgery and it should be considered only after conservative management measures fail. In any case, mild to severe, it is important to understand what is happening and to seek guidance and treatment from a qualified health practitioner as soon as possible. Remember to be patient and consistent with your home exercise program. Keep in mind that your trusted physiotherapist or chiropractor sees these types of conditions regularly and will be the best person to advise you on the best course of treatment. They will inform you if your symptoms are not progressing as expected and if you should book a consultation with a physician for further investigations or explore alternate treatment options.

What are the Best Exercises to Help with your Back Pain?

A well-rounded program should address breathing deficits, core strength, back mobility, hip mobility and graduated progressions. These exercises should be individualized to your particular needs and goals.

Some of the most common exercises are mention below, to help you get started. These exercises should be performed in a pain free range and modified or stopped if pain increases during or after their performance. For motor coordination please preform them paying close attention, in a slow and controlled fashion and about 3 sets of 10 reps.

Dead Bug or Bird Dog

Direction Biased Exercises

For relief you will choose to stretch in the opposite direction pain is created.

Pain increased with bending forward or prolonged sitting -then Lumbar extension is most likely to provide relief.

Baby Cobra – For this exercise lie down on the floor on your stomach and using your arm strength lift your shoulders and upper body off the ground while keeping your low back relaxed. Hold 10 sec repeat 5-10x as long as it is pain free.

If pain is increased with prolonged standing or arching backwards then Lumbar flexion is most likely to provide relief.

Knees To Chest- For this exercise lie down on the floor on your back and pull both knees into your chest using your arms to lift and hold them. Hold 30sec 2-3x

Figure 4 Hip Stretch

Lying on your back with your knees bent and your feet flat. Take the leg of the hip to be stretched and place the ankle on the lower thigh of the bent knee and turn your knee out so that your legs position now looks like the number 4. Grab behind the knee of leg that is on the ground and pull it up towards your chest. You will feel a stretching sensation deep in the buttocks of the crossed leg. Hold 30sec and Repeat 2-3x.

How to Treat Back Pain on Your Own?

  • If you have acute onset pain in your back you may first want to try ice over the area. If the pain has more of a gradual onset or has been lingering for some time then heat might be the better choice. You may also choose to apply both intermittently depending on how they make your symptoms feels. Ice or heat should be applied for 10min and then a 10 min break. You can repeat 3-4x.
  • You should also try to figure out the positions and activities that can aggravate your back pain. Pay close attention to the positions that make you feel worse such as sitting or walking/standing for prolonged periods. Try to modify these positions or avoid them for a temporary time until you can gradually reintroduce them as you get stronger with your exercise regime.
  • If you sit for prolonged periods a lumbar support roll can help with your sitting posture and take stress off your spine. Most office chairs although advertised as ergonomic are not build for our individual needs and this added support can make a big difference to how you feel. If you have further questions about your desk set up contact us to make use of our ergonomic program where an expert in the field can ensure proper desk set up and equipment.
  • Start basic core exercises and gentle low back and hip range of motion exercises as early as possible.
  • If the pain continues and does not respond to the aforementioned strategies, then over the counter pain or anti-inflammatory medication might be indicated, talk to your pharmacist or family doctor to help direct you.

If your back pain continues an assessment and treatment from a trusted and knowledgeable Physiotherapist or Chiropractor is highly recommended. Contact us today !

Mechanical Back Pain

What is Mechanical Back Pain?

Mechanical back pain occurs when a structure in the back, like an inter vertebral disc, joint or a bone, is stressed or deformed in a way to cause pain. When a load is applied to a structure past a certain threshold, the tissue becomes irritated and increases pain. If the load is removed the pain will decrease.

Mechanical back pain can be localized to a small area on the spine or it can spread more to either one or both sides of the back. If a nerve root is also affected, the pain may radiate away from the back and down the leg, and even sometimes to the foot, along the path of the affected nerve.

How do I get Mechanical Back Pain?

Mechanical back pain can occur from a trauma to the tissue, such as a fall or a car accident, or it can come on slowly over time with no obvious cause. Repetitive spinal movements, exercising incorrectly, and poor sitting habits are some examples that can lead to the development of mechanical back pain over time.

How can Physiotherapy, Chiropractic, and/or Massage Therapy Help?

Physiotherapy and/or chiropractic can help to determine the root cause of the pain, and create a treatment plan to offload the injured tissue of the spine allowing for healing to occur. The treatment plan for back pain may include shockwave therapy, manual (hands-on) therapy, exercise therapy, and education about how to protect your back. Massage therapy can decrease pain stemming from tight muscles, improve blood flow, and can have a positive effect on the nervous system. A well-rounded treatment plan that uses a multidisciplinary approach can lead to more successful outcomes for individuals with back pain.

What can I do when I’m in Pain?

Improving your posture to reduce stress on the back is key to reducing mechanical back pain during a flare up. The following strategies can help manage pain:

  • Sleep on your side with a pillow between the knees and/or on your back with a pillow underneath the knees
  • Use a lumbar support roll on your chair when sitting to decrease pressure on the spine
  • Take a standing break for every 15 minutes of continued sitting
  • Temporarily avoid situations in which repetitive bending, twisting or lifting is involved until you have strengthened your back.

