How physiotherapy treatment is helpful for back pain?

"Pain is inevitable, but suffering is optional."

The occurrence of lower back pain is alarming with nearly 80% of the people globally, having endured it at some point during their lifetime. The changing lifestyles, eating habits and long working hours are leading to people suffering with chronic pain at large. Work environments have evolved where sitting at a desk for hours on end has become the norm. Joseph’s passion for accounting & numbers led him into one such job.

Joseph had not been a very active person, and with age he started experiencing a common affliction among desk dwellers: low back pain. It started as a mild stiffness and ache which he ignored, but soon it escalated into a severe pain which made even simplest daily tasks feel like a burden. He consulted a doctor and started a course of painkillers using pain relief sprays under duress. With treatment, he found relief but soon the pain came back stronger than the last time. That is when Joseph’s orthopaedician recommended him to undergo physiotherapy treatment for low back pain.

With the help of his physiotherapist, Joseph learned exercises and stretches that targeted the root of his back pain. It wasn’t easy, but he stuck to his physiotherapy regimen, and gradually the pain began to subside. Through this journey, Joseph discovered that the key to overcoming low back pain is not just treating the symptoms but addressing the underlying cause as well. With this newfound knowledge of how to take the best care of his back and physical wellbeing, Joseph successfully beat the pain and returned to living a fulfilling life.

We are about to share that same secret with you without you having to undergo the excruciating backbreaking journey that Joseph took. Pursuant to that, we’ll learn about our spine anatomy, various causes of back pain and how to best manage them.

Understand your Backbone (Spine)

Our spine consists of strong bones, big muscles, extremely sensitive nerves, and flexible ligaments and tendons. It contains a total of 33 vertebrae that are divided into 5 distinct spine segments i.e. :

1. Neck (Cervical)

2. Upper Back (Thoracic)

3. Lower Back (Lumbar)

4. Hip (Sacral)

5. TailBone (Coccygeal).

The spinal column is extremely strong and highly flexible, allowing for mobility on a variety of planes while protecting the extremely sensitive nerve roots. The intervertebral discs between your vertebrae serve as cushions or shock absorbers for your spine as it moves. Injury to any of these body parts can lead to back pain.

Causes of Back Pain

The most common causes of back pain are due to strains, sprains or structural problems to the back. Strain or sprain can be caused by:

• Incorrect posture while lifting heavy objects.
• Sudden awkward movement.
• Sports injuries
• Incorrect posture while sitting.

Several other factors can also increase the chances of developing back pain. They include:

Fitness Levels: Lack of physical fitness can put one at risk for back pain. This is because weak back and stomach muscles(core strength) cannot properly support the spine.

Weight Gain : Obesity caused by an inactive lifestyle and a diet high in calories and fat can put unnecessary stress on the back

Job-related risk factors : A job that requires a lot of physical activity like heavy lifting, pushing or twisting can increase the risk of a back injury. Even at a desk job, sitting all day with a poor posture can affect the back.

Age: As people age, the chances of developing back pain increases due to degenerative disk diseases.

Nutritional Deficiency : Various vitamins and minerals are essential for our muscles to function properly and for the proper transmission of nerve stimulus to the spinal cord. Some of the most important vitamins and minerals are vitamin D, Magnesium, Potassium and calcium. Deficiency of these vitamins can lead to back and muscle pain.

Due to prolonged stress, structural problems might occur in the spinal column, leading to back pain. Some such ailments are listed below:

• Ruptured Discs - Intervertebral discs cushion each vertebrae in our spine. Rupturing of these discs can put more pressure on the nerves causing back pain.
• Bulging Discs - Bulging discs can also result in added pressure on the nerves.
  
  

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• Sciatica - It is caused by a bulging or herniated disc pressing on the “Sciatic nerve”. It results in a sharp and shooting pain through the buttock and down the back of the leg.
• Arthritis - Arthritis of the Spine is caused due to inflammation of the joint between the bones of the spine, known as facet Joints. The inflammation could be due to various factors such as wear & tear, autoimmune disorders etc. Hence, immediate medical attention is necessary with early detection of Arthritis of Spine.
• Osteoporosis - This causes the bones in the vertebrae of the spine to become porous and brittle. Thus increasing the chances of compression fractures.
• Spinal Stenosis - It happens when the space in the spine narrows. Thus compressing the spinal cord and nerve roots that travel through the spine.
• Scoliosis - Scoliosis is an abnormal sideways curvature of the spine. It is usually diagnosed in children and early adolescents. It can lead to lower back pain, back stiffness, pain and numbness in the legs due to compression of the spinal nerves.
  
