Lower Back Pain

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Most of us will experience lower back pain at some point in our lives, and there are multiple possible reasons for it. Lower back pain is rarely a result of serious damage, but more often a result of overuse, unaccustomed loading, weakness, or deconditioning. With most low back problems, a specific cause cannot be determined and a precise diagnosis cannot be made. With thorough assessment, we aim to identify any serious problems or possible abnormalities. We look at the way you move and perform your daily tasks. Based on our findings, our treatment is then focused on addressing any abnormalities, along with managing your symptoms and helping you to achieve full recovery.

Non-Specific Low Back Pain

When low back pain cannot be attributed to a known underlying problem such as infection, inflammation, osteoporosis, a spinal fracture or deformity etc., we call it non-specific low back pain (NSLBP). NSLBP is extremely common, with pain ranging from mild to severe. It is typically more noticeable when you bend forward e.g. to pick something up or when you sit or stand for a long time. Minor bending or twisting movements of the spine can bring on pain, or you can just wake up with it one morning for no apparent reason. Generally, the pain is spread around the lower back area, either one or both sides. Sometimes it spreads into the buttock or thigh.

Most cases of NSLBP resolve without treatment but this may take several weeks, and recurrence rates are high. A major aspect of our treatment will be to identify and address non-ideal daily habits such as poor postures, poor ergonomics and inactivity that increase your risk for suffering from NSLBP. These factors potentially place stress and strain on muscles, connective tissues, nerves, and joints in your lower back area.

Lower back Pain

Over time and with repeated stress, these structures will start complaining.

Non-specific low back pain can be treated successfully with physiotherapy. Depending on your unique situation, and events leading up to your pain, we will advise and guide you on how to adjust your postures and daily activities to manage your pain. We also help relieve your pain by applying manual techniques such as electrotherapy, dry needling, massage, myofascial release, and joint mobilisations. The sooner we can help you manage your own pain actively, the better. It is important to continue with your daily life as much as you can, instead of avoiding activity or movement. We often prescribe exercises based on the McKenzie method or develop an exercise program tailored to your body and needs. We have had great success using the BeActivated method in the management of low back pain since it incorporates a holistic approach including core activation and breathing mechanics to address issues that may be contributing to your pain.

Nerve Root Pain

In few cases, low back pain may be caused by compression and thus irritation of a nerve root where the nerve exits the spinal canal. The pressure on the nerve may manifest as pain, pins and needles, and weakness in the muscles of the low back, buttock or leg. The pain referred into the leg is typically more severe than the pain in your back. This is sometimes called sciatica, or lumbar radiculopathy. The most common cause of nerve root compression is disc prolapse. Other possible causes include narrowing of the spinal canal, abnormal bone formation around the area where the nerve root exits, instability of the vertebrae, or other degenerative conditions. It can also be due to diabetes, which reduces blood flow to this area, or from scar tissue from previous injuries or surgery.


To treat nerve root compression, we first have to reduce the inflammation, and then your pain. Ultrasound can help to reduce inflammation. Initially, we will guide you on how to adopt comfortable, pain-free positions to relieve pressure off the nerve. We can assist you with pain management through manual techniques such as gentle massage, nerve mobilisations, spinal mobilisations, breathing techniques, and electrotherapy. We will encourage you to gradually return to your daily activities, and increase spinal movement as pain allows. We teach you specific exercises to create more space for the nerve root to move. Generally, you will require medical treatment along with physiotherapy.

Stenosis

In older people, the spinal canal can sometimes become narrower, reducing the space for pain-sensitive structures such as nerves to move. This will cause diffuse pain in your back, buttocks, or legs. Pain will typically be worse when walking and relieved with rest. Physiotherapy treatment will help to manage your pain, and relieve pressure off the sensitive structures through therapeutic exercises and stretches.

Scoliosis

Scoliosis is the abnormal side curvature of the spine. It can occur in the lower, middle or upper back. We can either be born with a curved spine, or it can develop as we grow or adopt repeated postures during our lifetime. It can also result from nerve or muscle diseases, or even from degenerative changes that come with aging.

Scoliosis is common and does not always cause any problems. Only when the curve is severe, causes pain, discomfort or aesthetic problems, or influences the functioning of your internal organs, treatment would be considered. Most people have mild curves and won’t require surgery or a brace.

