Physiotherapy for Lower Back Pain

Introduction:

Low back pain is one of the most common problems in the general population. It is frequent among healthcare workers. Low back pain occurs due to various reasons, but in healthcare workers, it is due to improper posture and the failure to take care of themselves while caring for the patients. However, it can be managed through some modifications in work and treating it with physiotherapy.

What Are the Causes of Low Back Pain?

There are many causes of low back pain. Some of them are:

1. Improper Posture: Healthcare workers develop low back pain, usually due to improper posture while working or treating a patient. Poor sitting postures can cause fatigue in the muscles and creates excessive stress on the vertebral discs leading to LBP. Healthcare workers are prone to LBP as their work demands them to sit and work excessively, which causes strain and fatigue.

2. Aging: Due to aging, wear and tear of the muscles occur, which can lead to demineralization of the bones, including decreased bone density in the spine and degeneration of the disc, which ultimately leads to LBP.

3. Muscular Strain: Also, excessive strain can lead to low back pain due to weak muscles.

4. Nerve Injury: If the sciatic nerve is damaged, a sharp pain occurs in the lower back and buttocks region.

5. Bulging Discs: Due to pressure increasing on the discs or herniation, LBP occurs.

6. Ligament Tear: If a ligament is damaged in the lower back region, it causes difficulty in moving or even sitting and also creates LBP.

7. Chronic Diseases: Chronic conditions like spinal stenosis, ankylosing spondylitis, and fibromyalgia can cause LBP. Spinal stenosis is when too much pressure is exerted on the spinal nerves due to a narrowed spinal canal. Ankylosing spondylitis is a condition in which some bone joints fuse and create a hunched pose. Fibromyalgia is characterized by generalized pain and tenderness throughout the body.

8. Others: Several diseases can cause LBP, including arthritis and osteoporosis. Being overweight and having an altered walking stance can also cause LBP. Tumors and cysts in the ovary can cause LBP.

What Are the Symptoms of LBP?

• Low back pain is usually cyclic and occurs in episodes.

• The LBP is often referred to as the buttocks and thighs.

• There will be back stiffness in the morning, and pain is common.

• Pain occurs immediately when the patient tries to move.

• Pain on bending forward and also on returning to the erect position.

• Pain is often produced or aggravated by extension, side flexion, rotation, standing, walking, sitting, and doing exercise.

• The pain usually becomes worse over the day.

• Pain is relieved by changing positions.

• Pain is relieved by lying down and curling up in the fetal position.

• Pain is accompanied by numbness and tingling in the low back and buttocks region.

How Is It Diagnosed?

It is diagnosed by the examiner by observing and examining the physiologic movements and doing a few tests to confirm LBP. A straight leg raise test and Faber’s test are done to confirm LBP.

1. Diagnostic Scans:

• CT (computed tomography) is done to check if there is any soft tissue damage or any abnormalities in the spinal cord.

• Discography is done to check if there is any problem with the discs of the vertebrae. Through a needle, a contrast dye is injected, and if the pain is present, it can be confirmed that the problem is in the disc.

• MRI (magnetic resonance imaging) is done to understand the cause of low back pain, such as fractures, nerve abnormalities, or tumors.

• NCS (nerve conduction studies) identifies neuromuscular problems by stimulating the nerves with electric shocks sent via electrodes.

2. Straight Leg Test:

It is also called the Lasegue test, and it is a fundamental test for LBP. The patient is asked to lie in a supine position, and the examiner raises the patient’s leg gently with the hips bent, and the knee extended. If pain occurs, then it is a positive test.

3. Faber’s Test:

The patient is asked to lie in a supine position with the hips slightly bent and the ankle of the left leg resting on the knee of the right leg. If pain occurs on the left leg, then the test is considered positive for LBP.

How to Manage LBP?

• Patients are advised to take rest and remain less active, avoiding stressful activities.

• NSAIDs (non-steroidal anti-inflammatory drugs) like Ibuprofen, Aspirin, and Motrin are advised for pain control.

• Muscle relaxants like Cyclobenzaprine and Tizanidine can be taken for sprain-related back pain.