  

• Sacroiliitis - Sacroiliitis is an inflammation of the sacroiliac joints. This joint connects the lower spine to the hip. Sacroiliitis causes pain and stiffness in the lower back, buttocks or thighs. It is difficult to diagnose since many other conditions also cause pain in the same area.

Different Types of Treatments for Back Pain Home Remedies

In most of the cases of back pain, it gets better by simply giving your body a much needed rest. This means reducing the level of activity for a few days. Here are some tips to provide back pain relief at home:

• Lying on your back, with a pillow under your knees can help keep your back in a neutral position.
• Lying on the floor with the knees bent at a 90- degree angle and kept on a chair, can also provide some relief.

It's important to note that longer periods of inactivity is not advised as it can cause your muscles to weaken.

Other home remedies such as heat and ice packs can also help in increasing one's mobility and reducing the pain. The ice packs will help in reducing the inflammation on the affected areas and switching to a heating pad after a few days will loosen the tight muscles that cause the pain.

Over-the counter pain relievers such as Paracetomol, Non-steroidal anti inflammatory drugs(NSAIDs),Ibuprofen are also effective in managing pain and swelling due to back pain.

Injections

Injections will only reduce or stop the pain for a certain period of time, they are not intended as a long term solution and it should always be used under the care of a physician. Some of these injections include Epidural Steroid Injections, Radiofrequency Ablation and Nerve Blocks

Medication

Over-the-counter Medication

Over-the-counter pain relievers such as Paracetomol, Non-steroidal anti inflammatory drugs(NSAIDs),Ibuprofen are also effective in managing pain and swelling due to back pain.

Prescription Medication

If over-the-counter medications do not relieve the back pain, getting prescribed stronger medication from doctors is another option. Antidepressants, narcotics such as codeine and opioids are some of the medications that can be used. These medications have an addiction risk and should be used only for chronic back pain and should not be a long term solution.

Exercise

Most people would avoid exercises when experiencing back pain, but physical activity is an effective way to recover faster. It also helps in maintaining a healthy weight during this period as excess weight can put added pressure on the joints. Swimming and walking also helps in maintaining a healthy back and weight.

Surgery

Surgery is usually opted by patients who have severe back pain and have not responded to other treatments such as physiotherapy and medication. Surgery can be an option for people suffering with:

• Chronic, constant pain caused by structural abnormalities of the spine
• Nerve compression - Surgery to treat nerve compression helps in reducing the persistent pain and numbness in the legs caused by pressure applied on the nerves in the spine.
• Spinal cord compression
  
  

What is Physiotherapy?

The field of physiotherapy concentrates on helping patients with physical impairments, improving their mobility and functional ability, and maintaining healthy muscles to prevent the recurrence of the pain.It also helps in easing pain and stiffness in muscles, joints and bones. Physiotherapy treatment for back pain is a mixture of both passive and active treatments. In passive physiotherapy the patient does not need to move their muscles. Since it does not demand much effort from patients, it is used when the patients are in too much pain or unable to move. In active physiotherapy the patient is required to exert their joints and muscles. It is extremely important for the rehabilitation of the spine.

Thus, therapy for lower back pain provides a high quality of life to patients suffering, as it increases their mobility, range of motion and helps in maintaining a strong back. The common misconception is that physiotherapy is all about exercise. It is a degree-based field that falls under healthcare. Physiotherapists are highly qualified and possess a tremendous amount of knowledge in anatomy, physiology, biomechanics, and the musculoskeletal system.

Is Physiotherapy good for back pain?

