Back Pain

What causes back pain?

There are many reasons for back pain. Common reasons include:

  • Lifting or lowering heavy weight
  • Bending, twisting and lifting
  • Awkward postures and movements
  • Poor spinal alignment
  • Weak core muscles
  • Poor flexibility

The parts that usually hurt are muscles, nerves, joints, or discs found in the back. Mechanical back pain is common and this could be from a strain, sprain, tear, pinch or herniation.

What are some Physical Therapy treatments for back pain?

How can My PT relieve my back pain?

We provide education about the diagnosis we believe you have. Below is a list of back conditions we see most often. To learn more about each, just scroll further down the page.

  • Mechanical Back Pain
  • Degenerative Joint and Disc Disease
  • Spinal Stenosis
  • Muscle Spasms
  • Trigger Points
  • Herniated Discs
  • Sciatica

Next, we teach ways to prevent back pain from getting worse. In contrast to “keeping the back straight”, we teach neutral spine awareness. This can drastically reduce back pain once discovered. Clients are also taught how to activate the core muscles so it will be easier to hold correct posture.

The third part of our system is to treatment. All treatment is specific to the person and stage of healing. Clients will receive some combination of care that reduces pain, corrects a muscle or joint imbalance, and improves on a physical function. Personalized home exercises are provided carry over gains made from each session. Daily back exercises have been found to be a helpful method for individuals to control back pain.

The back revealed.

A Much Closer Look At The Back

As mentioned above, the back contains a many parts that could cause pain if damaged such as:

  • 33 vertebrae
  • 23 discs
  • 3 layers of muscles
  • Fascia
  • Spinal cord
  • Nerve roots exiting on the left and right sides
  • Ligaments holding the bones together
  • Small blood vessels

All of these parts have receptors that can detect pain and usually indicates there is a problem. Internal damage triggers the first phase of healing which involves inflammation and swelling. Because the fluid from the swelling takes up some of the space inside the back it may create a sensation of stiffness or pain during movement.

Where can you feel back pain?

Pain can be felt in any of the four spinal regions such as the cervical (neck), thoracic (middle back), lumbar (lower back), and sacral (tailbone). It could be felt on the left side, the right side or the middle. And some times it travels to a remote location that could keep you guessing its starting point.

Mechanical Back Pain

Active support and stability of the spine comes from muscles. Since the spine absorbs pressure very well when its upright, bending or reaching out of a neutral position puts it at risk for injury. This strains the deep, yet ever important muscles for controlling the back. One of the more common reasons for mechanical back pain is from bending and twisting while lifting at the same time. Snow shoveling is an example of when a person may bend, twist, and lift at once. Another way pain back will occur is from poor posture. Because all the parts of the body wear down over time, sitting or standing with the spine out of alignment can cause the joints to rub the wrong way, leading to pain. Weak posture muscle that can’t hold the spine in alignment will also lead to pain.

Classic Weekend Warrior Syndrome comes to mind. People who fall into this classification usually have a sit down or sedentary job during the work week. After years of not exercising regularly, the muscles are weak from non-use. The problem being that their body is not ready for the moderate to heavy level of work on the agenda like landscaping, remodeling, or deep cleaning, for example. Physical stress on the back can lead to muscle fatigue quickly and then moving the “wrong way” will set off muscles spasms that make it hard to bend or stand up straight. Good news, there are several ways to manage mechanical back pain.

Degenerative Joint and Disc Disease

Chronic back pain develops for different reasons. One of the most common chronic back pain diagnoses are degenerative joint disease (DJD) and degenerative disc disease (DDD). These usually happen simultaneously because discs break down over time causing the joints to compress. Shrinking discs cause people to shrink as we get older. Once the disc flattens out, other problems can happen like osteoarthritis and nerve compression. Have a condition like DDD and DJD might sound like there’s nothing to do to manage the pain, but there is quite a bit of influence we can have on chronic back pain when choosing the right approach.

Spinal Stenosis

Spinal stenosis is a common chronic back condition. What happens inside is a closing down of the tunnel where nerves travel safely. The tunnel becomes narrow and squeezes the nerve. Spinal stenosis can be related to a disc herniation, degeneration, bone spurs, scar tissue or from being born with a narrow spinal canal.

