Physiotherapy Treatment of Low Back Pain
Low back pain is very common and most people have some experience of a back pain episode at some time of life. Attendances at physiotherapy clinics for low back pain are very high so physios have a variety of assessment and treatment techniques to manage spinal pain and improve patients' function.
Back pain is rarely an indication of serious underlying medical condition such as cancer, infection or arthritic disease but the physiotherapist needs to be sure he or she is dealing with a non-serious back pain. Standard exclusion questions are asked by the physio to rule out loss of weight, loss of appetite, previous cancer history, bowel and bladder control, rheumatoid arthritis, diabetes, epilepsy, particular pain problems at night and generally feeling ill.
This subjective history tells the physio that the back problem is mechanical, i.e. it is related to the stresses and strains on the spinal joints now and in the past. They can then move on to the objective examination, looking at the patient with their clothes off. Initial examination starts with the patient walking in and with how they sit for the questioning, and posture is noted next. Many postural changes are not of great significance but some fit the overall picture and increase the confidence in the correct therapeutic diagnosis.
Next the physiotherapy examination moves on to active movements. Lumbar flexion is bending over forwards as if the hands are to touch the toes, and the range of movement and any pain is noted. This is repeated for extension and perhaps side flexions and side gliding, all adding to the picture forming in the physio's mind. The physio may test the hip joints, the sacro-iliac joints, the sensibility, the reflexes and muscle power. Palpation of the spinal joints can tell a skilled physiotherapist about the stiffness and reaction of individual spinal segments, thus localising a problem to a specific level.
Once the therapeutic diagnosis is made the physio will set the treatment goals and plan of treatment. If stiffness is a problem, mobilisation techniques can be used and the patient taught mobilising exercises as a home programme. If pain is the main issue then analgesia might be recommended with gentle mobilising and exercise techniques to ease the joints.
Core stability and Pilates techniques are widely covered in the media and used by most if not all trainers in gyms and athletic clubs. Scientific research has shown the importance of the stabilising muscle groups in the spine and pelvis to maintaining normal neutral spinal posture and preventing overstrains. Patients start with simple stabilising work on a plinth, progressing to maintaining stability against more resistance and finally in functional or sporting activities.
Postural correction can be an important part of physiotherapy treatment as poor posture can hold vulnerable tissues near their end ranges, stressing them and reducing the blood supply to such tissues under stress. Moving the joints away from the end ranges and teaching a person to maintain that as a new "normal" posture can reduce the tissue stresses and help the overall picture to settle down.
Many back pain physios use the McKenzie technique which uses repetitive movement to change the forces which the disc nucleus exerts on the walls of the disc, the annulus fibrosus. An increase in pressure against the posterior disc wall can worsen symptoms while a decrease can improve pain. Repeated movements in one plane establish a "directional preference", a direction of movement which improves the presenting symptom. McKenzie therapists treat patients depending on whether they have postural syndrome, dysfunction syndrome or derangement syndrome. McKenzie therapy is a popular technique, based on the idea that the disc nucleus exerts a force on the walls of the disc and can cause pain problems.
Apart from treatment the patient needs to consider changing some aspects of their behaviour if the treatment is going to get the best result. Pacing activity to avoid overdoing activities and suffering afterwards is important, allowing the problem to ease. Aerobic and muscle fitness in the gym or pool has good scientific evidence behind it for reducing the number and severity of back pain episodes, while many back pain treatments have little evidence to prove their effectiveness.
Back pain is rarely an indication of serious underlying medical condition such as cancer, infection or arthritic disease but the physiotherapist needs to be sure he or she is dealing with a non-serious back pain. Standard exclusion questions are asked by the physio to rule out loss of weight, loss of appetite, previous cancer history, bowel and bladder control, rheumatoid arthritis, diabetes, epilepsy, particular pain problems at night and generally feeling ill.
This subjective history tells the physio that the back problem is mechanical, i.e. it is related to the stresses and strains on the spinal joints now and in the past. They can then move on to the objective examination, looking at the patient with their clothes off. Initial examination starts with the patient walking in and with how they sit for the questioning, and posture is noted next. Many postural changes are not of great significance but some fit the overall picture and increase the confidence in the correct therapeutic diagnosis.
Next the physiotherapy examination moves on to active movements. Lumbar flexion is bending over forwards as if the hands are to touch the toes, and the range of movement and any pain is noted. This is repeated for extension and perhaps side flexions and side gliding, all adding to the picture forming in the physio's mind. The physio may test the hip joints, the sacro-iliac joints, the sensibility, the reflexes and muscle power. Palpation of the spinal joints can tell a skilled physiotherapist about the stiffness and reaction of individual spinal segments, thus localising a problem to a specific level.
Once the therapeutic diagnosis is made the physio will set the treatment goals and plan of treatment. If stiffness is a problem, mobilisation techniques can be used and the patient taught mobilising exercises as a home programme. If pain is the main issue then analgesia might be recommended with gentle mobilising and exercise techniques to ease the joints.
Core stability and Pilates techniques are widely covered in the media and used by most if not all trainers in gyms and athletic clubs. Scientific research has shown the importance of the stabilising muscle groups in the spine and pelvis to maintaining normal neutral spinal posture and preventing overstrains. Patients start with simple stabilising work on a plinth, progressing to maintaining stability against more resistance and finally in functional or sporting activities.
Postural correction can be an important part of physiotherapy treatment as poor posture can hold vulnerable tissues near their end ranges, stressing them and reducing the blood supply to such tissues under stress. Moving the joints away from the end ranges and teaching a person to maintain that as a new "normal" posture can reduce the tissue stresses and help the overall picture to settle down.
Many back pain physios use the McKenzie technique which uses repetitive movement to change the forces which the disc nucleus exerts on the walls of the disc, the annulus fibrosus. An increase in pressure against the posterior disc wall can worsen symptoms while a decrease can improve pain. Repeated movements in one plane establish a "directional preference", a direction of movement which improves the presenting symptom. McKenzie therapists treat patients depending on whether they have postural syndrome, dysfunction syndrome or derangement syndrome. McKenzie therapy is a popular technique, based on the idea that the disc nucleus exerts a force on the walls of the disc and can cause pain problems.
Apart from treatment the patient needs to consider changing some aspects of their behaviour if the treatment is going to get the best result. Pacing activity to avoid overdoing activities and suffering afterwards is important, allowing the problem to ease. Aerobic and muscle fitness in the gym or pool has good scientific evidence behind it for reducing the number and severity of back pain episodes, while many back pain treatments have little evidence to prove their effectiveness.
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