One of the biggest question that patients ask when considering physiotherapy for back pain, is how good is physiotherapy for back pain. To answer that question some of the advantages of back pain therapy are listed below:

• Patient centred and custom tailored: One of the main advantages is that the physiotherapy treatment for each patient is tailor-made to fit their individual needs. A physiotherapist will take into account a patient's body type, weight, age, lifestyle and other existing health conditions. The physiotherapist will also modify the treatment plan as it progresses, depending on how the patient responds to different types of physiotherapy techniques.
• Restoring strength and mobility: Physiotherapy not only focuses on reducing the pain, but also finding the root cause of discomfort. Physiotherapy exercises help to restore mobility through various strengthening and flexibility exercises for your back and surrounding areas.
• Reduces the need for medication: Medication may seem effective initially to manage the pain. But it comes with significant downsides. Some pain medications can become addictive, stop being effective, and cause other side effects. The various techniques used in physiotherapy helps patients reduce their need for pain medication or avoid it completely.
• Reduces the need for surgery: Surgeries are invasive, risky and require a long time to recuperate from. There is also the factor that surgeries are much more expensive than physiotherapy treatments. Physiotherapy helps in avoiding or delaying surgery through a regular plan that is updated as the treatment carries on.
• It is also observed that people who participate in physiotherapy treatments for back pain are less likely to experience a relapse of their pain leading to less visits to a doctor.

What can a physiotherapist do for back pain?

Physiotherapy Treatments for Pain Relief and Relieving Muscle Spasms

Lower back spasms usually happen suddenly, causing intense pain. It usually occurs due to overuse and muscle fatigue. They typically occur after a strain or an injury to soft tissues in the spine or surrounding areas.

Muscle spasms are our body's way of protecting these injured muscles or other sensitive tissues from movement, so that they don't get further injured. The following techniques are used by physiotherapist to reduce the muscle spasms and the pain associated with it:

• Deep Tissue Therapy : This technique is mainly used to target the spasms and severe muscle tensions that may arise due to strains or sprains caused by abrupt and awkward movements or lifting heavy objects improperly. It entails applying steady pressure on the inner layers of your muscles and connective tissues with deep, gentle strokes. This helps to loosen up scar tissue that develops after an injury and reduce muscle and tissue tension.
• Hot and Cold Therapies : Generally, physiotherapists alternate between hot and cold therapies. The heat therapy helps in enhancing the blood flow to the targeted area as this will deliver more oxygen and nutrients to the injured area. Blood is also necessary for the removal of the waste products produced by muscular spasms and aids the healing process.
• Transcutaneous electrical nerve stimulation : Also known as TENS, is an electrical stimulation technique that primarily seeks to reduce certain chronic pain by stimulating the sensory nerves. It uses varying intensities of electric current to stimulate your muscles.
  

• Ultrasound : An ultrasound aids in reducing muscle cramps, spasms, edema, stiffness, and discomfort by enhancing blood circulation. This is accomplished by transmitting sound waves deep into your muscles, which produces a mild heat that promotes healing and circulation.
• Stretching exercises help in reducing muscle tensions and muscle spasms. People experiencing muscle spasms usually limit their movement and do not perform such exercises. But simple stretches like the following can help in reducing the pain and muscle spasms:

• Child’s Pose:
  • Kneel on the ground with your knees apart.
  • Stretch up and then fold forward, bringing your chest down to your thighs.
  • Stretch your arms forward in front of your head, with palms down and elbows resting on the floor.
  • Hold this pose for 30 seconds to 1 minute.
    

• Hamstring stretch while standing:
  • Stand straight on your right leg, with your left leg on a table or a chair.
  • Stretch the left hamstring by slowly bending the right knee.
  • Hold for 10 seconds.
  • Repeat with the other leg to stretch the right hamstring and gently return to the starting position.
    

• Hip Stretches:
  • To stretch your hips, kneel on your left knee and place your right foot forward, with the right knee bent.
  • Hold your left foot with your left hand for 4 seconds, to pull it upwards.
  • Gently release the foot, switch the legs and repeat with the other leg.
  • Finally, release the other foot and return to the starting position.

• Wall Stretch:
  • Stand at an arm's length from a wall.
  • Press your palms against the wall at shoulder level.
  • Lean towards the wall with your upper body, but without moving your palms.
  • Hold this position for 5 seconds.

