Low Back Pain: Physiotherapy Treatment and exercise

Low Back pain and Physiotherapy Treatment

Low back pain is the most common condition, most of each and everyone affected once in a lifetime. Low Back area is a central part of the Body, plays a important role in our day to day activity.

Low Back carries upper body weight and have higher mobility, higher the mobility, higher the risk of wear and tear. There are too many causes of Low back pain and symptoms also varies depending upon cause, diagnosis.

Low back pain is a symptoms require proper diagnosis and according treatment plan are carried out, mostly rest with pain relieving medicine and Physiotherapy treatment helps to relieve mostly, in severe cases surgery is also recommended.

In this article we discuss the causes, symptoms, risk factors and Treatment, Physiotherapy exercise.

What are the causes of low back pain?

There are too many causes of the pain, few of them are:

Disc prolapse:

The intervertebral discs which are located between two vertebrae in the back are prone to injury mainly during lifting weight. This risk increases with age and obese people. The disc prolapse can tear or herniate mostly at the lower lumbar spine, l4-5 and l5-s1 disc are the most common.

A disc prolapse, also called as a slipped disc or herniated disc or ruptured disc, occurs when the cartilage surrounding the disc pushes against the spinal cord or nerve roots. The disc provides cushion that located between the spinal vertebrae extends outside its normal position.

Slip disc causes compression of the nerve root as it exits from the spinal cord and through the vertebral foramen. Disc injury mostly occurs suddenly during lifting weight or jerky movement at the back. Disc pain makes you difficult to sit and usually lasts for more than 72 hours and also associated with sciatica pain.

Sciatica pain:

Sciatic nerve compression mostly occurs with a herniated disc or spinal canal space narrowing or piriformis muscle tightness or degenerated vertebral body part compress the nerve roots mostly this occurs at the lower lumbar spine. The sciatic nerve originates from the spine and travels at the back of the thigh to the lower legs, if your sciatic nerve compress due to lower back pain, it may be associated with pain radiating down to one leg or both leg depending upon severity. Sciatic nerve pain usually feels like tingling numbness or burning, or pins and needles at the back of the thigh to the legs.

Spinal canal stenosis:

It is a condition of spinal column where the spinal column foramen narrows, leads to pressure on the spinal nerve roots and in severe cases it also compress the spinal cord.

It is occurs mostly due to age related wear and tear of spine - gradual degeneration of the intervertebral disc located between the vertebrae. This may leads to pressure on the nerve roots or spinal cord by osteophyte formation or bony spurs or soft tissues, such as discs.

Pressure on the spinal nerves causes symptoms such as:

• Radiating pain mainly sciatica pain is the most common symptoms
• Tingling numbness along the nerve roots area
• cramping at the back of the thigh muscles or calf muscles
• Lower limb muscles weakness

Mostly pain and other symptoms relieve with rest while increase with long standing or walking or after few activity.

Abnormal poor Posture:

Scoliosis, kyphosis, and lordosis are all conditions that cause abnormal posture in the spine.

All these conditions are mostly bi birth(congenital) or it may gradually developed mainly due to long illness or lifestyle, This condition reuiqured early diagnosis and exercise. The abnormal posture causes back pain and poor posture because it places extra pressure on:

• Paraspinal muscles
• Related tendons
• ligaments of spine
• spinal vertebrae

This may affect your performance and increase risk of repetitive low back pain.

Arthritis:

Lumbar spondylosis(osteoarthritis of spine) is the most common type of arthritis to cause lower back pain, It is age related wear and tear of spine seen mostly above 50 plus age of people. 

Ankylosing spondylitis also causes lower back pain, where pain, inflammation and stiffness in the spine and in severe cases, fusion of the spinal column is also associated. Rheumatoid arthritis also causes low back pain.

Lumbar Spondylolisthesis:

Where spinal vertebrae slip from their original position then it is called Spondylolisthesis and it is most common in lower lumbar spine, so it is called Lumbar spondylolisthesis. Lumbar Spondylolisthesis causes pain low back area and in severe cases often associated radiating thigh to leg pain as well.

Sacroiliac joint dysfunction:

The SI joint (Sacroiliac joint) joint the sacrum at the base of the spine to each side of the pelvis. It is a strong, low-motion joint that works as a shock absorber and provide support between the upper body and the lower body in day to day lifting and carrying activity. Trauma or over-stressful activity leads to SI joint can become painful and becomes inflamed called sacroiliitis.