• Active and passive PT (physical therapy) is done to relieve symptoms. Active PT involves stretching and strengthening exercises and low-impact aerobics. Passive PT is done by the PT to the patient using hot and cold packs, TENS (transcutaneous electrical nerve stimulation) units, iontophoresis, and ultrasound.

• Steroid epidural injections are given to ease the pain.

• Lumbar support can be given to the patient, but it has little efficacy.

Physiotherapy for LBP:

1. Education:

The healthcare workers are advised on the work postures and manual handling of the patient to prevent injury. Workplace education and provision for lifting equipment are given to the healthcare worker.

2. Manual Therapy:

In manual therapy, manipulation and mobilization are done by moving a joint beyond and within the normal range of motion, respectively. Deep tissue massage and trigger point massage are also done. Deep tissue massage involves deep stroking and giving pressure to the muscles and tissues, while trigger point involves deep pressure to areas of local tenderness. Spinal manipulation is done by a therapist gently and at a low speed.

3. Ultrasound:

Ultrasound therapy uses sound waves and vibrations as a treatment protocol to treat LBP. Vibrations are created by the machine, and heat is also produced. This will eventually reduce the pain.

4. TENS (Transcutaneous Electrical Nerve Stimulation):

It is a non-invasive technique in which electrical stimulation is applied to the affected area using electrodes.

5. Exercises for LBP:

• Ankle Pumps: Ankle pumps are done either by lying down or sitting in a chair. Try to lift the toes up and down as far as possible. Repeat this exercise ten times every hour.
• Heel Slides: Heel slides are done by lying down and trying to bend one knee and then straightening the leg. Repeat the same for the other leg one time on each side.
• Wall Squats: Try to stand leaning on a wall and squat in a half-sitting position with the back fully pressed on the wall for ten seconds and return to the standing position slowly. Repeat this exercise eight to twelve times.
• Straight Leg Raises: It is done by lying flat on the back by bending the knee of one leg and keeping the other leg straight. Try to tighten the abdomen and slowly lift the straight leg off the floor up to six to twelve inches. Hold the same position for five to ten seconds and lower the leg. Repeat this on the other leg ten times on each side.
• Single Knee to Chest Stretch: Try lying down and bending one knee and hugging it closer to the chest, placing both hands on the leg for support. Hold this position while simultaneously taking a deep breath and continue holding for 10 to 30 seconds. Then, repeat the same for the other leg.
• Hip Flexor Stretch: Try kneeling on the floor with the left knee forward and the other behind, keeping the hands on the left knee for support. Try sliding the right knee back until a stretch is felt. Now push forward the right glute bringing the trunk and hips toward the left foot. Hold the same position for 10 to 30 seconds. Repeat this on the other side.
• Piriformis Stretch: Try lying on your back on the floor with both knees bent. Now, try resting the ankle of the left leg over the left knee, pull the left leg towards the chest, and hold this stretch for 30 seconds. Repeat it on the other side and do it three times a day.
• Lumbar Stabilization Exercise: Pelvic tilt can be done for lumbar stabilization. Try to lie on the floor by bending the knees bent and feet flat on the floor and tightening the abdomen while pulling the back to the floor. Hold this stretch for ten seconds and for three to five times a day.

How to Prevent LBP?

• Follow a good posture while working, standing, and sitting.

• Avoid excessive strainful activities. Seek the help of a coworker in such cases.

• Follow proper lifting techniques when trying to lift a patient or any heavy object.

• Use a backrest or lumbar support if the work involves prolonged sitting. While sitting on a chair, keep the feet flat on the floor and the arms resting on the armrest.

• Modify the way of doing repetitive tasks. Prolonged stress on a certain muscle or bone can cause it to deteriorate, so it is better to avoid doing it the same way.

Conclusion:

Low back pain has a greater predilection among healthcare workers, and it can be prevented by taking some precautions. Some exercises are done to heal back pain. Strengthening of the muscles also helps in keeping the joints flexible and less prone to injury. The workplace also has to make some modifications to prevent injuries.