The Importance of Physiotherapy with Low Back Pain
It is understood that 70% of Australians will experience low back pain at some point in their lives. The origin of the back pain is often unknown with 85% of cases diagnosed as non-specific low back pain, mostly because the aetiology of back pain is complex. The main symptoms of a possible low back injury include pins, needles and numbness referring down the leg. Pain with back movements. Common difficulties include putting on shoes, sitting, laying in bed and lifting things.
Individuals with back pain often get scans to find out the cause of their pain. It is important that scan results fit the physical presentation of the individual, as often people can live symptom free. Studies looking at people without back pain have shown that by the time someone gets to 40 that 68% have disc degeneration, 50% have a disc bulge, 33% have a disc protrusion, 22% have an annular fissure, 18% have facet degeneration that rises to 83% by the time you reach 80, while 8% have spondylolisthesis that rises to 50% by the time you reach 80.
With an annual incidence of 10-15% of the population experiencing back pain it is often in the form of acute back pain. The patient usually highlights an activity that increased strain on a muscle or joint. The recovery rate of acute low back pain is 90% with physiotherapy being important in reducing the symptoms as well as guiding a gradual return to exercise and movement through the spine. A smaller part of the population develops chronic low back pain that lasts for 6 months or longer. These individuals generally have increased rates of depression and decreased job satisfaction due to the impact that their injury has on their personal and professional lives.
So how can Physiotherapy help:
– Research eliminated the notion that you should prescribe bed rest to patients with back pain. This often increases protective and adaptive strategies resulting in worse outcomes.
– Manual therapy is shown to reduce pain for short periods of time and is good for symptom management.
– Individualised exercises are used to decrease disability and improve function, guided by the patients personal and professional goals. These are designed to address the cause of injury rather than continual long-term symptom management
– Physiotherapists have a large amount of contact with patients with back pain that makes them ideal to apply cognitive behavioural training into their therapy tools to reduce the impact that beliefs have on their recovery. This is even more beneficial for chronic low back pain where they begin to develop opinions on whether they will get better.
– Hydrotherapy has two benefits for management of low back pain both acute and chronic. Buoyancy reducing the loading through joints and muscles allowing the body to move freely where it may be restricted on land. The viscosity of the water providing resistance around a patient allows for strengthening.
– Pilates focuses on safe movement while building the strength and control for the movements. Pilates also works in different planes allowing for better movement without their body weight on them.
It is important to be aware of red flags when it comes to low back pain:
– Cauda Equina syndrome – If the patient has bilateral sensation changes on the inner thigh, changes to the bowel or bladder including pain, this could be an indication that the spinal cord is being blocked. If your patient experiences this, they should be referred immediately to the Emergency department
– Tumours – If the patient has experienced a gradual onset of low back pain, experienced unexpected weight loss along with night sweats and pain without movement it is a good indicator for further investigations.
Physio Professionals have post graduate trained physiotherapists who specialise in low back pain.
Biggest take home messages for patients:
- Start physio treatment ASAP (eliminate bed rest)
- Avoid early MRI (research shows longer recovery in patients who had “changes” found early on MRI)
- Physio Hands-on manual therapy helps reduce the acute pain
- To avoid re-occurrence all low back pain patients need to be progressed to strengthening exercises / active classes such as hydrotherapy then tailored core stability (pilates). This is the biggest problem with chronic low back pain patients as they will seek treatment during an acute flare up but self-discharged and never receive the long term benefit of the strengthening phrase.
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