Back Pain

Back pain can be the result of direct trauma,such as whiplash from a car accident, arthritic changes or postural strain. Back pain can be referred into the legs and this is usually called sciatica.

Ann-Marie Ennis has over 20 years experience treating back pain. With increasing use of computers and sedentary lifestyles back pain will affect most people at some stage of their lives.

Recent research has shown that early movement after a back injury speeds up recovery.It is no longer advisable for back pain patients to rest in bed. Extended rest allows muscles to weaken , joints stiffen and this will slow down long term recovery .

Chartered physiotherapists are experts in restoring movement . At Swords physiotherapy we like to see back pain patients as soon as possible.

The following spinal structures can be injured and cause pain:

  • DISCS – these can move out of alignment and irritate or compress nerves causing local and/ or referred pain into the legs.[slipped discs]
  • MUSCLES – Muscles can be torn causing back pain. Also very weak muscles give the spine poor support making it easier to damage other structures within the spine.
  • JOINTS – Joints can become stiff from disuse or inflammed from arthritic conditions or trauma.
  • NERVES – Nerves, when injured can cause pain , pins and needles or numbness. Nerves in the low back supply sensation to the legs so symptoms in the legs may be a feature of a severe back strain.

Physiotherapy for back pain

If you have back pain a chartered physiotherapist will make a detailed assessment to identify the source of the pain. A treatment plan will then be implemented to resolve the problem and prevent recurrence.Firstly physiotherapy will be directed at reducing pain. Once pain levels are manageable, treatment will be directed at restoring movement in the back and improving muscle strength.It is very important to fully rehabilitate the spine i.e. restore normal flexibility and strength to minimise  the possibility of relapse.Physiotherapy can involve specific muscle strengthening and/or stretching, postural correction, ergonomic advise, joint mobilisation, dry needling,T.E.N.S., Therapeutic ultrasound,Interferential therapy, manipulation, traction and massage. Almost always a personal therapeutic exercise program is prescribed and compliance with this is important.We will always give our patients at Swords Physiotherapy a printed exercise sheet to take home. This helps patients remember the exercise techniques. Many of our younger clients like to have us record them doing their exercises correctly on to their smart phone-this gives them  4D  feedback.For postural correction we can tape the patients back with special sticky bandages to help remind them to stand and sit tall. There are many apps available to download to devices which remind the user about posture and the importance of movement during the day.Sciatica [leg pain coming from the sciatic nerve] is a common problem associated with back pain. It can occur without back pain too but less often. In the middle age group the intervertebral disc is often the cause of the problem. Most cases respond well to physiotherapy. Treatment will be directed at off loading the sciatic nerve using manual therapy and exercise.In a small number of cases the disc has actually ruptured and this can cause incontinence and noticeable weakness in the legs. These patients will require surgery to remove the disc material that is compressing the nerve. We work closely with Orthopaedic and Neuro surgeons and will refer to them  patients we feel may be surgical cases.
Back Pain in ChildrenWe treat ever increasing numbers of kids and teenagers with back pain. This can be related to heavy school bags , poor posture and prolonged sitting. At times of increased study such as  junior and leaving cert exams kids are more prone to back and neck pain.
Physiotherapy will be initially directed at easing the pain. Once pain levels are manageable physiotherapy will be directed at restoring range of movement and strength. Postural correction in sitting and standing is very important.  Exercises will be prescribed to improve posture . It is important to take  “movement”breaks from study frequently. Healthy joints and muscles require movement.School bag may need to be changed or modified. It is always advisable to keep weight in school bag to a minimum.School bags should NEVER weigh more than 10% of the child’s body weight. Parents should check this and inform teachers if necessary
Downloadable leaflets on back care for children;
School Bag Leafletcpp_back_care; a leaflet for parents and kids on back care for kids
Whiplash Whiplash type injuries occur usually in car accidents [where a car in rearended] but also in contact sports such as rugby. The neck is most commonly injured. However the mid back [ thoracic ] and low back can be injured.Often the sacro-iliac joint is strained in car accidents as the force from the collision is transmitted through the leg into the pelvis. We often have to treat 2 or 3 parts of the spine in whiplash injuries.

Physiotherapy will help ease the pain and ensure full movement is restored.

Physiotherapy for Anklyosing Spondylitis

Anklylosing spondylitis is an inflammatory condition that in severe cases will cause the vertebrae to fuse together. Pain from this condition  is usually gradual in onset, worse first thing in the morning and eased with exercise.

The patient will usually be under 45 when the pain starts and stiffness in the low back is a common feature. Rest does not help the pain. As the sacro-iliac joints in the pelvis can be affected patients often have buttock pain.

As this condition will need medical management we will liaise with the patients G.P. and Rheumatologist as appropriate.

