Low back pain

1) Low back pain

It is estimated that 80% of the human race experiences low back pain at least once throughout their lifetime. Fifty per cent of the working population admit to experiencing low back pain each year. Each year 20-35% of the people in Asia have complaints of low back pain. Three per cent of the population is either temporarily or chronically disabled by low back pain. Millions of workers suffer on-the-job injuries annually, which cost 100 billion dollars in lost salaries, time, productivity and medical costs.

It is important to understand that there is an outstanding chance that you will recover from your low back pain in the near future.

a) MECHANICAL LOW BACK PAIN
Mechanical low back pain has been reported to arise from trauma (either chronic or sudden) such as a fall, a motor vehicle accident, twisting, prolonged poor postures, mental stress, fatigue, disc extrusion (also known as a slipped disc, rupture, or disc herniation), sometimes painful degenerative disc disease(also called arthritis), ageing, congenital disabilities, poor flexibility, and more.

Acute low back pain is defined as activity intolerance due to lower back or back-related leg symptoms of less than 3 months duration. Chronic low back pain, therefore, is defined as pain/problems lasting greater than 3 months. Regardless of the cause or duration of mechanical low back pain, the result is likely to be damaged soft tissue(s), which can stimulate nerves and produce pain.

It is important to understand that it is next to impossible to determine exactly which tissue(s) are the cause of the low back pain. Someone like yourself may be experiencing pain, and quite frankly, the cause is unknown. It could be muscle(s), ligament(s), disc(s), tendon(s), joint(s), and/or other connective tissue. They all can produce similar symptoms, which commonly present as pain on one side of the back or across the back. It may radiate into the buttock or into the thigh. Often, it will be accompanied by painful cramping of the muscles, called a muscle spasm. The cause could be any number of structures.

So how do we treat something if we don’t know what exactly is wrong? We do know that mechanical low back pain is caused by damaged soft tissue. The damage stimulates pain nerves called nociceptors. The goal then is to promote healing of the damaged soft tissue, which will eliminate the pain, not just treat the pain itself. This is done with a program that is customised to your individual needs.

This is what we do here at Hallmark Physiotherapy

Protecting the damaged soft tissue to prevent further breakdown. The area of damaged soft tissue is protected with rest and positioning. Activities that cause pain should be avoided while the low back heals. Pain management techniques should be used, and your physical therapist will discuss these with you. Bed rest is usually only necessary for 1-3 days (longer periods of bed rest have not been proven to be beneficial).

Increasing circulation and mobility. This will deliver the proper building blocks (proteins, repair cells called fibroblasts, oxygen, proteins, and more), remove inflammatory and waste products that build up in painful tissue(s), and prevent tissue atrophy. Increasing circulation is accomplished by walking and performing painless range of motion, stretching, and strengthening exercises.

Correcting the dysfunctions (weakness, poor posture, poor flexibility) that caused the problem in the first place. Progressive strengthening exercises, flexibility exercises, and postural/body mechanics education will help reduce the stress on your low back and promote proper repair.

The Key: Your physical therapist will give you the tools to treat your dysfunctions and create your own customised treatment program. That’s not all. Anyone who has suffered from low back pain must understand that the problem is not corrected when the pain ends. Muscles must be stronger than before the pain started (that takes 12++ weeks), many weeks are needed to improve flexibility, and repeated practice is necessary to incorporate proper posture and body mechanics into your daily activities. Fortunately, it can be thought of and can be done at home with some discipline.

b) LUMBAR STENOSIS
Spinal stenosis is the narrowing of the spinal canals. It may involve the central canal, the hollow tube on the backside of the spine through which the spinal cord travels, and/or the transverse foramina, the canals from which the spinal nerves exit.

Narrowing of the spinal canals is usually an age-related process (called secondary stenosis). During this process, the vertebral discs lose their height (degenerate), the ligaments become stiff, and bone spurs may form. The combination of loss of disc height, hardening of the ligaments, and bone spur formation can cause stenosis. Other conditions, such as spondylolisthesis, trauma, or post-surgical complications, can also cause stenosis.

Because of mechanical compression and blood flow congestion, spinal stenosis can result in severe pain. With lumbar or low back spinal stenosis, symptoms often include low back pain and a diffuse radiation of pain into the buttocks and thighs. Tingling and numbness, as well as leg weakness, may be present as well.

Symptoms are often worse with standing, walking, and backward bending/extension of the spine. Sitting, forward bending and unweighting of the body often provide relief. One of the hallmark signs of lumbar spinal stenosis is decreased walking tolerance.

Physical Therapy may be helpful. Treatment may consist of stretching, strengthening, joint mobilisation/manipulation, aerobic exercise, and activity modification. Walking with an “unweighting system” or aquatic exercise may be helpful.