Physiotherapy Treatments to Increase Mobility of Spine

The next step in physiotherapy for back pain, is to increase the mobility of the spine, which has been affected by chronic pain experienced by the patient. Manual therapy is a key technique in physiotherapy treatment for low back pain. It includes restoring mobility to stiff joints and eliminating muscular tension. This helps the patient to move more naturally and pain-free. In manual physical therapy, physiotherapists use their hands to apply pressure on muscle tissue and manipulate joints. This reduces the back pain brought on by muscle spasm, muscle tension, and joint dysfunction.

A complete assessment of bone and muscle in the affected area as well as the blood and nerve supply is done by the physiotherapist, so as to make sure that the use of these physiotherapy treatments for back pain does not increase the risk of complications. The physiotherapist may carry out some or a mix of the following manual physiotherapy techniques, depending on the findings of the examination and the unique circumstances of each patient:

• Joint Mobilisation : Joint mobilisation involves applying pressure at a slow speed and increasing amplitude movement(increasing distance of movement) directly into the barrier of a joint, moving the actual bone surfaces on each other in ways patients cannot move the joint themselves. This loosens up the restricted joint and increases its range of motion.
• Muscle Energy Techniques : This technique for back pain therapy aims to extend shortened muscles and mobilise restricted joints. This method is described as using the patient's muscles to contract voluntarily while the physiotherapist applies a clearly regulated counterforce from a precise position and in a specific direction. After a 3-5 second contraction, the physiotherapist moves the joint to its new barrier, where the patient contracts their muscles once more. This is usually repeated 2 or 3 times.
• Strain-Counterstrain : This method focuses on removing unpleasant "tenderpoints" caused by abnormal neuromuscular reflexes that lead to structural and postural issues.By asking the patient when the soreness starts to fade, the therapist can determine the patient's preferred position. The patient is held in this position of comfort for about 90 seconds, during which time asymptomatic strain is induced through mild stretching, and then slowly brought out of this position, allowing the body to reset its muscles to a normal level of tension. This normal tension in the muscles sets the stage for healing. The main advantage of this method is that, it is gentle enough to be utilised for back pain problems that are too delicate to be treated with other techniques.
• High velocity, Low Amplitude Thrusting : The purpose of this therapy is to give joints their normal gliding motion so that they can open and close efficiently. A joint is taken to its limiting barrier and thrusted there, but not past the barrier. This is a more aggressive approach than joint mobilisations and muscle energy procedures. If used correctly, one should feel improved mobility and decreased muscle tone around the joint.

Below are some exercises to improve the mobility of the spine:

• Double Knee to Chest stretching:
  • Lie on your back on the floor with both knees bent, and feet flat on the floor.
  • Using your hands pull the left knee in towards your chest and hold your knee against your chest.
  • Keep your abdominal muscles tight and spine pressed to the floor.
  • Gently release the knees to the starting position and repeat with the other leg.

• Cat-cow Stretch:
  • Get on all fours on the floor with your knees under your hips and your hands flat on the ground in line with your shoulders.
  • Take a deep breath and arch your back while extending your head back.
  • Then exhale and round your back while pushing your chin toward your chest.
  • Repeat 5–10 times.

• Trunk Rotational Stretches:
  • Lie on your back with your knees bent and feet flat on the ground.
  • Keep the shoulders firmly on the floor
  • Gently roll both bend knees over to the left side.
  • Repeat the exercise by rolling the knees to the other side and return to the starting position.

• Lying Lateral Leg Lifts:
  • Lie on the right side with both the legs together.
  • Keep the right leg slightly bent.
  • Draw the bellybutton into the spine to engage the core muscles.
  • Raise the left leg about 18 inches, make sure to keep the leg straight and extended.
  • Gently return to the starting position.
  • Now repeat the exercise by lying on the left side.

• Trunk Flexion stretch:
  • Get down on both hands and knees.
  • Tuck your chin in between your arms and arch back.
  • Slowly sit back on your heels, while letting your shoulder drop towards the floor.
  • Hold for 7 seconds.