Sometimes from physiotherapy assessment of a patients back pain we may suspect an inflammatory condition such as A.S. In these cases we will ask the patients G.P to organize further testing such as X-Ray or blood tests to get a definitive diagnosis.

Physiotherapy treatment will consist of back education, pain management, postural correction and muscle strengthening. If the patient is in an acute inflammatory phase of the disease we may use ice and electrotherapeutic modalities to ease pain.

A.S. is a chronic condition and to ensure optimal care at swords physio we usually recommend periodic reviews at 3, 6 or 12 month intervals. We will check posture, flexibility and muscle strength. In this way we can prevent common complications.

Back muscle strains

Back muscle strains can happen if the back muscles are overloaded or overstretched. As most of us work in sedentary jobs now our back muscles can be quite weak and therefore easily strained .

Physiotherapy for acute back muscle strains

In the first 48 hours after a back injury it is advisable to rest from aggravating activities.The back pain can be quite strong depending on the severity of the strain. Ice is helpful -10 mins at a time- in controlling swelling , bruising and numbing pain. If resting try to rest lying down so the back is supported. In sitting avoid stools and instead sit on a chair with back support such as an office style chair.

Physiotherapy for chronic back muscle strains

Once the initial stage of healing has taken place physiotherapy will be directed at restoring muscle flexibility and strength. Massage – superficial and deep may be used to mobilise scar tissue. Electrotherapy such as ultra sound and interferential may be used to help optimize the healing process.

Exercises will always be prescribed . The patient will need to work on these at home  or in the gym in order to fully rehabilitate the injured muscle.

Muscle strains will make a good recovery in a relatively short time if advise given by the chartered physiotherapist is followed and exercises are carried out as prescribed.

To prevent recurrence it may be necessary to make lifestyle changes such as losing weight, improving posture and general fitness levels . We find many of our back patients have poor core strength, Pilates classes may be advised to help improve core muscle strength.


Scoliosis is an “S” shaped curve in the spine.  They can vary in severity. Fortunately in Ireland school kids are screened for severe scoliosis and will be offered surgical correction if deemed necessary.

Mild to moderate scoliosis can cause back pain. The joints at each end of the curvature can get painful and need treatment.

Physiotherapy for scoliosis

If pain is the presenting problem we will treat this with manual therapy and electrotherapeutic  modalities. Heat, T.E.N.S. and interferentail therapy can be used.The patient will be shown postural correction exercises and positions of ease.

Exercises will be prescribed to restore optimum movement and strength to the spine. Swimming is often a good way of keeping fit without irritating the problem. Pilates classes can also be beneficial to this group of patients.

At Swords physio we like to review our scoliotic patients periodically to ensure the condition is not worsening. We can also monitor and progress home exercise regimes appropriately.

Sacro-iliac joint pain

The sacro-iliac joint {S.I joint} connects the low back to the pelvis. It can be source of  low back pain.  Causes can be traumatic – such as a fall on ice or due to muscle imbalances in the low back, pelvis and hips. In pregnancy the hormones can make this joint less stable and more prone to problems.

Physiotherapy for sacro-iliac joint pain

The chartered physiotherapist will take a full history of the problem noting the onset and any trauma.The joints ability to move and irritability will be checked. Leg length will be measured. Muscle strength and flexibility will be tested.

Treatment may  involve joint manipulation, muscle energy techniques, stretches and strengthening. A personal exercise program will be prescribed and it will be important that the patient carries it out .

As with all our back pain patients we will advise on ergonomics, safe lifting and also correct poor posture.

Degenerative Disc Disease

This is a common finding on MRI scans and sound alarming. In fact this “diagnosis” is in fact a normal part of aging. It is not really a disease- it is not contagious -just a change in anatomy when compared to a younger persons spine. This  can be thought of as “wrinkles” on the inside. Just as we expect our skin to wrinkle as we age , internally our spines show signs of aging which is ofent termed “degeneration”.

As we get older our discs shrink a little. This is normal. Most of the “normal” population have “degenerative disc disease” on MRI scans but only a small percentage have back pain. We would like to see this noted on MRI reports as patients can be quite upset with the terminology.

Patient presenting  for physiotherapy with back pain and this “diagnosis” will be assessed to find out the main problem . It may be the pain itself, stiffness or weakness.

Physiotherapy for degenerative disc disease

At Swords physio we will actively manage this condition. We will explain the problem in more detail and also explain pain mechanisms.

For pain control elecrotherapeutic modalities such as interferental therapy, T.E.N.S. Dry Needling , Heat or ultrasound may be used, Manual therapy may be used to loosen up or re-align joints.

