How is Stress-induced Back Pain Diagnosed and Treated?


Stress, which most of us are forced to deal with in some form or the other, manifests itself through a myriad of physical and psychological symptoms. Often, mounting stress may result in unexplained irritability, fuzzy thinking, forgetfulness, and so on. Among physical symptoms, aches and pains could be most common. When we are anxious or stressed out, the muscles in our body lose the ability to relax and remain tensed for a long time. This results in chronic aches. Although physiotherapy can help improve the condition, stress-induced pain needs to be diagnosed and treated the right way.

Symptoms for diagnosis

How do you know if your pain has been induced by stress? Well, when you are stressed, the body is likely to experience muscle aches that are diffused in nature. Back pain would most often be accompanied by neck and shoulder pain as well. There could be tender points in your muscles. Patients also experience sleep disturbances and chronic fatigue. Patients may feel that the pain is “moving around” or shifting from one place to another.

Treatment specifications

The treatment for stress-induced back pain usually requires taking a holistic approach. Muscle relaxants and pain killers have to be taken for managing the physical symptoms. Physiotherapy sessions are often recommended for sustained pain relief. In addition, anti depressants can be prescribed for stress relief and mood alleviation. Regular exercises, yoga and meditation should also be advised for calming the mind.

Often times, counseling techniques can also go a long way in helping to manage stress induced pains and aches. Counselors help the patient deal with their inner fears and insecurities that are causing stress and leading to manifestations, such as muscle pain and back pain. Once the root cause responsible for triggering the stress is identified and dealt with, the manifestations can also be managed better.

When to See a Doctor for Your Back Pain


Back pains can be benign or a sign of something more serious. Often times, we tend to treat a persistent back pain with home based remedies like local application of muscle relaxants, hot fomentation and so on. What if the problem continues and gets worse by the day? When is the right time to reach out to a doctor or a physiotherapy clinic? Here are some red flags or warning symptoms that you need to make the move.

Fever that accompanies the pain

According to doctors, fever along with the regular back pain could mean a serious infection. At times, the fever may have been caused due to an entirely different nature of viral attack and the back pain could be an allied symptom for the same. Doctors will evaluate your condition and prescribe antibiotics in case a spine related infection is detected. In the absence of such a cause, anti inflammatory drugs and plenty of rest would be prescribed.

A pins and needles sensation   

If your back pain is accompanied by a tingling sensation in and around the lower back region, it could well be much more than muscle tension. A tingling feeling is often associated with nerve irritation which might be caused due to spinal stenosis or a set of herniated discs that might be putting unnecessary pressure on the nerves. In such cases, your doctor might advise you to visit a physiotherapy clinic for quick relief.

Emergency signs and symptoms

Often times, a dull ache in the lower back accompanied by symptoms like dizziness, vomiting, nausea, confusion, chills, sweating and so on signal emergency health conditions that could be serious in nature. These should never be ignored and medical help should be sought immediately.

Any persistent problem experienced by the body should be dealt with utmost seriousness. It is always better to be safe than sorry.

Causes and Symptoms of Piriformis Syndrome


The piriformis syndrome is a relatively uncommon neuromuscular disorder that occurs when the piriformis muscle puts pressure on the sciatic nerve. This muscle is band-like in shape and is located at the top of the hip joint, around the buttocks. The sciatic nerve is thick in structure and passes through the piriformis muscle and eventually branches into smaller nerves which run right up to the feet. Compression of this nerve can occur as a result of spasms in the piriformis muscle. The best way to alleviate the pain is by visiting a physiotherapy clinic.

Causes and Symptoms

In most cases, the condition is characterized with a pain or a numbness and tingling sensation in the buttocks. The pain can be extensive and severe and can run along the sciatic nerve, much like sciatica pain. Any posture that causes further compression to the sciatic nerve can aggravate the pain. So, it can be triggered by sitting in the car, while running, climbing stairs, applying pressure on the piriformis muscles, being seated for long duration and so on.

However, it is important to remember that most cases of sciatica pain are not causes by the piriformis syndrome. Irrespective of the cause of sciatic nerve compression however, a physiotherapy clinic is certainly the place to head to for some quick relief. A trained physiotherapist can help in relaxing the nerve and hence reducing the pain.

How is it diagnosed?

Typically, there is no specific diagnosis for piriformis syndrome.  There are no tests. Sometimes, an MRI may be performed for ruling out any allied causes for nerve compression. Doctors perform a physical examination and check the symptoms shared by patients for arriving at a conclusive diagnosis.

Apart from physiotherapy, pain killers might also be advised for acute pains. Steroids may also be prescribed in certain cases.


How Piriformis Syndrome is Diagnosed and Treated?


