Clinical
Practice Guidelines Low Back Pain Physical Therapy
If you have low back pain, you are not alone. Most people in their lifetime experience one or more
episodes of low back pain. In most
cases, the pain goes away within days to weeks; however, it can last for three
months or more. These extended episodes are defined as chronic low back pain.
The common treatment approaches for low back pain include exercises, relaxation
techniques and medications.
To understand how these treatments work, let’s first
look at the structure of your lower back. The spinal column is made up of
twenty-four vertebrae. Back problems and back pain commonly occur in the lumbar
region. Each vertebra has an opening that forms the spinal canal and protects
the spinal nerves. Facet joints and inter vertebral discs connect the vertebrae
above and below. These structures are held together by groups of ligaments and
muscles.
Muscles attached to the spinal column allow us to move,
and they also support the spine bearing the body's weight. If some of these
muscles are tight, weak or imbalanced, pressure can result in excessive wear
and tear of other structures. For example, a common problem in the lower back
is disc herniation. In this case, pressure on an intervertebral disc has caused
its center, the nucleus pulpous, to protrude backwards and push against the
spinal nerves, resulting in low back pain.
Clinical
Practice Guidelines Low Back Pain Physical Therapy
For some patients, this pain can also be felt in
nearby areas where the spinal nerves from the lower back also extend, such as
the leg and foot on the affected side. Exercise can relax muscles and reduce
pressure in the lower back structures.
It is important to consult your health team to determine which exercises
are best for your condition. Consider one common low back pain exercise program
called the McKenzie Method.
For patients with posterior disc herniation, lying in
a prone position reduces the pressure on the disc. If the pain condition allows, performing
extension movements can gently stretch and relax tight muscles. Your lower
spine also becomes more arched, with time, bringing the disc center forward
into the correct position and reducing the irritation on your nerves, therefore
decreasing the pain in your lower back and legs.
The benefit of exercising is more than just reducing
the pressure on your lower back structures. By integrating back exercise into
your daily routine, you can condition your abdominal and back muscles, referred
to as core muscles, and therefore prevent low back pain from happening again.
For some patients, relaxation techniques such as meditating in a relaxed
position, as well as cognitive behavioral therapy, can ease back pain.
This is because our brain not only perceives pain but
also regulates pain signals. When back structures are damaged, pain signals
ascend from the lower back through the spinal cord arrive in the brain region
that perceives pain, the sensory cortex. However, this is not a direct route;
at least two connections have to be made.
It’s at these relay stations, which include the spinal cord and the
thalamus, that pain signals can be regulated by the brain.
Let’s take a closer look at the first relay station
located in the dorsal horn of the lumbar spinal cord. Here, the incoming pain
signals are passed from a sensory neuron in the lower back to a relay neuron in
the spinal cord. The pain signals then ascend up to the brain. This pain
impulse can be reduced by a specific type of neuron carrying signals back from
the brain. As a result, fewer pain signals are sent to the brain, so we feel
less pain.
However, if for instance you are stressed, these brain
signals can increase the pain signals. Therefore, studies show that patients
with depression or anxiety experience more pain, while patients who have
positive attitudes and are engaged in their treatments feel less pain. Your
health professional may also suggest that you take pain-relieving medications
that fit with your existing medication regimen. The effects vary greatly
depending on what type of medication is prescribed.
Some medications help relax muscles and some act on
neurons in the relay stations to reduce the pain signals. It is important to
follow the advice of your health team and do exercises, learn relaxation
techniques and perhaps take medications. The benefits might not be felt right
away; it takes time and your active participation. By taking an active and
informed role in your own health. You are guaranteed to better control your pain and
lead a healthier life!,
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