What are Safe Home Exercises to do if the Pain is in Low Back?

Double Knee to Chest Stretch

Lie on your back and slowly bring one knee up to your chest and then the second knee. Hug the knees to your chest to feel a gentle stretch in your buttocks and low back. Hold for 5 seconds, repeat 10 times, 2-3x/day

Figure 4 Stretch

Lie on your back and cross one leg over the other knee. Pull the knee of the leg that is down towards the chest to feel a stretch in the opposite buttock. Hold for 20 seconds, repeat 2-3x/leg, 1-2x/day.

Cat/Cow Spinal Mobility

On all fours with your wrists under your shoulders and knees under your hips, arch your spine up to the ceiling, like a “cat”. Hold for 2-3 seconds, and then sink your spine down in the opposite direction for 2-3 seconds, like a “cow”. Only go as far up or down as you are able to with no pain. Repeat 10 times, 2-3x/day

Bird Dog

On all fours, extend your opposite arm and leg up and out without allowing your spine to move. Hold the arm and leg in the air for 5 seconds and slowly return to your starting position. Repeat the same with the other arm and opposite leg. 5-10 repetitions per side, 2 sets, 1-2x/day. You should feel this exercise in your core and abdominals as they work hard to stabilize you during and in/out of the movement.

How Long Does it Take to Recover from Mechanical Back Pain?

The earlier you seek professional care and consistency with your prescribed rehabilitation program the more likely you are to have a smooth recovery. There are many variables that will influence the length of time you are in pain, it can take anywhere from 4 weeks to 6 months. In the rare case your mechanical back pain has not improved as expected your Physiotherapist or Chiropractor will refer you on for a more specialized consultation with physician. Contact us today!

Degenerative Disc Disease (DDD)

Degenerative Disc Disease unlike the name suggests, it’s not a disease as much as it is a natural occurrence that happens with aging, and the pain symptoms that are present with DDD typically don’t progress or worsen. While the symptoms don’t progress, the discs in the spine (called intervertebral discs or IVD), that show signs of wear and tear can continue to degrade. When DDD is present, the spaces between the IVD decrease (referred to as spinal stenosis), and can affect the surrounding soft tissue, presenting as signs of pain in the low back or neck. Additional symptoms that can arise are traveling pain down the arms or legs (referred to as radiculopathies), intense muscle spasms through the neck or low back, and/or a feeling of instability when going through simple motions like bending forward to tie your shoe. The presentation of these symptoms can make simple activities difficult, but it definitely doesn’t have to be that way for long.

Physiotherapy, Chiropractic and Massage Therapy Treatment for Degenerative Disc Disease

Physiotherapy and chiropractic can help to determine the root cause of the pain, and create a treatment plan to offload the injured tissue of the spine allowing for healing to occur. The treatment plan for DDD may include shockwave therapy, manual (hands-on) therapy, exercise therapy, and education about how to protect your back. 

From a Massage Therapy perspective, a fundamental approach in treating chronic DDD is to find the balance between decreasing muscle tension and creating traction or decompressing the targeted vertebral segments. Finding the balance or a “green zone” of treatment is important since the spasms that are occurring through the neck or low back are happening because the body is trying to protect the area. Therefore, slow, repetitive, methodical approach between soft tissue and joint mobilization (or spinal decompression), techniques can help offer up pain relief and help the patient move easier in order to execute strengthening exercises efficiently.

A well-rounded treatment plan that uses a multidisciplinary approach can lead to more successful outcomes for individuals with back pain.

Exercises for Degenerative Disc Disease?

Since a layer of symptoms can accompany DDD, it’s always best to consult one of our Physiotherapists or Chiropractors who can provide an assessment and diagnosis of your condition and assign a comprehensive physical rehabilitation and therapy treatment plan for you. That being said, the exercises below tend to be suitable for most cases of DDD, and rebuild initial strength to progress from.

  • Upper Cervical Spine Chin Tucks
  • Mid-Cervical Spine Chin Tucks
  • Lower Cervical Spine Chin Tucks
  • Posterior Pelvic Tilt For Lumbar Spine

To get relief from a back pain today, book an assessment with our physiotherapist or chiropractor. Contact us today!

Lumbar Disc Bulges

What is a Disk Bulge?

A bulging disc, also sometimes referred to as a slipped disc or protruding disc, is an injury to your intervertebral disc, a complex cartilage structure between the bony segments of your spine. A disc bulge occurs when trauma or repetitive stress causes the soft more fluid inner portion of the disc to press against the strong outer layer containing it. If the force is high or applied long enough it will create a bulge. A disc bulge is more common in the lower back (Lumbar Spine), but can occur anywhere in the spine, including your neck (cervical). If the disk bugle is progresses and the outer layer of the disc starts to rupture it is referred to as a herniated disc.

What does a Lumbar Disc do?