Piriformis syndrome occurs when the sciatica nerve is compressed by the piriformis muscle. The condition, also known as “pseudo sciatica” can result in excruciating pain around the hip joints and buttocks. The pain can be aggravated by any untoward movement of the hip joint, long hours of sitting, walking and so on. So, how does your physiotherapy specialist diagnose piriformis syndrome?


To start with a clinical examination will be carried out to exclude other conditions that can replicate the symptoms of this syndrome. These examinations could be a CT scan, MRI scan, ultrasound, EMG and so on. The examination should also be able to negative lumbosacral spinal pathology as one of the causes for the pain.

Once these conditions are ruled out, the physiotherapy specialist will perform for tests for stretching the piriformis muscles and for provoking the sciatic nerve by maneuvers like internal rotation, flexion, adduction and so on. In some cases, a specialized test called the magnetic resonance neurography can also be performed for showing the irritation caused to the sciatic nerve. However, it is rarely required.


Once the cause has been identified, the physiotherapy clinic may advise

·         Re alignment techniques of the pelvis and spine for relief.

·         Techniques for mobilizing the affected joint for restoring mobility, function and range of motion.

·         Electrotherapy or massage for alleviating pain and spasms and enhancing blood flow might also be advised.

·         A complete stretching session for enhancing muscle flexibility will also help in going a long way.

Apart from physiotherapy, doctors may also prescribe pain killers at the outset or even steroids in case the pain is excruciating and limiting movement. However, these medications have their side effects and minimal consumption is advised. Your physiotherapist is the best person to suggest holistic treatments that are free from harmful side effects.

Should You Exercise with Lower Back Pain?


When you visit a physiotherapy clinic with excruciating back ache, you hardly expect your therapist to advice regular exercise. Believe it or not, doctors actually feel that regular exercising can help alleviate chronic back ache. Specialists consider exercising to be an inexpensive, non invasive and affordable means of curing back related problems.

Why is exercising advised?

To begin with, regular exercising helps in reducing weight. Losing weight reduces the stress on the muscles of the lower back, relieving you of the pain. Exercising also improves body flexibility and a range of body motions. It also works towards strengthening the back muscles, thus preventing future episodes of chronic pains or aches.

What kinds of exercises are advised?

Since the lower back muscles are already stressed, safety becomes a top priority before you begin your exercise regime. You need to visit your physiotherapy clinic and stick to the suggestions offered by your physiotherapist. Exercises that put pressure on the affected area should be avoided completely. Here are some exercise suggestions.

·         Swimming – Water provides excellent support to your muscles and joints when you exercise. Apart from swimming, you can also try walking in water, lifting your body slowly with the help of your hands and similar movements for stretching and strengthening your muscles. Going for an aquatic exercise class might also help.

·         Bicycling – Cycling is an excellent exercise, which helps strengthen the joints and muscles of your lower back. Go slow and stop if you experience discomfort in and around the hip area. Make sure you do not overdo your biking schedule. Start with shorter durations and increase as the days pass.

·         Playing golf – If you love playing golf, your physiotherapist will certainly advise you to continue since it happens to be a low impact sport. However, make sure you stretch and warm up before starting off.

Remember to keep your posture right and use the right shoes before you begin exercising.

Tips for Flying with Back Pain


Flying long distance with severe back pain might prove to be extremely tiring. You will need assistance with respect to seating arrangements, additional help for moving around and so on. So, what should you do? Your physiotherapy specialist is the best person to guide you. Here are some more tips for your assistance.

Carry a letter from your doctor

It is wise to carry a letter with you, duly signed and stamped by your physiotherapy specialist. The letter should be addressed to the customer service department of your airline. It must specify your condition and the kind of help and assistance that you might need for a safe and comfortable flight. Although most airlines have a bad reputation with regard to the quality of customer service, a letter will at least brighten your chances of getting some help.

Choose your seat wisely

Some seats would be free while others will require additional pay. You must book a window seat that is not too far away from the washroom. Being on the middle or the aisle seat would require you to move out multiple times, whenever your co passenger wishes to step out for a quick washroom visit or a small walk down the aisle. The window seat remains undisturbed.

Keep medications handy

If the pain is severe, you can take a painkiller tablet right ahead of your boarding time. This will help manage the pain during the course of the flight. Keep other medications handy too. If it is a long haul flight, you may need to pop another pill or apply muscle relaxant for additional relief.

Don’t pack unnecessary things

When you are traveling with pain, it is always advisable to pack light. Carrying heavy bags will only worsen your condition.

Ask your physiotherapist to provide you contacts of some specialists you might have to consult, during your stay.

4 More Ways to Indulge Your Spine


Let’s face it; most of us are ignorant about spine care. And it is this casual approach that makes the spinal cord more susceptible to pains and injuries. Physiotherapy specialists assert that timely care and maintenance goes a long way in protecting it. Here are 4 more ways to take preventive care of your spine.

