Low back pain afflicts both the active sportsperson and the desk-bound individual. Poor posture such as a swayback, flat back or excessively arched low back is usually the predisposing factor. Exaggerated spinal curves from poor posture cause muscle imbalances, over-stretched ligaments and excessive loading of discs and joints. The uneven distribution of forces on the spine leads to accelerated wear and tear. In the active sportsperson, the low back is under intense demands to move into all kinds of extreme positions and to provide stability for the skilled actions of the trunk, arms and legs. The low back can be compromised if the hips, legs and upper body restrict mobility, if there is mal-alignment or muscle imbalance, and if the back and abdominal muscles (the core) are weak. Physiotherapy treatment involves identifying and correcting these contributing factors to facilitate a strong, supple and stable back.
There are many structures that can be affected in the back, including ligaments, joints, discs and nerves. When the sciatic nerve that runs from the low back into the buttock and down the back of the leg becomes stimulated or compressed anywhere in its course, it can lead to pain, numbness and tingling in these areas. A prolapsed disc in the spine or contracted piriformis muscle in the buttock are common sources of pressure on the sciatic nerve. This condition is termed “Sciatica”. Physiotherapy aims to relieve the irritation or pressure on the nerve through manual therapy techniques such as spinal manipulation or mobilization, deep tissue massage of the piriformis muscle, traction and pressure-relieving exercises. 95% of sciatica can be resolved with conservative methods and only 5% of severe cases require surgery.
The desk-bound person spends most of his day in one position, usually sitting. Being in one position for long periods increases spinal stiffness, muscular and ligamentous fatigue. Sitting also multiplies the compressive forces on the vertebral discs of the low lumbar region. Lifting and twisting, sneezing or even the most insignificant movement can lead to a prolapsed (ruptured) disc in an already weak and vulnerable back. Initially, the pressure causes the disc to bulge and then with additional load, it bursts, tearing the outer fibres and spilling out its inner gel-like contents. The pressure of the disc material applies pressure to pain-sensitive ligaments and nerves, causing back pain with or without pain, numbness, tingling and weakness into the leg. Physiotherapy aims to relieve the irritation or pressure on the nerve through manual therapy techniques like spinal manipulation or mobilizations, traction and pressure-relieving exercises. 95% of disc lesions can be resolved with conservative methods and only 5% of severe cases require surgery.
TREATMENT AND PREVENTION OF LOW BACK PAIN
Effective treatment of low back pain requires a thorough assessment to accurately diagnose the condition. Factors such as joint stiffness, muscle tightness and imbalance, lack of core stability, mal-alignment and poor posture must be addressed. The main physiotherapy methods for treating back pain are manual “hands-on” techniques, traction, deep tissue massage, specific back exercises and electrotherapy. Recurrences are extremely common and tend to get progressively worse. It is of paramount importance to get your back rehabilitated fully and keep up a regular back exercise program.