Lower Back Pain Physiotherapy
Lower back pain is the most common complaint seen in physiotherapy practices across the western world. It is second only to the common cold as a primary cause of sick leave in Ireland with sufferers taking an average of 11 days off work a year due the condition. Statistics show that over 80% of the population will suffer from lower back pain at some stage in their lifetime. The vast majority of people will recover from an episode of lower back within 2-6 weeks. In up to 30% of cases however back pain persists or re-occurs often due to inadequate rehabilitation.
It is important that all back pain sufferers seek professional help early for an accurate diagnoses and a comprehensive treatment plan to help relieve symptoms and address any underlying causes. There are a number of structures in the lower back which can result in lower back pain, when injured. These include the muscles, ligaments, facet joints, nerves and intervertebral discs. Below is a list of conditions which can cause lower back pain.
Conditions associated with Lower back Pain
- Schuermanns disease
- Sacroiliac joint problems
- Disc related lower back pain
- Ankylosing spondylitis
- Muscle strains
- Facet joint syndrome
- Disc herniation
- Pinched nerve
Like all other parts of the body the lower back is comprised of numerous muscle groups, these muscles work to stabilise and move the lumbar spine and pelvis. Occasionally the muscles in the lower back become overloaded as a result of vigorous activity or heavy lifting and bending movements resulting in a strain. A strained or torn muscle in the lower back leads to inflammation and pain at the site of injury. Particular movements of the lower back which stretch or place stress on the injured muscle are usually painful and the area is often tender to touch.
Facet Joint Syndrome
The facet joints lie between and behind adjacent vertebrae and allow for bending, twisting and rotational movements of the spine. Under normal circumstances these joints glide smoothly over one another allowing for pain free movement in all available directions. Occasionally when placed under prolonged periods of stress (i.e. extended periods of sitting with poor posture or falling asleep in an awkward position at night) or due to sudden overloading of the joint, the joint surfaces can become compressed together leading to inflammation, irritation and reduced joint motion.
What are the Symptoms of Facet Joint Syndrome?
Often it is very hard to diagnose Facet joint Syndrome based on symptoms alone as many of the common symptoms associated with facet joint injury mimic that of other common lower back pain problems. Typically patients will complain of localised pain in the area of the injured joint(s) however occasionally there can be referred pain into the buttocks, thigh or groin. Pain is often aggravated by certain movements which compress or stress the injured facet joint, typically bending backwards or to the side that is injured. The injured area usually feels stiff and movement is restricted due to pain.
How is Facet Joint Syndrome treated?
Typically facet joint injuries are treated with a combination of hands on manual therapy and corrective strengthening and stretching exercises to prevent pain reoccurring. Hands on manual therapy usually consists of joint mobilisation and deep tissue massage techniques to restore normal joint movement and alleviate symptoms of muscle tension. Spinal decompression therapy may also be used to provide gentle and painless separation of jammed facet joints.
Herniated or Bulging Disc
Commonly referred to as a “slipped disc”, herniated discs occur when the nucleus of the disc (a soft jelly-like substance in the centre of the disc) starts to push outwards against the disc wall resulting in a protrusion or bulge. In some cases excessive pressure can lead to a tear in the disc wall and leakage of irritating disc substances onto nearby tissues and nerve roots. This leakage can result in both localised and/or referred pain down the into buttock, leg and foot. Where the disc herniation is severe it may compress on the nerve root itself causing pain, altered sensation (pins/needles, numbness, burning) and sometimes weakness in the leg. Disc herniation is often the first sign of degenerative disc disease and is common in the lower back and neck.
Causes of Disc Herniation?
There are a number of factors which can affect the health of discs and increase the risk of herniation. Mechanically, a stiff spine that doesn’t move well and/or weakness in the surrounding tissues that support the spine, means that other structures including the discs are forced to withstand greater stresses. This places the discs at a higher risk of injury. Other contributory factors to the deterioration of disc health include poor lifestyle choices such as lack of general exercise, prolonged sitting, smoking, poor dietary habits, and obesity. Additionally poor posture, heavy lifting, bending activities, and history of previous injury can increase susceptibility to disc injuries.
How is disc herniation treated?
The treatment of disc herniation must target both the source and the factors which are contributing to the injury. In mild to moderate cases treatment may involve a combination of joint mobilisation and soft tissue massage techniques to help regain pain free movement and the use of correction strengthening and stretching exercises to prevent reoccurrence. In more severe cases of disc herniation spinal decompression therapy may be used to reduce pressure on the injured disc and aid healing.
The term pinched nerve is often used to describe symptoms of nerve pain in the body. Common examples of conditions which are caused by nerve related pain or injury include carpal tunnel syndrome, thoracic outlet syndrome, sciatica, piriformis syndrome. In all of these conditions inflammation or tightness/ spasm in the surrounding muscles and connective tissues leads to the nerve becoming compressed and irritated. Compression of peripheral nerve fibres causes pain and altered sensation (i.e. pins/needles, numbness, weakness) in the areas supplied by the nerve.
How is a pinched nerve treated?
Treatment of a pinched nerve is aimed at releasing the structures which are compressing the nerve such as the muscles and connective tissue. In most cases this involves the use of manual therapy techniques, dry needling and corrective stretches.