Exercise will be prescribed to decrease pain, restore optimum movement and strengthen surrounding muscles. The patient will need to work on a home exercise regime which will be clearly explained.



This is a slippage of one vertebra forwards on another. It is diagnosed on x ray but can only be seen on specific side on views. It is thought to be something the patient is born  The condition may cause back pain. Many mild cases are not symptomatic.

The diagnosis is often frightening to a patient . However mild to moderate cases can be successfully managed conservatively. Severe cases may need surgical correction.

The tennis player Andre Aggassi has a spondylisthesis . Whilst back pain did force him to retire from tennis he played successfully until his mid thirties.( not many players play much older than this nowadays). He was able to manage elite international tennis for many years despite the condition. This shows that maintaining excellent physical fitness is so helpful in managing the condition.

Physiotherapy for spondylolisthesis

Physiotherapy will address the pain and manual therapy , electrotherapy and exercises may be used. It is important for this group of patients to maintain strong core muscles .

Piriformis Syndrome

The piriformis muscle is a muscle that connects the hip muscle to the pelvis/low back. It can become dysfunctional and cause back pain, hip pain and leg pain. Often the back movement is quite good in these patients with just stiffness in the sacrro-iliac joint and hip.In some patients the sciatic nerve passes through the piriformis making sciatica [leg pain] a feature of the problem.

Physiotherapy for Piriformis Syndrome

Following a full assessment and history taking a treatment plan will be devised. This may involve electrotherapy,heat, dry needling and exercise. The piriformis muscle may need to be stretched and strengthened. Core muscles including the gluts ,deep  abdominals and back stabilisers will need to be re educated and strengthened. Your physiotherapist will prescribe appropriate exercises and e mail you videos explaining exactly how to do them

Oesteoporosis and back pain

Oesteoporosis is a condition where the bones lose their density becoming weaker. It often affects the thoracic spine and can cause a “dowagers hump” or rounding of the upper spine.

Unmanaged it can lead to spinal fractures. Diagnosis is by DEXA scan which can be easily organised and advisable in patients at risk of the condition.

Fortunately with correct management which may include calcium and vitamin D supplements , medication and exercise it can be treated.

Physiotherapy for oesteoporosis

If pain is a feature of the condition this will be addressed using massage, exercise, electrotherapy [interferential therapy and T.E.N.S.]and possibly dry needling.

To maintain strong bones a specific program of weight bearing exercises will be prescribed. As this group of patients would be at risk of fracture balance and co-ordination exercised may be included in the exercise regime.


Facet Joint Dysfunction/Degeneration

The facet joints are small joints on either side of the spine. They open and close as we move. The are synovial joints so have small amounts of synovial fluid inside them which helps the joint move.

As we get older these joints commonly get arthritic and the spine gets stiffer. This is a normal part of aging and will not  necessarily cause pain.

On MRI scans a common finding is “facet joint degeneration”. This sound alarming and often worries patients.  However this is a common finding in the normal [ back pain free patients] population.

Physiotherapy for facet joints

At swords physiotherapy we automatically assess facet joints when examining the spine. If we find that they are not moving correctly we will treat them. This may involve manual therapy, manipulation, muscle energy techniques to loosen them up.

If pain is a feature we may use ultrasound, interferential therapy, heat or cold to ease it. Exercises will then be prescribed to maintain the movement regained during physiotherapy.

Facet joints can be stressed by faulty posture and faulty movement patterns so postural correction often forms part of the physiotherapy treatment.


The sciatic nerve is one of the main nerves connecting the spinal cord to the leg. Pain in the buttock, thigh and calf  can be due to pressure or irritation of the sciatic nerve.

The sciatic nerve can be compressed by a spinal disc that is out of alignment. It can also be irritated by faulty buttock muscles, instability in the low back and from stenosis [ narrowing of the bony space the nerve root  passes through exiting the spinal column ].

Physiotherapy for sciatica

A full history of the problem will be taken. The patient will be asked about possible causative factors, aggravating activities and also positions or actions that ease the pain.

Posture will be looked at and range of motion of the lumbar spine, sacro- iliac joints and hips will be checked. The mobility of the nerves will be examined. Muscle strength of some of the leg muscles will be tested.Reflexes in the legs may be tested. This helps determine if further investigations are called for such as a MRI scan.

Physiotherapy will aim to treat the cause of the sciatica, ease  pain levels and prevent it from recurring. This will be accomplished with manual therapy,therapeutic exercises and electrotherapy.

At swords physio we place an emphasis on preventing recurrence. Back pain and sciatica can be effectively managed with appropriate exercises and  postural correction . Home and work ergonomics may need correcting. Our therpists are trained in the McKenzie method of treating discogenic low back pain and sciatica.

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Co. Dublin, K67 X2T8

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