1. Choose the right pillow for your sleep

Ideally, you need a pillow for supporting the curves of your neck. So, people with different sleeping postures will need different pillows. If you sleep on the side, your pillow should be thicker for ensuring correct positioning of the head and neck. Similarly, a lot depends on your built as well. Petite frames will need slimmer pillows and broad shouldered people will need thicker ones.

2. Exercising in water

Exercising in water is excellent for your spine because the buoyancy of water provides upward support to your spine and reduces the downward force of gravity. In addition, the mild viscosity of water provides the right resistance to motion, by friction. This reduces the risk of spine injury during exercising and provides additional flexibility to the spinal joints.

3. Kick the butt

Smoking actually increases the chances of developing spinal disorders that are degenerative in nature and may lead to back pain. This is because smoking is responsible for damaging vascular structures of joints and discs. Therefore, if you are a smoker, it is time to kick the butt and opt for healthier addictions instead. Although this may seem difficult at first, the efforts are surely to pay off.

4. Opt for a standing desk

The sitting posture puts three-fold pressure on the spinal discs of your lower back, as compared to the standing posture. Your lumbar spine can be under huge stress if you sit at your desk for long hours. Opting for a standing desk for intermittent use will do a whole lot of good to your spine.

Never ignore pain or discomfort in the spinal discs. Seek comprehensive guidance and help from your physiotherapy specialist before it is too late.

Top 4 Ways to Indulge Your spine


Most of us tend to be ignorant about the condition of our spine, and neglect aches and pains till they are manageable. It is only when the problems become acute, requiring frequent visits to a physiotherapy clinic, do we sit up and take note. It is important to understand that problems of the spinal cord can lead to fair amount of complications. Ideally, you should take proactive measures for keeping the all important support system of our body, in perfect shape. Here are 4 ways to pamper your spine.

1. Include yogic postures in your daily regime

Believe it or not, practicing yoga is the best way to strengthen your spinal cord. You need to keep aside half hour everyday and practice the cobra pose, cow pose, twist while sitting, dog pose by facing downwards and triangle pose. When practiced daily, these posses nourish the spine and make it more flexible.

2. Take a walk regularly

Another way to indulge your spike by strengthening the core muscles is to set time aside for a walk, on regular basis. Low impact aerobic exercises like jogging can also be considered. Apart from strengthening the core, daily walks improve flexibility and reinforces the bone structure.

3. Eat right

Avoid saturated fats, too much sugar, baked good, processed or packed foods in your diet. These are extremely harmful for your spine. Choose fresh fruits, whole grains and veggies instead. Opt for sources of lean protein like chicken or tofu.

4. Check your sitting posture

This is especially important if you have a desk job. The spine has several curves and ideally, the sitting arrangement should support these for proper comfort. You will certainly need ergonomically designed chairs. You may also consider sitting on an exercise ball for few hours in the day.

As your physiotherapy clinic will advise you, any problem concerning the spine, should be tackled immediately. Preventive measures go a long way in managing these problems in future.

The ankle sprain – when can I return to play?

The ankle sprain – an injury all too familiar to us athletes and non-athletes alike. Often, we take it through the age-old “rest & ice method”, start wriggling our ankle after a few days of limping around and return to play within a week or two. Why then, do we find it more difficult to maintain our balance on the court or field even months after the initial injury?

Ankle inversion injuries (foot twisting inwards) are the most common ankle sprains which can occur during twisting or turning movements, or landing from a height. The sudden twisting of the foot places shearing forces on the ligaments on the outer side of the ankle, resulting in an overstretch, or in more severe cases, tearing of the ligaments.

Pain and swelling often arise from the trauma of an ankle sprain. Subsequent pain-avoidance behaviors, which include limping and limiting movement in the acute phase, can also alter the way we move. Additionally, mechanoreceptors embedded within the ankle joint and ligaments also lose their ability to provide proprioception – the way the body tells where it is in space (this partly explains why you feel wobbly when attempting to balance on the injured leg!). These changes often result in compensatory movements, which may over time lead to tissue adaptation further up the kinetic chains of our body. Left unaddressed, these deficits in neuromuscular control contribute to a higher risk for recurrent injury, leading to chronic ankle instability.

Our physiotherapists will be able to guide you through your recovery and advise on your readiness to return to sport, with a goal of reducing risk for recurrence. This includes an in-depth assessment of your posture, movement, neuromuscular control and other risk factors. Your physio will then guide you through the rehab process which may include swelling management, taping, postural & neuromuscular training, strengthening & proprioceptive exercises to aid your return to sport. Our goal is to have you back in play with a reduced risk for recurrent injuries so that you minimise your injury downtime!


Gribble et al., (2016). Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains. Br J Sports Med, 50 (24), 1496-1505.