Lumbar intervertebral discs serve many purposes. One being, they are shock absorbers that sit in between the bones that make up the lower part of your spine. Discs have a unique architecture that evenly distribute pressure to absorb the impact of the body’s movement and daily stresses, while at the same time allows the spine to have mobility. The disc is made of a tough outer layer called the annulus fibrosus and a gel like middle called the nucleus pulposus. A helpful analogy is to think of the discs as miniature jelly doughnut, with the dough being the annulus fibrosus, and the jelly inner being the nucleus pulposus. The annulus fibrosus is innervated which means that there are nerve endings that can sense pain while the nucleus is not. Adjacent to the disc are spinal nerve roots that exit the spinal canal in between the vertebrae/disc and spinal joints and form the nerves that travel down to innervate the legs. Sometimes, if the disc bulges or herniates, it can compress a nerve root which is why disc injury symptoms can be felt in the lower body.

How do Discs Bulge?

Trauma or repetitive stress can start to push the jelly towards the back and sides of the disc and the dough starts to weaken. Prolonged sitting, lifting, twisting and bending and any combination are common stresses that will wear down the Annulus. Eventually, even a simple activity such as picking up a pen can cause the jelly to bulge out into the weakened dough. Since the outer dough is innervated pain can start to be felt. Pain can also be brought on by the chemical reaction that occurs when the jelly material comes in contact with the outside environment. The nerve root can be irritated or compressed by inflammation that develops as a result of the bulging disc.

What is the Difference Between a Disc Bulge and a Herniation?

Discs can be often be described as protruding, bulging, prolapsed, sequestered or herniated which can be confusing to patients. Generally, when the jelly has been moved into the outer dough but it still contained within the dough it is called a bulge while if the jelly has broken through the dough into the surrounding area it is called a herniation.

What are Possible Symptoms of a Disc Bulge?

  • Acute sharp pain in the low back that can travel down into the hip, leg, even into the foot.
  • Pain typically is on one side but can be variable with the pain location.
  • Pain with prolonged sitting
  • Difficulty Bending forward
  • Burning, Numbness, pins and needles, and/or weakness into the leg or foot
  • Standing shifted to one side or inability to fully straighten spine
  • Pain with a cough or sneeze

It is important to note that disc bulges are quite common and will often not cause any pain. Studies demonstrate that a large number of healthy young adults without any back pain have one or more bulging discs visible on MRI.

It is also important to note that if you are experiencing severe symptoms in both legs, changes in going to the bathroom or numbness around your anus, seeking urgent medical assessment right away could prevent long term injury.

Who Gets Disc Bulge?

A disc bulge can happen to anyone but they are more common in people who weight lift, prolonged poor sitting posture or who have physical labor jobs with repetitive motion.

How Can I Prevent a Lumbar Disc Bulge?

  • Posture: Sitting in a slouched position puts pressure on the front part of the doughnut pushing the jelly towards the back. Sit with a lumbar roll or lumbar support to ensure your low back maintains a natural arch while sitting and your pelvis does not roll back.
  • Keep Moving: Our bodies are designed to move. Studies show that on average people maximally flex (bend forward) 50 times a day and maximally extend (arch backwards) an average of 0 times a day. So, make sure that you keep moving in all directions. If you are sitting for a while stand up, take a walk, stretch out.
  • Core Strength: A strong core helps support the low back. Incorporate a core strengthening program into your exercise or workout routine.
  • If you enjoy weight lifting (especially exercises like squats or deadlifts) it is very important that you use proper form, if you can’t use proper form with the weight you are lifting you greatly increase your risk of injury

Physiotherapist, Chiropractic and Massage Treatment of the Disc Bulge

If you suspect you have a disc bulge it is very important to see a physiotherapist, chiropractor or sports medicine doctor right away to get professionally diagnosed. Often through a clinical assessment your physiotherapist can find one simple specific exercise that can help push the ‘jelly’ back towards the middle of the disc. If you follow the exercise regimen and avoid activities that push the jelly towards the outside of the disc, pain can resolve quickly.

Once you are no longer in acute pain your therapist will teach you what exercises and lifestyle changes can be done to help prevent re-injury in the future. The most common predictor of back pain is previous incidents of back pain so it’s important to continue to practice what you have learned from your physiotherapist, chiropractor or sports medicine doctor.

Your physiotherapist may also work with a Massage therapist to help with the recovery and prevention of disc bulge. Pilates can be used to help improve your core strength, form, and posture while exercising or performing daily activities, and massage can help relax tight muscles that are aggravating your disc bulge.

Best Exercises to Help with a Lumbar Disc Bulge

The best exercises to treat a disc bulge will depend on the location and severity of the bulge. You should see a physiotherapist and/or chiropractor so they can prescribe exercises based on your specific disc bulge injury.

Lower back (lumbar spine) disc bulge exercises can include:

1. Repeated Extension in Lying – a Mackenzie based exercise.

Lying on your stomach, arch your back (extension) by pushing up through your hands. While doing this keep your back relaxed and belly hanging towards the ground with gravity, achieve this with using just your arm strength. Only go as high as you need for pain relief.