• Pelvic Tilts:
  • Lie on the floor with your knees bent and feet flat, with your arms by the side.
  • Gently, arch the lower back and push the stomach out.
  • Hold for 5 seconds, then relax.
  • Flatten the back and pull the bellybutton in towards the floor.
  • Hold for 5 seconds, and then relax.

Physiotherapy Treatments for Muscle Strengthening

The initial stages of physiotherapy treatment for back pain focuses on managing the back pain, by reducing muscle spasms and increasing the mobility of the spine. The next phase of therapy for lower back pain is to strengthen the lower back as well as increase its flexibility, with the help of strengthening , stretching and mobilisation exercises. Exercises are an integral part of back pain therapy and is regarded as the best physiotherapy for back pain. These exercises for the lower back, support the upper body by stabilising the lower spine.
Some of these exercises are:

• Glute Bridge:
  • Lie on the back with the knees bent and the feet flat on the floor, hip-width apart. Place the arms down by the sides of the body with the palms of the hands facing upward.
  • Tighten the abdominal muscles and squeeze the gluteal muscles.
  • Lift the pelvis off the floor. Continue to lift so that the body forms a straight line through the shoulder, hip, and knee.
  • Hold the position for at least 2 seconds.
  • Slowly return to the start position.
  • Repeat the steps above 10–15 times.

• Cobra Stretch:
  • Lie in the prone position and keep your hands on either side of the chest.
  • Keep your feet planted firmly on the floor and press into your hands as you push your upper body, from your chest to your head, upward.
  • Hold this pose for 10 seconds and then gently lower yourself.

• Bird-Dog:
  • Begin the exercise on the hands and knees, with the shoulders directly over the hands and the hips directly over the knees.
  • Tense the abdominal muscles and stretch the right arm straight out in front of the body.
  • Hold the position while staying balanced.
  • Slowly lift the left leg and extend it straight out behind the body.
  • Hold the position for 15 seconds.
  • Slowly return to the starting position and repeat on the opposite side.
  • Repeat 5 times.
    
• Alternate Arm Leg Extensions:
  • Get down on your hands and knees.
  • Keep your spine straight, with your hands directly below your shoulders.
  • Keep your knees aligned directly under your hips.
  • Slowly raise and extend your right arm while extending the left leg.
  • Keep the extended limbs straight and at the same level and make sure to not arch your neck.
  • Hold for 5 seconds and gently lower your arm and leg to starting position.
  • Repeat with opposite limbs.

• Superman Exercise:
  • Lie face down on the ground and stretch both arms out in front of the body.
  • Keep the legs stretched out and flat on the ground.
  • Look straight and raise both the hands and feet about 6 inches off the floor, stretching them outward as much as possible.
  • Try pulling in the bellybutton and hold the position for 2 seconds.
  • Gently return to the starting position.

• Partial Curls:
  • Strong abdominal muscles are very crucial in supporting the spine and maintaining proper hip alignment. To do this exercise.
  • Lie on the ground with your feet flat on the floor, keeping your knees bent.
  • Cross your hands over your chest.
  • Take a deep breath. While you exhale, brace your abdominals by pulling your belly button in toward your spine.
  • Slowly lift your shoulders off the ground a few inches. Try to keep your neck in line with your spine instead of rounding, to avoid pulling up with your neck.
  • Return to the starting position.
  • Repeat 10 times. Perform 3 sets.

Conclusion

As we move into a highly industrialised and automated era where sedentary work is common, it brings about associated health problems also. This dramatic reduction in movement and activity not only results in the development of diseases such as cardiovascular diseases and obesity, but also leads to the rise of musculoskeletal disorders like back pain. These musculoskeletal disorders are common among office workers worldwide due to the absence of physical activity, lack of movement and the sedentary lifestyle. It has also been reported that lower back pain is the leading cause of disability, with almost 80% of the people experiencing back pain at some point in their lives. Most of the people who experience back pain try to manage their pain by taking painkillers and not getting the necessary medical attention. Using such narcotics is only a short term solution and can become addictive. Studies show that early intervention of back pain with physiotherapy is associated with lower costs and reduced risk of invasive procedures such as surgeries.

The pain relief and improvement in mobility and functionality provided by physiotherapy is long lasting and helps one to return to everyday life.