Treatment of scoliosis will depend on your history, our physical assessment, how the scoliosis affects your daily life, and thus your goals. We can develop an exercise program tailored to your specific body and needs. The exercises will be focused on strengthening weak muscles, stretching and releasing tight, overworked muscles, and improving your spinal mobility. The program may also include balance and coordination exercises. Because we always try to approach any problem holistically, we can help to improve your breathing capacity if your scoliosis is affecting your lung function. We may also incorporate the BeActivated method to address fascial dysfunctions or do Pilates-/Yoga-based classes with you.

If your scoliosis is causing pain and discomfort, we will also help to manage your pain. The exercises will already address the pain, but we may include some passive pain management techniques.

Sacroiliac Joint Disorders

Sacroiliac joint (SIJ) disorders can cause low back or buttock pain. Sometimes it can refer pain to the groin on your thigh. Pain is typically worse when climbing stairs, turning in bed or getting in and out of a car. It is difficult to provide a definite diagnosis of SIJ disorders since these joints are extremely complex and work so closely together with the pelvis, lower back and hips. However, in some instances, such as during pregnancy, or after a fall directly onto your sacrum, it can be assumed that these joints and surrounding structures may be responsible for your pain. During pregnancy, hormones cause your ligaments to become laxer, which reduces the stability of the SIJ. Pregnant women often find great relief from taping the SIJ.

Our treatment will be focused on pain management, and then restoring any identified abnormalities that may be contributing to your pain. This may include weakness in your core, poor pelvic/hip control, muscle imbalances, connective tissue restrictions, or joint instabilities. To manage your pain, we can use electrotherapeutic modalities, ultrasound, massage, joint mobilisations, muscle energy techniques, dry needling, taping, and stretching.

Stress fractures

With repeated loaded movements of the spine, stress fractures may develop. This is common in sportspeople e.g. cricketers, gymnasts, tennis players, and weight lifters. Generally, repeated movements into hyperextension and rotation will lead to stress fractures of the sides of the vertebrae known as the pars interarticularis. The fracture is usually on one side of the vertebra and will cause pain on one side of your back. If both sides of the vertebrae is fractured, you may experience instability of your spine, along with pain (see Spondylolisthesis). Pain may also radiate into your buttock and will be worse when you extend your spine backwards. Discomfort may come on suddenly or more gradually.

Non-displaced, low-grade fractures can be successfully treated without surgery. At Just Physio, we will guide and educate you on how to restrict aggravating activities, help manage your pain, help to stabilise your spine, and ultimately help you recover fully. Pain management may include electrotherapeutic modalities, ultrasound, massage, gentle joint mobilisations, stretches, taping, and dry needling. We will assess for, and address any associated joint, muscle, or connective tissue tightness. Lower back, gluteal, and hamstring muscle flexibility and function must be addressed during rehabilitation. We will also consider your training technique and see how we can help to correct these in order to prevent injury recurrence.

Spondylolisthesis

Spondylolisthesis is when one vertebra slips forward on another vertebra. This may happen with stress fractures of both sides of a vertebra during sporting activity but may be due to a spinal defect that develops in childhood. The severity of the slip will determine the management thereof. Grade I injuries are often asymptomatic. Greater slips (grade II-IV) may cause lower back pain, with or without buttock or leg pain. Discomfort will be worse when you extend your spine backwards. If the injury is detected and treated early with physiotherapy, the outcome is generally very good.

Since your muscles will try to protect against such an injury, you will have muscle tightness/spasm in your lower back, gluteal and/or hamstring muscles. After completing a thorough assessment of your specific presenting problem, our initial treatment of spondylolisthesis will aim to reduce pain and gradually improve your spinal movement. We will guide and educate you on how to rest from activities that may worsen your symptoms. To encourage protection and stabilisation of your spine, we can apply tape and start working on a stabilisation exercise program specifically tailored to you. Gentle spinal mobilisations can be used to encourage normal positioning and movement of your vertebrae, and also to reduce muscle tension. Further soft tissue release can be done with the massage, electrotherapy, dry needling and heat application. We will then guide and supervise your gradual return to activity.

In greater slips, we may recommend a brace.

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