HOLD 5 seconds, repeat 10 times, up to 5x/day depending on symptom severity.

Warning: DO NOT do this exercise if you are shifted or the pain that increases into the legs.

2. Bird-dog (Transverse Abdominis “Core” strengthening).

Position your body in 4-point kneeling by placing hands under shoulder and knees under hips. Set your spine to neutral by maintaining a normal lower back curve and also ensure your rib cage is higher than your shoulders by pushing the floor away. Draw tension around your core. Without moving your spine draw the opposite arm and leg off the ground, keep the weight even between your 2-points of contact (the other hand and leg).

HOLD 5 seconds, repeat 10x per side, up to 3x/day.

Warning: This is a more advanced exercise and should be done at a later stage of healing.

What Should be Avoided with a Disc Bulge

If suspect you have a disc bulge you should avoid the following activities.

  • Lifting
  • Twisting
  • Bending forward
  • Prolonged sitting

Again, it is important to be diagnosed by a heath care profession such as a physiotherapist and/or chiropractor in order to get information specific to your disc bulge injury.

How can I Treat my Lumbar Disc Bulge at Home?

If you have acute pain in your spine that you suspect may be a disk bulge you can try doing the following:

  • Rest in a comfortable position, lying on stomach, flat on your back or on the side with a couple of pillow between your knees, and apply ice and/or heat intermittently 10 min on/off.
  • Avoid any movement or position that makes the pain or leg symptoms worse. BUT do remain active with intermittent walking.
  • Try some gentle breathing and abdominal tightening exercises

How Long Does It Take to Recover from Disc Bulge?

Recovery time will vary for every individual injury. If this is a reoccurrence, do not expect the pain to resolve as quickly as the first time.

Best case scenario, recovery will take 6-8 weeks until you are back to your pre-injury lifestyle. This is if you are able to get control of your symptoms in the first few days by modifying your lifestyle, as well as seek medical care from your trusted physiotherapist and/or chiropractor.

In more complex cases, it may take a 3-6 month to get back to your lifestyle and in the most severe cases you may have to modify your lifestyle long term and possibly require surgical intervention.

A disc bulge is a serious injury and if symptoms do not improve you should seek professional help from a physiotherapist and/or chiropractor, who can give you a comprehensive treatment plan with exercises you can do at home. It is important that you follow the prescribed exercise routine as well as avoid doing activities that will make your disc bulge worse.

Lying on your back with your knees bent and your feet flat. Take the leg of the hip to be stretched and place the ankle on the lower thigh of the bent knee and turn your knee out so that your legs position now looks like the number 4. Grab behind the knee of leg that is on the ground and pull it up towards your chest. You will feel a stretching sensation deep in the buttocks of the crossed leg. Hold 30sec and Repeat 2-3x.

Herniated Discs

A herniated disc also referred to as a slipped disc or bulging disc is most common in younger and middle-aged populations. In most cases, this painful condition can be managed successfully with chiropractic and/or physiotherapy care.

What is a Herniated Disc?

The intervertebral discs are found in between the vertebral bones (aka back bones). The discs function to assist in spinal flexibility, shock absorption and offer a pathway for nutrients into the bones. They play a significant role in absorption of forces and movements that are transmitted through the spine. The space that is formed by the intervertebral disc creates a space between the back bones so that the spinal nerve can exit the spinal cord to travel into the body and into the limbs.

Movement such as forward bending, causes the disc to be compressed along the front end which can cause the weaker more vulnerable outer and back portion (of the annulus) to be stretched out allowing the internal jelly part of the disc (the nucleus) to protrude outwards. To understand this better, just imagine a jelly doughnut. When the disc is pinched at the front, similar to a jelly doughnut being pressed in the front, the jelly gets squeezed out the back.

If you irritate the disc enough and cause pressure that pushes the disc contents backwards then the inner part of the disc called the nucleus gets squeezed further and further backwards. The pressure from the nucleus breaks the many protective layers of the annulus and weakens the integrity of the disc.

Portions of the disc have limited or poor innervation and this means that you can sometimes not feel any pain as this process is developing but then all of a sudden, your back can spasm and you can be left in severe, unrelenting pain. Also, if the nerves are compressed by the protruding disc, you may experience discomfort radiating down your leg.

What Causes a Herniated Disc?

It is common and natural that the discs will suffer from normal wear and tear with aging during daily movements and activities that we participate in. Bending forward, such as putting on your socks or shoes, reaching down, lifting heavy objects and twisting to place them on a shelf can contribute to the stress on the discs and wear them down.

If your back is strong enough, you will not even notice these changes and it should not contribute to any pain or disability. However, if your core is deconditioned and/or you do not have smooth movement through the joints above and below your back or you participate in tasks that require repetitive bending, lifting and twisting (including sit-ups) then you can be putting your discs at increased risk of herniation/injury.

What Should You Avoid with a Herniated Disc?