Other health related conditions that can cause lower back pain are:

• Kidney and bladder problems
• pregnancy stress
• endometriosis
• ovarian cysts
• uterine fibroids
• cancer

Symptoms of Low Back pain:

Low back pain may be start suddenly due to injury or during lifting weight called acute low back pain, if this pain not treated well enough may become chronic back pain. Timely treatment with enough rest to manage pain is important at an early stage can help relieve your symptoms in both time and severity.

There are mainly 3 types of Back pain:

• Acute Back pain
• Chronic Back pain
• Neuropathic Back pain

To know your symptoms well helps for proper diagnosis and treatment also.

Common symptoms of Low back pain:

• Pain at lower back area
• Pain with tenderness in lower lumbar area mainly area involved are l4 l5 and s1 are the most common
• Para-spinal muscle spasm
• Difficulties from bed to sitting position and also increase your pain
• Pain increases after long standing or walking
• Lifting activity is painful mainly from ground
• Radiating from Back to buttocks area down to back side of the leg also called sciatica pain
• Sometimes pain relive with rest and few activities will increase your pain
• Muscle tightness of Back with Hamstring, Piriformis and other related hip muscles
• Sometimes night-pain or early morning pain
• Tingling numbness in one or both legs depends upon severity and compression of the nerve roots
• Rarely Bladder or bowl function is also affected in severe cases of traumatic injury of low back or severe cases of sciatica pain
• Weakness of lower limb with difficulties in walking

Diagnosis Low Back Pain:

If you are looking for accurate diagnosis of Back pain, It is depends upon cause, related symptoms, patient History that helps your Doctor to diagnoses of your low Back pain. 

Your doctors also perform few Physical examination on you, ask you few question related to your pain such as when your pain is increases and which condition where to get relive (aggravating factor and relieving factor).

Doctor also recommend few imaging test for accurate diagnosis of the Back pain. This images provide accurate pictures of spine, disc, ligaments and muscles.

This imaging test are:

Low Back X-ray, which uses radiation to produce images of lower lumbar spine or sacroilliac joint.

Magnetic Resonance Image (MRI), which uses a magnetic-radio waves to create pictures of spine, disc, muscles, tendons and other related soft tissues.

A computerized tomography (CT) scan, which uses X-rays and a computer to create 3D images of spine, disc and related soft tissues.

EMG (Electromyography) study helps to test nerves and muscles and check for neuropathy related pain(nerve damage), which can cause radiating pain or tingling numbness in your legs.

If your Doctor may also suggest blood tests or urine tests. Blood tests can help to diagnose the genetic conditions that cause back pain eg. ankylosing spondylitis, while urine tests helps to check for kidney stones, which cause intense pain in the sides of the low back.

Treatment of Low Back pain:

Treatment is varies depends upon cause, symptoms, diagnosis and also depends upon which specialist doctors you select for treatment.

Most common treatment option in acute low Back pain are Pain relieving Medicine mainly NSAIDs such as Aceclefenac, Diclofenac with Rest and Physiotherapy treatment.

Use of Ice packs and Hot packs 2 times a day at home also helps to relive your Back pain.

You can also use Lumbo-sacral belt that helps to stabilize spine during your day to day activity.

You can also notedown which activity and position will increase your pain, you should avoid this activity untill you relive your Back pain.

You also marked that which activity and Body position that helps to ease your pain, you should replace with painful activity.

Regular Physiotherapy session also helps to relieve your pain.

In severe cases depends upon diagnoses your doctor also recommend you surgery.

Physiotherapy treatment of Back pain:

Physiotherapy treatment is also depends upon causes, symptoms and Diagnosis of Back pain, Most commonly followed treatment are pain relieving electrotherapy modalities such as Interferential therapy(IFT), TENS, Ultrasound Therapy, Lumbar traction, Short wave Diathermy(SWD).

Exercise that helps to relieve your Back is mainly Back flexion exercise also called Williams flexion exercises, Back extension exercise and Core strengthening of the Back exercise with stretching exercise of the tight muscles.

Back extension exercise helps to strengthen the muscles that are located at the Back side while Back flexion exercise helps to strengthen abdominal muscles while core strengthening exercise are the deep muscles helps to stabilize the spine during day to day jerky movement.

Exercise must be pain free, if you feel pain during exercise you must avoid this exercise and report to your Physiotherapist, few exercise may increase your pain if you do it wrongly. Never perform exercise with jerks. Increase exercise gradually.