Chronic Low Back Pain?

Chronic low-back pain is pain in the lumbar region of your spine that has lasted for more than three months. It may be constant or intermittent, mild or severe, and is often caused by certain postures or activities. Pain may consist of acute episodes with little pain in between or constant pain with occasional flare-ups. Its impact on your life will be dictated by these factors.

Causes

In 70 percent of cases of chronic low-back pain, the cause is one of the following: a lumber disk internal strain or disruption, a facer joint problem, a strain of the sacroiliac joint and/or ligaments. These causes can sometimes be determined by diagnostic blocks. Occasionally, the pain is caused by a combination of spinal segment changes that lead to an ‘instability” syndrome. These are many other physical and environmental factors that can cause low-back pain, and most of these can be addressed. Serious conditions, such as cancer or fracture, account for less than one percent of low-back pain.

Sometimes, however, there will be no identifiable cause of your pain- this is commonly known as nonspecific low-back pain.

Symptoms

Facer joint tends to occur in older people and is usually worse with upright activity. Recurrent episodes of more severe pain can be triggered by trivial factors such as twisting, stooping, sneezing, lifting, or prolonged sitting. Your back may feel weak and unstable .Chronic sacroiliac pain can cause this symptom, but the pain will be in your buttock, rather than your lumber area. At times pain may shoot or move down one of your legs , like sciatica –this is often the result of a disk injury. The pain can develop nerve-related features, such as burning sensations.

Risks And Complications

If serious causes of disease and pathology such as infection or tumor have been ruled out, the risks of chronic low-back pain are both psychological and physical: your mood and sleep patterns may become disturbed and the effect on your life may cause frustration and even depression.

Treatments- Disk Related Pain

Immediate treatments

If your pain has been diagnosed as coming from a disk, you should;

• Stay as active as you can

• Take acetaminophen or ibuprofen inn recommended dosages, sparingly, on a regular schedule, rather than only when the pain becomes unbearable.

• Consult your doctor or physical therapist for advice on how to reduce disk pressure and strain.

Short Term

If the pain is moderate or severe and you have not improved with physical therapy, your doctor will refer you to a specialist who may:

¨                 Suggest a rehabilitation program to improve your control of movement, posture, strength, flexibility and general fitness.

Medium Term

If further treatment does not help, your specialist may:

¨                 Give you further imaging investigations, psychological assessment,    and/or diagnostic blocks of specific structures in your spine.

¨                 Recommend trial of intradiskal therapy.

Long Term

If you continue to experience pain and no further treatment is available, you should seek advice from a specialist who may:

•       Provide a pain management program that includes physical and psychological help.                    

•       Help you to moderate your expectation of what you can do.

•        Advice you on how to use medication sensibly and appropriately.

Physical Therapy for Chronic low back pain

Once your doctor has referred you, your therapist will perform a thorough assessment, your therapist may:

Perform gentle manual rhythmic traction on your legs, passive rotational joint mobilizations, specific and non-specific rotational manipulations and acupuncture for pain relief

Your therapist may:

• Recommend relaxation techniques, such as autogenic training and progressive relaxation therapy.

• Suggest gentle stretching and self mobilization techniques such as single-leg elongations, hip hitchers, side glides, supine pelvic tilts, seated pelvic tilts, alligators, knees to chest stretches, back rotations, child’s poses and cat and camels.

If you have an almost full range of movement in your lumber region and are experiencing slightly less pain.

You may:

• Begin a functional rehabilitation program including gentle core-stability exercises such as kneeling supermans, prone arm and leg lifts, four-point supine knee lifts bridges, and dead bugs.

• Continue stretching, adding modified self-traction press-ups and isometric hip flexions to exercise program.

Your therapist may:

Advice you on aerobic training, such as using a cross-trainer and taking up aqua aerobic.

If your pain is not improving or is getting worse, you should:

  Return to your doctor for review.

If you have full range of movement in your lumber region and are free of pain, you may:

• Begin more intense stabilizing exercises such as planks from knees, progressing to prone planks. Swiss ball roll-outs. Swiss ball twists, plank levels, and single leg bridges

•    Perform sensor motor training such as single-leg stands.

•    Resume other sports by gradually increasing effort and duration as pain allows.

Physical therapy with a trained professional may be useful if pain has not improved after 3 - 4 weeks. It is important for any person who has chronic low back pain to have an exercise program. Professionals who understand the limitations and special needs of back pain, and can address individual health conditions, should guide this program. One study indicated that patients who planned their own exercise program did worse than those in physical therapy or doctor-directed programs.