  • Sit-ups- Avoid these at all costs when your disc is injured. It is a common misconception that doing sit ups is what our core needs to get stronger. There are many other core exercises that will help your back when your discs are flared up. Unfortunately, sit ups increase the pressure on the discs and lead to further disc protrusion.
  • Forward bending and prolonged sitting will also cause increased pressure on the posterior part of the disc and worsen a pre-existing disc injury.
  • Lifting heavy objects combined with a twist is one of the most demanding stresses you can place on a disc.

What Exercises Can You Do for a Herniated Disc?

Baby Cobra-McKenzie Based Exercises

Lying on your stomach, keeping your arms close to your body and elbows tucked in. Push through your hands and allow your upper body to lift off the floor while lengthening the front of your body. Hold for a 5 seconds and repeat 10 times every hour.

Core Strengthening

One of the things you can do for a sore back is to strengthen your trunk and all layers of your core muscles so that they are able to support your low back and prevent excessive strain through the discs. So how do you strengthen your core without sit-ups?

There are many different options and of course the best exercise for you can be determined by a health professional such as a chiropractor or physiotherapist who will conduct a thorough assessment of your muscle balance. However, you can try these three simple exercises to keep your back strong and healthy:

  • Bird Dog
  • Bridge
  • Forward Plank – Facing the ground with your hands directly under your shoulders, step back to stretch your legs out long behind you. Create a strong line (plank) with your body from your ankle to the top of your head while keeping the natural curves of your spine. You will need to engage your core (tighten your stomach muscles) to keep your buttocks below shoulder height without over-arching your back. Hold 30 seconds and repeat 3x
  • Side Plank – During this exercise you will try to form a strong line from head to toe with your body while on facing the side. One hand/arm will stabilize from under your shoulder while you balance on the outside edge of your feet. Hold 30 seconds and repeat 3x

Be sure you are doing these exercises correctly and your spine is staying in a neutral position as you hold and move through this exercise. You should not experience any pain, strain or discomfort while you are doing these exercises.

Chiropractic and or Physiotherapy Care for a Herniated disc.

It is always best to get assessed by a health professional so that they can guide you through an individualized exercise sequence. Your trusted health professional will be able to point out your compensation strategies and can guide you on how to preform each exercise correctly so that you get the most out of it. Your physiotherapist or chiropractor will also provide you with hands on treatment to release stiff muscles and joints. They will also offer therapeutic modalities, acupuncture and provide education so that you understand your condition and how to best care for yourself while you recover.

You may also need soft tissue release and mobilization from a Registered Massage Therapist to compliment your treatment and relieve pain and tension.

How Long Does it Take to Recover from a Herniated Disc?

Recovering from an acute injury may take 6-8 weeks, with the right balance of rest and activity as well as rehabilitation exercises. You will most likely see quicker results with professionally guided treatment.

In re-occurring or long-term back conditions, it can take much longer to respond to treatment. These cases can take a few months to resolve and you may need to put long term self-management strategies in place to prevent recurrences.

Contact us today if you are suffering from a disc herniation injury and would like to book an appointment with one of our experienced chiropractors or physiotherapists.


Spondylolisthesis refers to the forward slippage of one vertebra on another due to an injury of the boney structures that keep the vertebra aligned one on top of the other. The bony structure becomes compromised due to repetitive forces or sudden forces occurring at that segment or due to a genetic or congenital defect. This weak link of the spinal vertebra typically occurs around a thin bony bridge on the back portion of the spine bone called the Pars Interarticularis.

Once this structure is damaged, the spinal bone affected can start to slip forward because the boney integrity is decreased. This change can lead to increased strain on the disc and ligaments which are taking on additional forces to resist the slippage. Over time, pressure on these structures can cause even further damage to the area and lead to increased slippage of the vertebrae which may result in pain and disability. Conservative management can significantly help to optimize function in these individuals and prevent pain, disability and support a healthy, active lifestyle. It is important to seek the care of a qualified physiotherapist or chiropractor who can educate you and provide treatments to alleviate pain and strengthen the supporting musculature in the region.

What are the Different Types of Spondylolisthesis?

Terminology regarding this condition can get confusing and the words used to describe this condition can seem like tongue twisters. There are two important definitions that you should understand. The difference lies in the severity of the condition and whether or not the vertebra has slipped forward:

  • Pre-Spondylosis: This is an asymptomatic stage where some degenerative changes have begun but not enough to stimulate the pain receptors
  • Spondylolysis: This is a fracture of the Pars Interarticularis which ultimately results in the degenerative narrowing of the canal where the nerve root exits the spine
  • Spondylolisthesis: This is a break of the Pars Interarticularis with the forward slipping of the vertebra

There are a few different types of Spondylolythesis each describing a different underlying cause for the condition.

  • Congenital Spondylolisthesis: This refers to abnormalities in the bony structure since birth.
  • Spondylolytic Spondylolosthesis: In this case, a fracture of the pars interarticularis is due to repetitive strain on the segment. This typically occurs in younger age groups and can manifest in a variety of ways from no symptoms at all to very debilitating symptoms. This condition is quite common in gymnast’s due to the repetitive leaning back motions required in this sport.
  • Degenerative Spondylolisthesis: This type is most common over the age of 50 and occurs due to degenerative changes and marked osteoarthritis that occurs in the joints of the spine with wear and tear.
  • Traumatic Spondylolisthesis: This type is rare but can occur with high impact injuries to the spine especially those causing overextension.
  • Pathological Spondylolisthesis: This type of spondylolisthesis is due to bone diseases or cancers that weaken the bone.

