Q. After years my ongoing back pain, my New Year’s resolution is to get rid of it for once and for all in 2011. What could physiotherapy offer me? Ms. M.McC. Roebuck
Chronic ongoing or episodic back pain is extremely common but nowadays in many cases, very treatable with conservative management. Research teams around the world have given us clinicians working in chronic back pain better information about how and why some back pain keeps coming back.
The first thing from a physiotherapy viewpoint would be to assess your back and work out the individual components of your pain. This allows us to assess in detail the different components of an individual’s presentation and devise specific treatment strategies that work to optimise function and control pain.
The main components break down into mechanical causes of back pain, muscle dysfunction, nerve impingement, weakened back muscles and perhaps surprisingly, faulty learned pain behaviour.
In terms of faulty mechanics in the spine, wear and tear, degeneration, arthritis or the presence of disc bulging or prolapse, all alter movement of the lower back region. Physiotherapy, manual therapy, flexibility exercise, and medical acupuncture along with relearning better movement patterns can address mechanical back pain successfully.
If ongoing nerve pain, or sciatica, is part of the reason for your symptoms, the pain may come from local nerve scarring from old injury. Nerve pain can cause what the pain researchers term central sensitization. This complex problem responds to a multi-targeted approach including physiotherapy and medication. Often a form of psychology known as Cognitive Behavioural Technique can be valuable also. CBT challenges pain beliefs to allow a person move on with less fear of re-injury or avoidance of actions that might have been thought to be harmful, but in fact are not.
Specific exercise for back pain has been demonstrated to be highly effective in longstanding low back pain. Focussing on the lumbo-pelvic area, based on regaining ‘core stability’, physiotherapists have a detailed understanding of how to retrain these muscles, usually on a one-to-one basis initially, then progressing to a rehabilitation environment. We find excellent results progressing back strengthening via Pilates classes, which in turn gives confidence about having a stronger more, supple spine.
The scientific evidence in chronic low back pain supports a combination of medication, manual therapy, pain relieving techniques such as acupuncture or electrotherapy, rehabilitative exercise and lifestyle advice as achieving good long term outcomes. So, why not make 2011 the year you banish your back pain for good. |
