• Physiotherapist Treatment of Acute Lower Back Pain

    May 1, 2013 | News
  • “I Bent forwards and then couldn’t get Back up…”

    What have I done to my back?…

    Acute Lower Back Pain is one of the most common conditions that we as Physiotherapists see. It can occur from even the most minor of events, such as leaning over to pick something small off the floor, or sneezing. The pain experienced can range from being reasonably mild to the point of being unable to move. The area in which the pain is felt can also vary – from being concentrated in the Lower Back to being felt into the leg. The Lumbar Spine (lower back) has a number of structures in it that can be affected when an injury is sustained. The major ones include: – the discs between vertebrae – the Facet joints (the joints joining vertebrae together) – and/or the muscles in the lower back. In many cases, there will be a combination of the above.

    So what does my diagnosis actually mean

    When you first consult your Physiotherapist, you will be made to perform a series of movements and tests that will help the therapist get a better idea of where the pain is actually coming from. When the disc is involved, it usually means that the outer ring, the Annulus Fibrosis, is damaged, and could be causing a “disc bulge”. In severe cases, the disc can tear right through, causing what is known as a Disc Herniation or more commonly known (but incorrectly) as a “slipped disc”. When the facet joints are involved, the pain may be more concentrated on one side of the lower back, with accompanying restriction in movement.

    The Joints in the lower back can be injured in the same way as other joints in the body, such as the ankle. This means that they can also suffer from sprains, and cartilage dysfunction. Commonly with injuries to the facet joints the swelling process is set off, as with any other joint injuries. This means that swelling will occur, which puts pressure on the surrounding structures in the lower back, and increases the intensity and area of the pain felt. In many conditions, there will be an element of neural or ‘nerve’ involvement, with either tightness or a loss of sensation being felt in your extremities. Although indicative of a more serious problem, this does not mean that the problem cannot be resolved reasonably quickly.

    What Do I Need to Do?

    STAGE 1: PAIN MANAGEMENT Rest: Avoid using the back in anything even remotely strenuous. Ice: Early; Often in the first 48 hours, over the area of pain; 15-20 minutes every 2-4 hours. Try to keep the back moving within your range without pain – this will reduce stiffness and prevent muscle wasting. Contrary to popular belief, complete immobility is not ideal. Taping may be an option to help with immediate pain relief.

    Seek treatment.

    STAGE 2: SUB-ACUTE MANAGEMENT What Next? Pain reduction and Restoration of movement will be the focus of treatment at this stage. Manual Therapy applied by the Physiotherapist will likely be the main treatment modality used. Soft Tissue (e.g. Muscle) manipulation are likely to be used by the Physiotherapist. Your Physiotherapist will guide you as to what you should expect, according to you individual condition.

    STAGE 3: RETURN TO FUNCTION Once movement has started to return, and pain begins to subside, the focus of treatment will turn towards restoration of function. In some cases, a graded rehabilitation programme will begin, aiming at ensuring that no muscle strength is lost, and that core stability is maintained. Your Physiotherapist will guide you through any rehabilitation programme step by step. Return to normal function at work will be a major goal – ensuring that you are able to perform your work tasks safely and comfortably. In this stage, time frames can be hard to quantify for injury resolution. The initial severity and the structure injured in many cases is the main determinant as to how long the injury may take to resolve. If you are at all concerned about how long the injury is taking to resolve, do not hesitate to speak with your therapist.

    A Final Word… Remember, each individual is different. Almost all patients will progress at different paces, and will have different end goals, meaning that rehabilitation programs will differ substantially between individuals. Each stage will have certain goals that your Physiotherapist will look for you to achieve before moving onto the next stage. Working together with your Physiotherapist, you will achieve the best outcome for your injury. If you have any queries about the rehabilitation programme that you are given, please discuss this with your treating Physiotherapist.