Symptoms and Diagnosis of Spondylolisthesis

A person who has spondylolisthesis will commonly present with achy central low back pain. Sometimes this condition can lead to squeezing or pinching of the nerve roots and if that is the case, the symptoms can also include pain or numbness into the legs. The pain will have some unique characteristics such as, it increases with standing, walking or any movement that extends the back. Pain may improve with bending forward or hugging knees to chest. X-ray’s and MRI can be used to confirm the diagnosis of Spondylolisthesis as well as identify the exact location and severity of the injury.

Physiotherapy and Chiropractic Treatment of Spondylolisthesis

If you suspect you have Spondylolisthesis you should seek professional diagnosis from a physiotherapist and/or chiropractor.  Once your Spondylolisthesis has been properly assessed, your physiotherapist or chiropractor will use a combination of soft tissue mobilization, shockwave therapy, modalities and hands-on treatment to optimize your function and decrease your pain. Your physiotherapist, chiropractor or sports medicine will also educate you on specific positions to avoid and positions that will help to relieve your pain. Learning about your postural habits and how to correct your posture will also be an important aspect of your treatment. Most importantly, the physios or chiros you work with will develop an individualized core strengthening program for you so that your muscles can support your spine in a better alignment.

How can I Treat Spondylolisthesis at Home?

In a very acute stage, you can try a lower back support brace for a very limited amount of time (2-3days). This will help to settle the inflammation and should not be worn 24/7 but when you are going to be walking and or required to engage in light lifting. It should be supplemented with gentle core engagement, anti-inflammatory medication, ice and rest.

In later stages, training your core muscles and learning how to engage them properly during functional movement is the most important strategy. You also might want to incorporate a daily stretching regime focused on your lower back, pelvis and hip mobility.

Best Exercises to Help with Spondylolisthesis

Your physiotherapist or chiropractor will educate you on what the core is and how to target these muscles properly. The core muscles create a natural corset for your spine and help to stabilize it so that there is increased support around the area of injury.

Below are some gentle stretching and strengthening exercises that may be helpful to start at home as long as you can manage to do them without worsening pain.

Knees to Chest

Lying relaxed on your back, pull both knees up into your chest. Hold 30sec repeat 3x

Bird Dog core exercise

Perform this exercise in 4-point kneeling with your hands directly under your shoulders and knees under hips. Make sure your core is firing by keeping the natural curves of your spine and drawing your belly button up and in. From there extend your opposite arm and leg away from you. Be sure to breath. Hold 5 seconds, do 10 reps

Hip stretching

Stretch your piriformis muscle with the figure 4 stretch and also hip flexor in standing. Make sure you are not arching into your back, you do not want to put additional stress on the injured area.

What Should be Avoided if I have Spondylolisthesis

  • Arching your back backwards, or any sport, posture or activity that promotes this ie. Cobra in yoga.
  • Heavy lifting, especially combined with rotation
  • Prolonged standing or walking maybe painful, try to understand your tolerance and rest before pain increases

How Long Does it take to Recover from Spondylolisthesis?

Depending on the type, stage and severity of your condition, your recovery time will vary.

Best case scenario, with some education, exercise and lifestyle modifications you will be feeling better in 4 to 6 weeks after starting treatment.

In a more severe case where there is a fracture and slippage your recovery may take longer (3 to 6 months) and your response will vary based on how well your body can adapt to changes and whether or not you are able to make the required lifestyle changes.

Core strengthening can take 6-8 weeks before you see the effects so stay committed to your exercise program and be patient. You will see results but they will take some time and regular practice.

If you are looking for a trusted physiotherapist in North of Edmonton be sure to contact us today, so we can help show you the path to recovery.

Spinal Stenosis

Does walking increase the pain in your back and down your leg?

Does your leg pain feel better when you lean forward or sit down?

If you answered YES to the questions above you could have spinal stenosis.

What is Spinal Stenosis?

Spinal stenosis occurs as a result of the normal wear and tear and degeneration that occurs in the spine with age. The key word here is NORMAL. This process is part of the natural process of aging. Spinal stenosis specifically refers to the narrowing of the canals formed by the spinal vertebra making the tunnels that the nerves travel through much narrower. These types of degenerative changes typically develop gradually over a prolonged period of time and if our body is functioning optimally, we can easily adapt to the changes and we remain symptom free. In some circumstances, when there is an overload of tissue strain, a significant change in lifestyle or if there has been injury to the back, the tissues may not adapt quick enough and the result is that you feel pain and stiffness. Sometimes this change and degenerative process can put pressure on the nerves that exit your spine and this can create pain, numbness or tightness that travels down your leg. Rest assured that our bodies are remarkable and you will adapt! Some tough cases will require individualized treatment from a qualified and experienced physiotherapist or chiropractor to get you back on track.

