Back pain is a prevalent condition affecting millions globally, ranging from mild discomfort to severe pain that can disrupt daily life. Whether caused by injury, aging, or underlying health conditions, back pain can significantly impact mobility and overall well-being.
Back pain can be caused by a variety of reasons including overuse injury, sudden trauma, and/or underlying conditions such as arthritis. While pain originates in specific musculoskeletal and neural tissues, its long-term persistence is mediated by complex interactions between mechanical strain, biochemical inflammation, and central nervous system sensitization.
Accurate diagnosis requires identifying the exact anatomical structure generating nociceptive signals. Below are the primary spine and hip structures detailed in our clinical practice:
Small joints at each segment of the spine that provide stability and help guide motion. The facet joints can become painful due to arthritis of the spine, a back injury, or mechanical stress to the spine.
Medial branch nerves are small nerves that transmit the pain from the facet joints in the spine and carry pain signals from the facet joints to the brain.
Space used to administer a caudal epidural injection which involves placing a needle through an opening in the tailbone (sacral hiatus) to deliver medications into the caudal space. The lower portion of the spinal cord contains the nerves that extend out to the legs and feet; when these nerves become irritated or inflamed, they can cause pain to radiate down the leg.
A large group of muscles that run vertically on both sides of the spine, roughly one hand's width from the spinous processes. As a group, these muscles extend and stabilize the entire vertebral column and cranio-cervical region.
Your greater trochanter is typically located at the widest point of your hips. Bursitis is when the bursa, a "balloon" type structure which normally holds a small amount of fluid, becomes inflamed. This inflammation causes excess fluid to build-up within the bursa, leading to irritation in the surrounding areas.
Visual guide illustrating the lumbar facet joint, medial branch nerves, caudal space, and trochanteric bursa. Click to view high-resolution diagram.
Injections generally provide a temporary reduction in pain which is meant to help you start a rehabilitation program. Some of the items below may be important to your program. OHIP and private insurance will cover some of what you need, however, it may not cover everything, and you will have to invest both time and money in order to return to your maximum level of functioning.
A procedure using a special needle that heats nerves to reduce pain. An electrical current produced by a radiowave heats a small area of nerve tissue, essentially burning part of the nerve and thereby decreasing pain signals from the medial branch nerves around the spinal facet joints.
Platelet rich plasma is blood plasma with concentrated platelets (the body's repairmen for damaged tissues). The concentrated platelets contain growth factors vital to initiate and accelerate tissue repair, promote development of new blood vessels, and stimulate the healing process.
A medicine injected into the body to help ease pain and swelling from arthritis, injury, or illness. This medication mimics the effects of cortisol produced naturally by our adrenal glands (not bodybuilding steroids; your muscles will not get bigger).
A recognized orthopaedic regenerative injection procedure that stimulates the body's natural healing processes to strengthen joints, tendons, and ligaments weakened by trauma or overuse injury. Directly addresses the cause of joint instability.
Considered when structural deficits, progressive nerve compression, or persistent spinal instability do not respond to non-surgical interventional options.
Considered when structural deficits, progressive nerve compression, or persistent spinal instability do not respond to non-surgical interventional options.
The mind has tremendous power over pain and we use it subconsciously all the time. Learning how to react and adapt to pain and its consequences can result in a range of emotional problems, such as depression and pain-related fear, which can lead to poor concentration and memory.
We know that we are able to interpret pain in different ways depending on the circumstances, even though the pain is the same. For example, a mother who has been looking forward to and preparing to have a child will probably experience less pain during birth than a teenager who became unexpectedly pregnant and is terrified or unprepared. Training your brain through Cognitive Behavioural Therapy (CBT) is an effective way to alleviate negative emotional responses to pain.
Aimed at reducing the influencing factors that create and maintain negative behaviours, beliefs, or thought patterns. Teaches how increased awareness of thoughts reduces symptom severity using specific behavioural strategies.
The pain centre in the brain decides whether or not to send pain signals to the amygdala (the emotion centre enabling fear, anxiety, and depression). When overwhelmed with pain signals, it triggers these emotions when it otherwise shouldn't.
Physical inactivity can lead to weakened muscles, worsening arthritis, increased pain, and less mobility. Exercise also helps keep bones and muscles strong, providing vital support for your joints.
Be sure to have an ACTIVE rehab physical therapy plan. Such a plan involves condition-specific and patient-specific education on expectations, recovery processes, self-care strategies, and pain science, all delivered in combination with an active care exercise program.
Very important! It is not just about weight loss (which lessens the load on the spine and decreases inflammation associated with body fat), but also avoiding foods which cause inflammation and eating foods which fight inflammation!
If receiving steroid injections, talk to your family doctor about Vitamin D, calcium, or bone medications. In addition, Vitamin K2 (90mcg) has been shown to support bone strength.
If struggling with weight, consider exploring Intermittent Fasting outlined in The Complete Guide to Fasting by Dr. Jason Fung, MD. More info at Harvard Health.
Anti-inflammatories and targeted neuropathic pain medications are used strategically to reduce pain and allow progression in physical therapy.
Safe and relatively well tolerated option for chronic pain at recommended dosages.
Helpful orally or topically; watch for heartburn, stomach ulcers, high blood pressure, and kidney problems.
Found to help with pain, sleep, and depression. At doses lower than used for depression, they help soothe chronic pain pathways.
Common side effects are dizziness and drowsiness which may go away as your body gets used to the medication during gradual upward titration.
These medications help heal damaged nerves and decrease pain. Dual action on serotonin and norepinephrine neurotransmitters.
Your doctor will likely start these medications at a low dose and gradually increase it to allow your body to get used to the medication. The dose is increased until pain relief is achieved or side effects appear.
Educational media and evidence-based self-management resources recommended by Dr. Michael Wansbrough.
A podcast and website created by Dr. Wansbrough and Dr. Perelman explaining modern pain neuroscience, treatment pathways, and interventional breakthroughs.
Describes how the brain and body interact and provides useful tools for reducing pain using pain reprocessing therapies.
Coupled with his "Big Three" low back exercises, providing actionable resources for spine stability and functional recovery.
"Calm" is an application which helps with meditation and relaxation. "Headspace" includes dedicated modules for managing chronic pain.
Watch our specialist guide on targeted exercises and care instructions.
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