Low back pain (LBP) affects 60–80% of people at some point in their lives and is the sixth most prevalent reason for doctor visits.According to certain research, up to 23% of adults worldwide experience persistent low back discomfort. Additionally, a one-year recurrence rate of 24% to 80% has been observed in this group.
Low back pain is described as "pain and discomfort, localized below the costal margin and above the inferior gluteal folds, with or without leg pain" in the European Guidelines for the Prevention of Low Back Pain.
Three categories of low back pain are typically distinguished: acute, subacute, and chronic low back pain. The length of the back pain determines how this split is made. Acute low back pain is defined as a period of less than six weeks, sub-acute low back pain as long as six to twelve weeks, and chronic low back pain as long as twelve weeks or longer.
Physiotherapy Assessment for Low Back Pain-
Classifying a patient presenting with back pain in accordance with the diagnostic triage suggested by worldwide guidelines for back pain is the primary goal of the physiotherapy examination. Although serious back pain causes including fractures, cancer, infections, and ankylosing spondylitis are uncommon, it's nevertheless vital to test for them. Specific back pain causes with neurological abnormalities like radiculopathy and caudal equina syndrome are also uncommon.
Of those who arrive with low back pain, 1-2% have serious illnesses to blame, and 5–10% have specific causes of LBP that involve neurological deficits[18]. People are said to have non-specific (or basic or mechanical) back pain once significant and specific causes of low back pain have been ruled out.
Most people who come to physiotherapy with low back pain do so because they have non-specific low back pain, which makes up over 90% of patients presenting to primary care. Assessing patients for impairments that might have exacerbated the pain or increased the risk of chronic pain is the goal of physical therapy.
Biological (such as weakness and stiffness), psychological (such as depression, mobility phobia, and catastrophizing), and social (such as work environment) aspects are among them . The evaluation does not concentrate on pinpointing physical features (such the intervertebral disc) as the cause of pain, as it may in peripheral joints like the knee. Prior studies and global recommendations indicate that pinpointing the precise tissue origin of discomfort is neither feasible nor essential for the efficient treatment of mechanical back pain.
Aims and Objectives-
Physical therapy for back pain usually aims to achieve the following short- and long-term objectives:
Reduce the discomfort in the leg or lower back.
Enhance low back function to enable maximum independence in enduring regular activities.
Make the spine more flexible and enhance its range of motion.
Provide a preventative maintenance program to stop back issues from happening again.
Physiotherapy Management for LBP-
Physical therapy is generally recommended as a primary treatment for the majority of lower back pain conditions. Therapeutic activities that are guided and target the lower back muscles, spinal structures, and joints are all part of physical therapy for low back pain.
Physical therapy for back pain aims to relieve pain, enhance daily function, correct posture, and stop the discomfort from returning. Physiotherapy for back pain uses a variety of treatment modalities because back discomfort necessitates a multifaceted approach to treatment. To provide you with an excellent pain relief, the treatment is tailored specifically for you.
1- ELECTROTHERAPY - Transcutaneous electrical nerve stimulation (TENS), ultrasound therapy, and interferential therapy are some of the machines used by physical therapists for back pain in order to minimize pain. Targeting the specific structures causing back pain is a skill that each machine possesses. Inflammation and pain can be effectively reduced by them.
2- LASER THERAPY- An energy wavelength known as laser therapy is used to start the healing process and lessen back discomfort. It slows down back muscular spasms and promotes the healing of the back's supporting tissues. It expedites healing by enhancing blood circulation in close proximity of the wound.
3- MOBILIZATION OR MANIPULATION TECHNIQUES- This techniques uses spinal manipulation and mobilization for the treatment of back pain. It helps restore the range of motion at the joints in the back and improves their function. It also helps reduce nerve irritability and improve the movement of soft tissues around the spine.
4- GENERAL STRETCHES AND EXERCISES- A set of carefully designed stretches and exercises are typically performed in consideration of the patient's unique condition and the underlying reason of their lower back discomfort.
5- THERAPEUTIC EXERCISES- Therapeutic exercises employ a variety of techniques to relieve tension from the structures in your back. They are usually done or acquired under the supervision of a physical therapist. Nerve exercises are useful in lowering stress and pain that radiates. The gliding muscles surrounding the spine become more powerful and resilient with progressive strengthening activities.
6- ERGONOMIC ADVICE- Physiotherapists focus on delivering accurate ergonomic devices and advising patients on how to use the proper infrastructure at work to prevent and treat lower back pain, as work-related dangers account for over 65% of lower back disorders.
7- POSTURAL GUIDELINES- This part of physical therapy involves teaching the patient how to maintain proper posture and what postural habits to avoid in order to prevent lower back pain.
Physiotherapy or physical therapy can help reduce low back pain through different methods and treatment programs depending upon the person’s condition. A physiotherapist can help with lifestyle modification, strengthening exercise program for core, glutes and lower back muscles, changing the ergonomics. An experienced therapist can provide manual therapy techniques like joint mobilization, myofascial release, nerve gliding techniques to minimize the pain. One can avoid major surgical procedures by following a proper physical therapy program. Physiotherapy can help with a long term solution for low back pain.
Dr. Sujit Biswas, MPT, Sports Physiotherapist, Bengaluru, India
How long is a physical therapy program for low back pain?
The duration and severity of low back pain determine how long an exercise program should last.
Physical treatment for chronic low back pain usually begins with an 8-week program carried out under a physical therapist's supervision.
Following the guided phase, a longer-term maintenance or rehabilitation therapy—which can be performed at home—is recommended.
Certain back pain conditions may also require a patient's doctor to prescribe a combination of physical therapy and lumbar epidural steroid injections. Moreover, doctors may recommend painkillers. For better tissue healing and to reduce pain and inflammation, physical therapists may recommend self-treatments like heat and cold therapy.
References:
https://www.spine-health.com/treatment/physical-therapy/physical-therapy-low-back-pain-relief
https://www.physio-pedia.com/Low_Back_Pain
https://www.londonpainclinic.com/back-pain-treatment/the-role-of-physiotherapy-in-the-management-of-lower-back-pain/
https://www.physiotattva.com/blog/physical-therapy-treatment-guide-to-lower-back-pain
(By Priyanka Pandey)