There are two types of stenosis in the back. First, central canal stenosis and this affect the spinal cord. This may cause pain in the center of the back or other symptoms into the lower body. A herniated disc or bone spur can cause lateral canal stenosis. Typically, this causes pain on one side of the back. The crowding of space gets worse usually with standing, walking, or getting out of a chair. In either case, the pressing on the nerves and ligaments could cause symptoms other than back pain. A person with spinal stenosis may also feel numbness, tingling, muscle weakness, or difficulty with balance. Spinal stenosis can be so bad that a person needs surgery to decompress the back. Physical Therapy can help people avoid unnecessary surgery, but it will always have a place in recovery after a surgery.

Muscle Spasms

Another cause of back pain are muscle spasms. These can be excruciating because entire muscles contract and do not let go for an extended period of time. Back muscle spasms are typical after a mechanical injury or with acute pain. Muscle spasms squeeze so much they cut off oxygen the surrounding tissue. Receptors in the body detect this and tell your brain that something is wrong because it hurts.

Certain things trigger muscles spasms once they become active. Things to avoid making muscle spasms worse may include cold, overstretching, poor posture, and twisting the back. Somethings to help muscle spasms reduce is to gently stretch, apply moist heat, or gently massage. Physical Therapy has other means to reduce the spasms and can introduce them to clients individually as appropriate.

The inner bundles that make up skeletal muscle fibers.

Trigger Points

Trigger points are mini-muscle spasms. Rather than the entire muscle cramping up, only part of the muscle tightens into a knot. You know you have a muscle knot when you can feel a hard, dense nodule in the muscle that hurts if your press on it enough. You can get trigger points from overuse of muscles, sprains, strains, poor posture, or from nerve compression. The pain might be felt at the location of the trigger point and it could also refer to another area. For example, a trigger point in the gluteus minimis muscle (buttocks) can create sciatica.

Naturally occurring hormones in the body cause pain in trigger points. This includes calcitonin gene related peptide, bradykinin, tumor necrosis factor alpha, interleukins –Norepinephrine, serotonin (5-HT), and cytokines. Notice how I didn’t say lactic acid? Trigger points are highly electrified that don’t get enough healthy blood flow. Not only do muscle knots cause pain they create a mechanical stress on tendons which could be the reason for poor posture and bad alignment. Deactivating trigger points is important for health back function. Physical Therapy can treat and show clients how to self treat their own trigger points.

Herniated Discs

Herniated discs can cause mild to severe back pain. The disc is like a spacer between each vertebra that acts like a sponge full of water. It is flexible to allow movement like bending forward and back. Discs also provide a cushion for the weight of the upper body so well that it keeps an appropriate space for the nerve roots to not be compressed.

Pain from a bulging disc begins once the inner disc material pushes through two-thirds of the outer layers. That’s where the nerves start to attach. When the outer wall of the disc tears then the pulpy center will squeeze through, invading a space near the spinal cord or nerve roots. Symptoms will get worse which may include numbness, tingling, muscle weakness, paralysis, and loss of control of bowel and bladder function. The body sees a herniated disc as a foreign invader. Inflammation triggered by the body’s defense mechanism will break down and resorb the damaged disc before scarring over.

Treating a herniated disc can be challenging because healing takes months to years. It all depends on how bad it was. If the disc is causing nerve compression then it will make sense to consult a surgeon. Prolonged nerve compression can lead to permanent damage, disability, and pain. There are ways to reduce the pressure from the disc pressing on the nerve without surgery. Physical Therapy can help to manage symptoms and train a person how to modify lifestyle while the healing takes place.


The term sciatica is used to express the sensation of pain traveling down the back of one leg. It can be due to a compress sciatic nerve. Compression of the nerve doesn’t happen in just one place so it helps to have a Physical Therapist evaluate for the problem site.

As mentioned above, a herniated disc can press on a nerve as it passes through the lower spinal column to cause sciatica. Even though this is before the sciatic nerve actually begins, it still sends a painful message. This condition is call Lumbar Radiculopathy.

