Hmm, this is a tough question. I can outline for you all the possible treatments that exist for back and neck pain in a specific or general way. But perhaps a better approach is show you how physiotherapists think.
1. While the source of your pain is important to us, we are also very interested in the factors that contribute to your pain. The source of pain might be a pinched nerve or arthritic joint or a “disc” or a muscle or many other things…it can even be your brain “playing tricks” on you making something that is a normal sensation to feel like a “painful” one. As physiotherapists, we want to know *why* the things that are sore are sore. That is why physiotherapists perform a thorough physical assessment after taking a good history.
2. Once we know what is the source of your pain and what the contributing factors are, we will address these issues with many different approaches. Some have more research evidence than others and some therapists prefer certain approaches over others but the main point to understand is that we are seeking to address the source and the cause/s of your problem.
3. It may be helpful to think of the 6 areas that physiotherapists might treat:
a. The Articular System - these are your bones, joints, ligaments, cartilage etc. We use manual therapy, electrotherapy and even put casting materials on for broken bones, splints etc in the treatment of these probelms. Other things include acupuncture, exercise, advice, etc etc
b. The Myofascial System - these are your muscles, tendons and coverings (fascia) that can pull and tramsit tension throughout the body. The treatments are similar to above
c. The Neural System - this is about your brain, the nerves and how they coordinate the whole body's systems including how you move
d. The Visceral System - not many physiotherapists work on this area - this is more traditionally an osteopathic type of treatment - however the effect of the internal organs and how they are functioning can cause your musculoskeletal system to work differently. Identifying and addressing the visceral causes of your problem is a possible treatment option - sometimes the “treatment” is a referral to your doctor for further tests
e. Your strategies for performance and function - this is basically where we look at how you are moving and how you “do” life. Often our physical examination begins with looking at how this area. Common treatments are posture correction, movement correction, technique correction, etc.
f. The Psychosocial considerations - this is how factors in your life andyour beliefs about what is going on in your body can affect your physical wellbeing and outcomes. We often have to encourage our patients to move when they think they should rest OR to rest when they want to play. Encouragement, education, addressing the things that are important to you are all part of this area we treat.
4. Lastly, it is important to note that you should feel long lasting benefit from your treatment. Sometimes, it is not oossible to be completely pain-free. However, your ability to get on with life and do the things you want to do are still valid outcomes. If you end up seeing a therapist with no improvement with how you feel or ability to work, then you have to ask yourself the question “Is this working for me”. Obviously you have to be realistic (e.g. a back fracture takes 6-8 weeks to heal for example). The goal of any therapy of chronic neck or back pain should be on helping you become more self reliant and aware of when you can take care of yourself and when you need a therapist to help.
Hope that helps!
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