What Causes Spinal Stenosis in the Lower Back?

Lower back spinal stenosis is ultimately caused by wear and tear and can be influenced by your genetics as well as any previous injuries or recurrent strain that you have placed on your low back. This means that the process of wear and tear is unavoidable but your genetics and the strain that you put on your back can either speed up or slow down this process.

To simplify this even further, if you put a lot of pressure on your spine doing heavy work like bending, twisting and lifting like in a manual labour intensive job you will speed up the degenerative process. The terms spinal stenosis, wear and tear joint degeneration or osteoarthritis in the spine can all be used to refer to this condition and are often used interchangeably.

Below is a list of the degenerative changes that can be related to Spinal Stenosis:

Disc Bulge or Disc Herniation

Disc Bulges and Disc Herniations are degenerative changes that could be related to Spinal Stenosis. There is a disc in between each spinal bone and its fluid centre helps to absorb shock through the spine. If too much pressure is put through the spine, the discs can bulge and even herniate. Over time the chronic inflammation of the discs can lead to narrowing and sclerosis, boney growths around the disc. This can lead to pressure or rubbing against the nerve roots exiting the spine and pain down the leg.

Facet Joint Degeneration

The facet joints are the joints that connect two spinal vertebrae together. Every spinal vertebra is connected to the one above and below at the facet joints on the left and right side of the vertebrae. Over time, with increased compression, the facet joints start to wear down. The cartilage in the facet joints start to wear down and sometimes there are bone spurs that grow at the edges of these joints. This can cause pain in your low back and also can increase the pressure around the nerve roots causing pain in your legs.

Thickening of Ligamentum Flavum

The ligamentum flavum is a ligament that travels down the spinal canal from the neck to the low back. It helps to reinforce the tunnel where the spinal cord travel down and this thick ligament protects the spinal canal by limiting movement of the spinal bones. With age, the ligament gets thicker and can increase the pressure on the spinal canal and nerve roots. The ligament can get so thick that it narrows the passage way of the spinal cord and nerve roots. This can lead to increase pressure on the nerve roots as well and cause pain in one or both legs.

Spondylolisthesis of the Spinal Bones

Spondylolithesis happens when one spinal vertebrae slips forward on the spinal vertebrae below it. This can happen when you have a fall or a big injury but quite often it can occur as a result of the degeneration process we talked about before. The degeneration will cause enough wear and tear near the back of the vertebrae, like a rope rubbing over rocks, that eventually there will be too much pressure and the vertebrae will start to slip forward. When the vertebrae slips forward enough the tunnel for the spinal cord gets smaller and the tunnel for the nerve roots gets sheered and compressed. The nerve roots can have increased pressure on them and this can cause pain in the back and leg.

Chiropractic and Physiotherapy Treatment for Spinal Stenosis?

All of these degenerative changes can seem daunting. However, there is definitely hope! Visit a trusted chiropractor or physiotherapist who will help you develop an individualized treatment plan to get you on the road to recovery. Ultimately, your nerves and joints will get adapted to the wear and tear and become tough enough to endure these changes but having a strong core and good mobility through your hips and spine will decrease the pressure on your joints and reduce the tension through your nerves.

The best physiotherapists and chiropractors will incorporate some of the following treatment methods listed below:

  • Education about positions and activities to avoid
  • Core strengthening program
  • Manual therapies to increase hip and spine mobility
  • Soft tissue release such as Active Release Therapy
  • Acupuncture
  • IMS
  • Shockwave therapy can eliminate pain, speed up healing, and improves mobility quickly.

Treatment with your physiotherapist and chiropractor may be complimented with massage therapy for pain control, to relieve muscle tension, to improve joint mobility and provide relaxation through muscles that may be guarded or in spasm.

What are the Best Exercises to do for Spinal Stenosis?

When you are diagnosed or suspect you have spinal stenosis it is important that you take steps to strengthen your core muscles.

Below are three progressions, listed easiest to hardest. We always recommend working with an experienced physiotherapist or chiropractor who will choose the most suitable exercises for you.

Best Exercises to Help with Spondylolisthesis

Your physiotherapist or chiropractor will educate you on what the core is and how to target these muscles properly. The core muscles create a natural corset for your spine and help to stabilize it so that there is increased support around the area of injury.

Below are some gentle stretching and strengthening exercises that may be helpful to start at home as long as you can manage to do them without worsening pain.

Transverse Abdominis in crook

Lying on your back with your feet flat and your knees bent. Your spine should be resting in a relaxed position with its natural curves and good rib cage and pelvis placement. Engage a very gentle tension around your abdominals like a corset was just done up but do not hold your breath or brace. Hold your trunk and pelvis steady as you slide one leg at a time out and in along the floor.

Repeat 10x per leg 2-3x day

Dead bug

Lying on your back with your hand placed in the air directly over your shoulders and your knees placed directly over your hips with shins parallel to the floor (table top position). Maintain your trunk in a neutral positon and bring the opposite arm and leg away from the centre of your body, slowly and controlled. Do not let your pelvis rock or your rib cage raise off the ground. Switch and perform the same movement on the other side. If you notice excessive arching in your low back as you perform this maneuver, then try only moving one limb and if the arching continues, you will need to step back until you are strong enough. Remember do not brace or hold your breath.

