The spinal column is a series of overlapping bones stacked on top of each other and separated by discs that cushion the forces between the bones. They protect the spinal cord which runs through an opening in the bones, giving rise to the nerves which supply the entire body. This column is then stabilized by muscles, tendons, and ligaments to keep it in place. Irritation to any of these structures can cause low back pain or pain that radiates to other parts of the body. The symptoms and severity of this pain can vary greatly from patient to patient.
Low back pain has become a major health issue because of its high prevalence in the general population, being the second most common reason patients seek medical attention. It is a costly injury with an annual healthcare cost estimated to be nearly $100 billion per year. Low back pain often occurs without the degenerative changes you would see on an MRI. This is referred to as nonspecific low back pain, which may be caused by poor muscle control of the trunk, poor posture, low body mass, decreased trunk extensor endurance, poor hamstring flexibility, or psychological distress.
Some red flags that may be a cause of concern with low back pain include fever and chills, unexplained weight loss or recent weight loss due to trauma, significant leg weakness, sudden bowel and/or bladder incontinence (either difficulty passing urine or having a bowel movement or loss of control of urination or bowel movement), or severe and continuous abdominal pain. If patients are experiencing any of these symptoms they should seek medical attention immediately.
Treatment for Nonspecific Low Back Pain
If none of the above symptoms are noted, physical therapy may be appropriate to treat the low back pain. With injury to the muscles or surrounding structures of the low back, aching pain with activity, movement, or lifting heavy objects is common. Pain that moves around the groin, buttock, or upper thigh is also common, often with muscle spasms or soreness to touch. The severity of the pain may range from mild discomfort to disabling pain, depending on the extent of the injury.
The use of exercise is a major component of treatment for low back pain. The chronic nature of this pain is often accredited to core weakness and instability, particularly of the lumbar and pelvic regions. Core stability exercises can help decrease these impairments and restore patient function. Proper motor control of the back muscles and spine position are the keys to maintaining spinal stability during activities. Stabilizing exercises have been proven to be more effective in reducing long term pain compared to treatment by a general practitioner.
What do I mean by stabilizing exercises?
These exercises target both abdominal and deep lumbar muscles that help stabilize the core. Early in treatment it is important to isolate these muscles in relaxed positions (patient lying on their back with their knees bent) by drawing in the abdominals, bringing the belly button up and in toward the spine, feeling the muscles tighten. Normal breathing is important while maintaining a muscle contraction. While the patient maintains the abdominal contraction they can perform bracing, which is bending at the waist side to side, keeping their back down on the table, in a slow and controlled manner.
To progress this exercise to make it more challenging on the core, the patient can either hold one leg straight up and hold for 30 seconds, or raise both feet with the knees bent and hold, all while maintaining the same abdominal contraction. This can further be progressed by performing abdominal contractions and bracing in different positions like sitting, standing, or on their hands and knees (quadraped). In the quadraped position they can raise one arm and the opposite leg to further challenge the core. The last progression would then be to maintain abdominal contractions with high speed activities such as walking or running. The increase in function and decrease in pain is reportedly higher with stabilization exercises vs. strengthening exercises.
Deep tissue massage (DTM) is also a component of physical therapy treatment for low back pain. It is often used to decrease muscle tension, improve vascular circulation to the affected area, and treat trigger points. Trigger points are small knots that develop in a muscle when it becomes injured or overworked. These areas are highly irritable and sensitive to pain when pressure is applied and can often send referred pain to other areas. DTM can help decrease the pain caused by trigger points and should be used in combination with exercise.
Research has found that yoga has also made significant improvements in functional disability, pain intensity, and depression in adults with low back pain. Yoga includes maintaining specific postures, meditation, relaxation, and breathing techniques. Maintaining prolonged postures improves endurance of the lumbar stabilizers and improves posture and flexibility. Breathing techniques and meditation help reduce pain and improve function in individuals with low back pain.
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