Low back pain (LBP) is a common presenting complaint for the general population. A majority of the active population also experience back pain at some time in life. The athletic population, by virtue of higher level of demands, may be at increased risk of low back problems. Certain sports may be at increased risk compared with others (1). LBP can be caused by quite a few problems in any parts of the complicated, interrelated set of connections of the spinal muscles, nerves, bones, discs or tendons in the lumbar spine. The symptoms of low back pain typically get better within a small number of weeks from the time they begin, with 41-90% of people absolutely better by six weeks (2). That being said there is a lot of the population who suffer with chronic LBP (pain that lasts longer that 6 weeks) and there are a number of causes for this, a few risk factors might include: Age, Lack of exercise, Excessive weight lifting, Disease, Improper lifting and Psychological conditions.

Here at the 5Physio, we are regularly treating patients with chronic pain. Breaking them out of the pain cycle allowing them to return to their everyday lives in the absence of pain. This looks different for every patient that comes through the door, whether they haven’t been able to pick up and hold their grandchildren or if their pain has been inhibiting their sporting performance, we always drive to get you pain free and returning towards normality.

The vast majority of people who suffer with chronic LBP are often worried or frightened because it’s something wrong with your spine, right? Studies have shown that as many as 80% of patients with chronic LBP exhibit signs of psychological distress (3), but by seeking professional advice instead of accepting that you’re in pain and that’s the way it is lowers that statistic to between 5-10%. So by seeking help and combatting your pain is by far the most effective way to protect your mental health as well as breaking you out of that pain cycle. 

How can the 5Physio break you out of the chains of pain?

Firstly, it’s crucial to identify the root cause of pain. This is something we begin to investigate from the moment we begin that initial conversation when you come into the clinic. By digging into your previous lifestyle habits, sporting background, and any other clinically relevant history, our practitioners will start to find that out so we can get to work and begin to correct it. As I mentioned earlier, there are so many different causes for the pain to present in your everyday life. Commonly, we see facet joint irritation being that underpinning factor because the vertebrae aren’t moving efficiently.

There are two facet joints on each vertebral level, hence why you might not have central pain (both joints being irritated) you may only suffer from unilateral (single-sided) pain. For example; rotating over your right shoulder might be absolutely fine and you have no issues there but rotating over the left side might always give you that 3/10 chronic pain that comes on every single time you rotate. Why has this facet joint become irritated? The reason is different for every patient. Frequently, muscle imbalances or dysfunction is to blame, there stabilising muscles that support the hips which originate from the lumbar spine and attach to the greater trochanter (side of the hip). If there is dysfunction there it can alter the vertebral kinematics (how the vertebrae move, basically), causing the joints to have excessive friction and therefore become irritated.

Now, in this instance, treatment is relatively simple. We first up need to correct that dysfunction, we do this by using our manual therapy skills, soft tissue techniques as well as vertebral joint mobilisations. After this, we need to work on restoring normal vertebral kinematics. Just because we have corrected the cause of pain doesn’t necessarily mean we are out of the woods just yet. When we have to get those affected joints moving again, which luckily for our patients, we’re pretty good at! Our methods of breaking into those painful ranges involve a method of de-sensitising the area using movement.  

There are too many ways that our therapists do this to put it simply into words. But as Jess says ‘Mechanical lower back pain is my bread and butter’, we can get you on the road to recovery as quickly as your first session.

How do we prevent this from happening again?

So, now you’re back moving well again and the pain has settled back down, how are we going to prevent these things from happening again? For some patients, we can simply address the reason why it occurred and work on rectifying that dysfunction, but that isn’t the case for everyone. The rehabilitation process needs to be specific to you as a generalised ‘one size fits all’ plan simply isn’t effective. Our assessment will have identified areas of muscular weakness and arthrokinematic dysfunction which together may have contributed to the cause of your LBP. An appropriately balanced mixture of strength training, movement re-training, and improving neuromuscular control will begin the process of bulletproofing your back. So how might that look in a rehabilitation programme? 

As always, education is high up on my priority list when treating my patients. Dispelling myths about chronic lower back pain, I believe that too many people are afraid of back pain and that hinders their recovery. When addressing chronic LBP, we need to look at the biopsychosocial model. To break out of the chronic pain cycle we need to make sure all of the biological, psychological, and social factors of the patient are all working well together, this is all information that we will find out from our initial chat at the beginning to make sure that all of your lifestyle factors are in tune to breaking you free from those chains of pain!

First and foremost – we need to ensure that all of your movement has been restored, if not then that’s our first priority. Our therapists can use a whole range of effective interventions such as vertebral mobilisations, lumbar distractions, and soft tissue techniques (4). A clinical study conducted in 2012 has shown that a significant reduction in pain intensity and improvement in body posture can be achieved by the usage of active physical therapy methods. Their methods included stretching muscles that articulate with the lower back and that are prone to hypertonicity such as the Iliacus, Psoas and the erector spinae, and strengthening muscles that are prone to weakness and hypotonicity such as the Glute Medius, Glute Max, and Hamstrings. This research is backed up by a whole host of other papers, Deyo and Weinstein(5) backed this up by finding that 97% of chronic lower back pain is due to musculoskeletal issues. Interestingly, international guidelines suggest it is not necessary to identify the specific tissue source of pain for the effective management of mechanical lower back pain, physical therapy interventions should effectively treat the root cause of the tissue dysfunction and therefore rectify it.

Strengthening the surrounding musculature and improving neuromuscular control of the area now will improve the support for the lumbar spine. Our therapists like to give you some homework when you leave our clinic, as what you do away from the session is just as influential as what we work on in your session. Exercises we might have you doing could include; Hollow holds- to improve the isometric strength of the abdominals, dead bugs – to improve neuromuscular control across the limbs and to utilise the myofascial sling effect, RDL’s or good mornings – to not only improve hamstring function but to get the spine stronger through flexion by strengthening the erector spinae. These are just to name a few but of course, the exercises we prescribe will be tailored to you and will work on your weaknesses. 

Finally, Movement retraining shouldn’t be ignored. This is because where you have been in chronic pain for a little while now, it is more than likely that the body has slightly changed the way that it works as it will always take the path of least resistance.

Our physical assessment would have highlighted any of these changes and as a part of your homework, we will be trying to correct these. We use these things called drivers and they are super effective. These drivers are fantastic for unlocking the ranges of motion that you haven’t been able to access due to chronic pain. A select combination of movements across all three planes of motion will allow open up of the affected joints 

Our team can help diagnose the cause of your pain and develop a treatment plan to alleviate it. This can include exercises, stretches, and manual therapy to improve mobility and strengthen the muscles that support the back. In many cases, physiotherapy can be more effective than relying solely on medication for pain management. If you’d like to find out more about how we might be able to help, visit our practice. Our clinic covers the surrounding areas in Essex, including Benfleet, Hadleigh, Southend-on-Sea & Leigh-on-Sea.

References:

  1. https://www.primarycare.theclinics.com/article/S0095-4543(04)00131-9/abstract
  2. http://dstore.alazhar.edu.ps/xmlui/handle/123456789/422
  3. https://www.sciencedirect.com/science/article/abs/pii/S0304395905005373
  4. https://journals.lww.com/clinorthop/Fulltext/2006/02000/Nonspecific_Lower_back_Pain__Surgical_versus.25.aspx
  5. Deyo, R. and Weinstein, J. (2001). Low Back Pain. New England Journal of Medicine, 344(5), pp.363-370.
  6. Koes, B.W., van Tulder, M., Lin, C.C. et al. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 19, 2075–2094 (2010)