In today’s era Low back pain is the most common ailment affecting our lives. Low back pain can be classified into
1) Mechanical (or Acute low back pain) : which occurs due to poor postural habits and
Poor postural habit leading to mechanical low back pain
2) Anatomical ( chronic low back pain) that is commonly a result of a clearly identifiable cause I.e. – herniated disc
– degenerative disc disease
– spinal stenosis
– spondylolysthesis
Disc herniation causing low back pain
Disc herniation leading to pinched nerve
Spondylolysthesis: cause of low backpain
Mechanical LBP can be successfully treated with physiotherapy i.e conservative treatment protocol.
For Chronic pain treatment : conservative Physiotherapy , medication ,vitamin and mineral supplementation should be done first before recommending surgery.
It has come into our notice that many orthopaedicians / neurosurgeons nowadays are recommending surgery for the correction of disc bulge/ herniated discs at an early stage of diagnosis.
This further adds on to the misery and suffering of the patient.
However, most people who have low back pain with MRI reports showing a mild disc bulge, or a bulge at for example L4-L5 or L5 -S1 or anterolysthesis L4 over L5 doesn’t need surgery. Conservative treatment plays a major role and should always be the first option when you have lower back pain that is not caused by major trauma.
Pain-relieving medication is usually necessary for herniated disc.
Also the patient should not be advised for complete bed rest , slight amount of mobility is good for the patient , so long as their symptoms are not aggravated.
This is based on the fact that research shows no significant difference between bed rest and staying active, and that there is no evidence that staying active is harmful for either severe low back pain /Sciatica/ herniated disc. A “Back Brace ” can be helpful to improve posture and relieve pain by preventing aggravating movements.
Physiotherapy treatment aims to minimise joint stiffness, improve mobility/ decrease pain and improve core muscle strength of surrounding musculature. This is achieved using passive joint mobilisation, manipulation of the spinal joints and self mobility exercises/postures along with the use of electro therapeutic modalities which relieves pain.
Manual therapy in the form of spinal manipulation has also been shown to be effective in the treatment of disc related problems and Sciatica/ spondylolysthesis .
This can relieve nerve root compression caused by fibrous scar tissue following a disc prolapse, or the build up of gas (Nitrogen). This gas build up is a consequence of disc degeneration and tends to be more common in those aged over 40. Usually, the main exercise is spinal extension which is leaning backwards by propping yourself up on your elbows when lying on your front. This mobilises the joints but more importantly closes the area of the prolapse and reduces the disc prolapse. If the disc prolapse is reduced , the tear in the disc can heal.
In order to avoid a recurrence of the problem it is important to take better care of the back in future. An understanding of good posture is necessary to achieve this.
In the long term, “good posture ” is maintained by increasing the muscular stability of the spine, but an effective aid to improve sitting posture is a Sitting Support that can be used when driving or when sitting in the office.
Sitting postureCorrect way to wear a backpackCorrect driving postureCorrect way of carrying a baby!Correct lifting postureCorrect Sitting postureCorrect Posture versus bad posture
Correct Sitting Posture
In our view, we advice you to first consult a Physiotherapist before taking the risk of surgical procedures as efficacy and success rate of conservative management is markedly proved in low back pain cases.
We here at Physioheal have also managed and treated such cases so well and completely with the use of conservative forms of Physiotherapy , Spinal mobilization and manipulation. , that we have reduced the chances of surgical methods of treatment ( used for disc bulge/ prolapse disc) by a larger percentage.
L5 Sacralisation and lumbar disc bulge/ shift in base of support while sitting
Written By: Dr Sunita Sharma ( PostGraduate Neuro Physiotherapist)