The piriformis muscle is another culprit. It is a small muscle that attaches to the tailbone to the outside of the hip. The sciatic nerve is passes right next to the muscle or through it. A spasm in the piriformis can cause compression of the sciatic nerve, hence the name for the condition, Piriformis Syndrome.

You may also find it interesting to know that sciatica can be caused by having a tight buttocks muscle. That’s right, the gluteus minimis muscle has a trigger point that can cause sciatica. Sometimes it’s caused by over training in the gym.

How to treat back pain?

Physical Therapy for back pain starts off with the PT asking important questions. Where does it hurt? Have you been in pain for long? Do you remember how it first happen? How much does it hurt now? Is it getting better, worse or staying the same? Are there any other symptoms?

Conservative Treatment

The conservative approach to treating back pain begins with finding a comfortable position that you know you can get up from later. One of the best places is sitting back in a recliner or zero gravity chair. This will reduce the strain on the back muscles and take pressure off the discs. The other good option is to lie down on your back with a pillow under the knees. Getting the hips and knees bent to 90 degree angles with the legs propped up on a wall or couch can be a great position for comfort. Keep in mind, some people prefer standing over sitting or lying flat on the back, so listening to your body is imperative to the speed of healing.

Lying on your belly in small intervals can help a herniated disc heal. Gravity shifts the disc material back to the center when you lie on your belly, relocating it closer to it’s home. Disc material can gently squeeze back into a less painful position and take pressure on the nerves with bending backwards.

Do-it-yourself (D-I-Y) options include a moist heating pad, ice pack, massage tools on the muscles, foam rollers, TENS machines and inversion tables. Consult a professional before using anything new to you for treating your own back pain. This is because of the variability in causes of back pain and the up-teen options you could google. How do you know what is the right choice? How do you know it won’t make you worse?Consult a professional like a Physical Therapist.

Foot Orthotics

Fallen arches can cause low back pain. Most people have one foot flatter than the other. Consequently, a flatter arch makes a leg seem shorter and that throws off the balance of the hips.

Pain sets in when there is difficulty balancing the back over the hips. Flat feet tend to twist the legs inward which causes the hip alignment to get thrown off. Therefore, supporting the arches with foot orthotics helps control the leg twist and balances the hips. Better foot alignment equals between hip alignment equals back pain relief.

Back pain that was caused from a car accident can actually improve with foot orthotics. Click to read more.

Core Strengthening

Core strengthening is another treatment option that most back pain cases require. Tiny, deep stabilizing muscles of the spine shut off during a back injury and pain. The outer layer of muscles tend to engage more as if to help however they do not perform the same function and this causes painful and awkward movement. Back or abdominal muscles that are weak can cause painful movement. Sometimes, its not just weakness but the muscles react too slow to stabilize the spine, putting it out of alignment. Selecting the proper exercise and intensity can be a challenge because most people will over do it trying to rehabilitate themselves. Heavy lifting is what normal backs might be able to do. Injured backs benefit from a progressive program with moves that come from Core Education.


Many people have learned that flexible muscles can help prevent injuries. They also help to treat injuries. In the case of the back pain, finding what muscles you should stretch and which ones you shouldn’t stretch can really make or break a program. Remember the old saying “no pain, no gain”? Well that can really mess your back up. In fact, most flexibility is lacking in the hip muscles when people have back pain. The piriformis muscle is can spasm and compress the sciatic nerve. It can be a great muscle to loosen up in many instances to relieve back pain.

Often times, new clients will explain how they like to stretch first thing in the morning by bending over to touch the toes. The problem behind this move is the timing. Early in the day, for the first hour of being out of bed from sleeping, our spines are at their tallest. That’s because the discs have rehydrated and expanded in the absence of spinal compression from the affects from gravity. Bending over when the spine is it’s tallest places extra strain on the disc which can lead to a disc injury.

What is the best stretch for the back?

We will usually explain the concept of spinal traction. Traction happens when the surfaces of the spinal joints separate in the opposite direction of compression. This creates an even pull on muscles that maintain the natural curves of the spine. It also stimulates blood flow by decompressing the joints, nerves and blood vessels. It will help to rehydrate some of the disc which can also alleviate back pain symptoms.

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