Low Back Pain

It has been estimated that Low Back Pain will affect at least 85% of the population at some stage of their life.
While the majority of people recover rapidly from an acute episode, a very small percentage will continue with persistent pain.
Other than trauma, low back pain is often insidious in origin, likely to be associated with a complex combination of factors that predispose the patient to experience their specific symptoms.
Some factors associated with back pain may include, work, lifestyle, sport, psychosocial factors or genetic predisposition.


What can be done about your back pain?

By understanding your everyday lifestyle, work postures and movement strategies that elicit or diminish your symptoms, we can start to understand and treat some of the culpable tissues involved.
All back pain is not the same. The physical assessment seeks to identify the sensitized structures and underlying factors that drive the pain.

Treatment

Treatment is based on the underlying mechanism that drive the pain or disability.
It’s important and empowering that the patient takes an active role in their treatment.
Make patient aware of positions and movements that are stressors and aggravate pain.
Pain management with the use of; Manual therapies, dry needling and soft tissue techniques.
Improve movement patterns and biomechanics.
Patient specific graded exercises to improve stability and muscle endurance.
Sport oriented strength and conditioning if required.

Causes and Capacity

We all have a functional capacity to deal with all our daily functional demands, as long as we adapt or don’t exceed this capacity we remain pain free.
Pain and sensitivity are often a direct result of exceeding the functional capacity of anatomical structures, by inappropriately overloading them statically or dynamical leading to pain sensitization.

Why Look at Movement

A directional movement assessment can help us understand why a structure is under pressure and what approach we can take to relieve that pressure.
These activities can be as simple as prolonged sitting, getting out of a chair, turning over in bed, bowling in cricket or stretching to end range.
For example leaning forward while getting out of a chair sets of your pain. Then try standing up without flexing your spine. If this approach is pain free, it demonstrates bending forwards is a pain trigger.

Assessment

The assessment may vary depending on the history, chronicity, signs and symptoms linked to the disorder.
Should include a thorough history and elimination of any sinister problems (red flags).
Include all active motions and sport or work specific movements, including overpressure and compression.
Include balance and proprioceptive testing.
Use provocative or ameliorating movements of the spine.
Screen for pelvic and sacral dysfunction.
Screen foot/ lower limb movements, strength and endurance.
Screen for low back and abdominal strength and endurance.
Screen for low back/pelvis stiffness or instability.
Palpate the spine and muscles of the back and pelvis.
Palpate for trigger points.
Use nerve tension tests if required.
Use DTR, motor and sensory tests if required.
In sport knowing the mechanism of injury, can be fruitful, in determining the specific tissues involved.

Anatomy

The Vertebral Spine
The spine travels from the skull to the pelvis. In a normal spine it has three curves, an inwards curve in the neck (cervical spine) called Lordosis, an outwards curve in the mid back (thoracic spine) called Kyphosis and an inward curve again in the low back (lumbar spine) called Lordosis.
For an optimal spine these segments should be balanced, known as a neutral spine.
Bones and Joints
Each individual bone of the spine is called a Vertebra with bony protrusions called processes, these act like levers for the muscles. The top and bottom of each vertebra has an End Plate allowing for diffusion of nutrients to the Disc.
Attached to the vertebra are the two Facet joints surrounded by its capsule, these guide the movements of the vertebra adding support and stability during movements.
Discs
Between each vertebra there is a Disc it provides some space between the vertebra allowing some cushioning and a degree of bending.
The outside rings are made of tough collagen tissue, while the inside is called the Nucleus made of a gel like substance that helps distribute the load throughout the disc.
The disc may increase 1-3 millimeters in height, because of fluid dynamics in horizontal position during the night.
Spinal Nerves
The spinal cord travels from the brain down the spinal cord, with nerves exiting at each spinal level.
Damage to the spine or disc can damage or irritate the nerve leading to a variety of symptoms including pain.
Sciatica: refers to pain that originates from the lumbar plexus (L4-S1) of the lower back, and is felt into the buttocks and along the back or side of the leg.
Muscles
The ligaments and muscles manage the integrity and movement of vertebral.
Muscles manage the motions and postures of the spine. They can act like guywires helping us control the various movements and shear forces applied to the vertebra of the spine.

Low back pain treatments available with Raymond Smith, Chiropractor, 114 Alexander Street, Crows Nest, NSW 2065


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