Repeat 10x per side 2-3x day.


How can you Treat Spinal Stenosis at Home?

At home, you can take steps for improving your symptoms with a balance of rest and activities that do not exacerbate your symptoms.

You will want to start a gradual core strengthening program (see above). You will also want to ensure that your lifestyle activities are modified to reduce strain and load on your spine. This may involve changing your work space and sitting postures or modifying the way you lift and move.

Once your symptoms have settled and you are progressing well with core strength you will gradually re-introduce your pre-injury activities back into your routine and return to your normal lifestyle.

Everyone’s experience with Spinal Stenosis can be different and these are just some general suggestions. It is always recommended that you have a professional assess you and help guide you through an individualized treatment plan for best results.

How Long does it Take to Recover from Spinal Stenosis?

Resolution of symptoms can take 6 weeks to several months to resolve depending on the severity of symptoms and the patient’s lifestyle.

The sooner you seek treatment from a professional Chiropractor and/or Physiotherapist the more favorable the recovery timeline.

Contact us to book your appointment today!

Facet Joint Dysfunction

Facet joints are the articulations formed between two adjacent vertebrae (bones) in the spine. There are two facet joints between each vertebra, and they are responsible for segmental movement in the spine. The facet joint surfaces are lined with cartilage and are surrounded by a fibrous capsule, ligaments, muscles and exiting nerve roots.

What is Facet Joint Dysfunction?

Facet joint dysfunction arises when there is abnormal wear and tear of the joints, affecting the cartilage and fibrous capsule. This wear and tear can result in spinal pain and limited movement. The surrounding muscles may become tight and feel like they are in spasm.

What Causes Facet Joint Dysfunction?

Abnormal force absorption of the spinal structures results in this wear and tear. Facet joint dysfunction can occur because of degeneration, trauma, or repetitive strain.

Degeneration of the spine decreases vertebral disc (soft ligament-like structure between vertebrae) height and causes increase loading onto the facet joints. This will accelerate the degeneration of the cartilage on the facet joint surfaces, leading to osteoarthritis and pain.

Facet joint dysfunction can also occur from traumatic events such as quick twists or extension type movements (whiplash in car accidents). This causes forceful impaction of the facet joints, damaging the articular cartilage or fibrous capsule, which creates an acute inflammatory response.

Prolonged facet joint compression, occurring from poor sitting posture, or repetitive movements that constantly compress the facet joints, will over time wear down the cartilage of the facet joints and result in pain and dysfunction.

How can Physiotherapy, Chiropractic and Massage Therapy help with Facet Joint Dysfunction?

A Physiotherapist and or Chiropractor can diagnose a facet joint dysfunction and help to alleviate the pressure from the joint surfaces with manual therapy techniques. They will prescribe mobility exercises to regain spinal flexibility and strengthening exercises (specifically core) to limit the excessive strain placed on the joints.

A Registered Massage therapist can help decrease the tone and spasm of the surrounding muscles to decompress the joint. They may also recommend or communicate with your treating Physiotherapist or Chiropractor what areas to focus on strengthening.

What Should be Avoided with Facet Joint Dysfunction?

With facet joint dysfunction, end range extension and rotation of the spine should be avoided as these movements will increase compression of these joints.

How Long Does it Take to Recover from Facet Joint Pain/Dysfunction?

With proper treatment, an acute facet joint dysfunction can resolve within a few weeks. However, there can be underlying degeneration of the spine that can prolong the recovery. A good treatment plan will be more condensed at the start-up to two visits per week until the pain has been managed and continue weekly or every few weeks until your strength and spinal mobility has improved. Typically, you will need to be seen for 3-6 months and possibility some monthly-yearly check ins in more advanced cases.

What are Safe Home Exercises I can do for Facet Joint Dysfunction?

Safe home exercises that can be done for Facet Joint Dysfunction include:


Starting on all fours, round out back and tilt head down, stopping before pain. Then look up and arch backwards, stopping before pain.

Thread the needle

Start on all fours, turn body and raise arm to ceiling, stopping before pain. Then rotate to the opposite direction and thread your arm along the floor under the opposite arm, stopping before pain.


Start on your back with knees bent. Actively contract core muscles by drawing in your belly button, contract glutes, and raise hips to ceiling, stopping before pain.

Bird dog

Start on all fours, keep lower back in neutral and head and neck retracted. Raise arm and opposite leg, stop before pain. Repeat with the opposite arm and leg.

Facet joint dysfunction can be painful and impact your quality of life. Our professionals are Rebalance commonly treat this condition and have great success in getting patients back to their goals and lifestyle. If you think you are experiencing Facet Joint pain, then contact us to book an initial assessment with one of our highly trained Physiotherapists, Chiropractors or Registered Massage Therapists.

To get relief from a facet joint dysfunction pain, book an assessment with our physiotherapist or chiropractor. Contact us today!