Finding Relief: Physiotherapy for Lower Back Pain and Lumbar Disc Herniation

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Lower back pain is a complex and multifactorial condition and symptom, it is often associated with conditions like lumbar disc herniation, can significantly impact daily life and mobility. Whether stemming from poor posture, muscle imbalances, or spinal issues, seeking effective management strategies is essential for alleviating pain and promoting spinal health. Physiotherapy offers a comprehensive approach to addressing lower back pain, focusing on pain relief, strengthening, and rehabilitation to enhance overall function and well-being.

Understanding Lower Back Pain and Lumbar Disc Herniation

Lower back pain can stem from various sources, including muscle strains, ligament sprains, or structural issues such as lumbar disc herniation. Lumbar disc herniation occurs when the inner core of a spinal disc protrudes through the tough outer layer, potentially aggravating or compressing nearby nerves and causing pain, numbness, or weakness in the lower back and legs (1). Understanding the underlying cause of lower back pain is crucial for developing targeted treatment approaches.

What a Physiotherapist Can Do to Help

Physiotherapists play a pivotal role in the management of lower back pain and lumbar disc herniation. Through a comprehensive assessment, physiotherapists can identify contributing factors such as muscle imbalances, postural abnormalities, or biomechanical issues. Treatment modalities may include exercise prescription, and education on ergonomics and body mechanics to alleviate pain and improve function (2).

Signs and Symptoms

Recognising the signs and symptoms of lower back pain and lumbar disc herniation is essential for timely intervention. Common indicators include localised pain in the lower back, radiating pain down the legs (sciatica), numbness or tingling sensations, and weakness in the lower extremities (3). Symptoms may worsen with certain movements or positions and may be accompanied by difficulty standing, walking, or performing daily activities.

When to Seek More Urgent Help

While most cases of lower back pain and lumbar disc herniation improve with conservative treatment, certain signs may indicate the need for urgent medical attention. These include severe or worsening pain, progressive weakness or loss of sensation in the legs, loss of bowel or bladder control, and sudden onset of symptoms following a traumatic injury (4) as well as problems associated with sexual function. Prompt evaluation by a healthcare professional is warranted in such cases to rule out serious underlying conditions.

Jargon Buster

  • Lumbar Disc Herniation: A condition where the soft inner core of a spinal disc protrudes through the outer layer, potentially compressing nearby nerves.
  • Sciatica: Radiating pain, numbness, or tingling sensations along the path of the sciatic nerve, typically extending from the lower back down the buttocks and into the legs.
  • Biomechanics: The study of the mechanics of movement and the forces acting on the body, particularly related to posture, alignment, and movement patterns.

Myth Buster

The management of lower back pain and lumbar disc herniation varies depending on the severity and underlying cause of the condition. While some individuals experience relief with conservative measures within a few weeks to months, others may require more extensive treatment or intervention (6). Physiotherapy, combined with self-management strategies, plays a crucial role in facilitating recovery and preventing recurrence.

How to Effectively Self-Manage

Physically

In conjunction with physiotherapy interventions, several other self-care strategies are available to help alleviate lower back pain and enhane recovery. These may include maintaining good posture, practicing proper lifting techniques, avoiding prolonged sitting or standing, reinforcing relaxed and varied movement of the back, and incorporating regular exercise to strengthen muscles and improve flexibility (7).

Emotionally

In addition to addressing physical factors, it’s crucial to consider the psycho-social aspects of back pain and their impact on management outcomes.

Research suggests that psycho-social factors, including beliefs, attitudes, stress, and social support, can significantly influence the experience and perception of pain (1).

Negative emotions such as anxiety, depression, and fear-avoidance behaviors can exacerbate pain and hinder recovery, while positive psychological factors like resilience and self-efficacy are associated with better treatment outcomes (2).

Therefore, incorporating strategies to address these factors, such as cognitive-behavioral therapy, mindfulness-based interventions, and education on pain neuroscience, can be helpful to comprehensive back pain management (3).

By addressing both the physical and psycho-social aspects of back pain, physiotherapists can optimise treatment outcomes and improve patients’ overall well-being.

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References
  1. Kreiner DS, Hwang SW, Easa JE, et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 2014;14(1):180-191. doi:10.1016/j.spinee.2013.08.003
  2. Qaseem A, Wilt TJ, McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514-530. doi:10.7326/M16-2367
  3. Rajaee SS, Bae HW, Kanim LE, Delamarter RB. Spinal fusion in the United States: analysis of trends from 1998 to 2008. Spine (Phila Pa 1976). 2012;37(1):67-76. doi:10.1097/BRS.0b013e31820cccfb
  4. Patel ND, Broderick DF, Burns J, et al. ACR Appropriateness Criteria low back pain. J Am Coll Radiol. 2016;13(9):1069-1078. doi:10.1016/j.jacr.2016.06.005
  5. Standaert CJ, Friedly J, Erwin MW, Lee MJ, Rechtine G, Henrikson NB. Comparative effectiveness of exercise, acupuncture, and spinal manipulation for low back pain. Spine (Phila Pa 1976). 2011;36(21 Suppl):S120-S130. doi:10.1097/BRS.0b013e31822ef878
  6. Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017;389(10070):736-747. doi:10.1016/S0140-6736(16)30970-9
  7. Deyo RA, Mirza SK, Turner JA, Martin BI. Overtreating chronic back pain: time to back off?. J Am Board Fam Med. 2009;22(1):62-68. doi:10.3122/jabfm.2009.01.080102
  8. Wertli MM, Rasmussen-Barr E, Weiser S, Bachmann LM, Brunner F. The role of fear avoidance beliefs as a prognostic factor for outcome in patients with nonspecific low back pain: a systematic review. Spine J. 2014;14(5):816-836. doi:10.1016/j.spinee.2013.09.036
  9. Vibe Fersum K, O’Sullivan P, Skouen JS, Smith A, Kvale A. Efficacy of classification-based cognitive functional therapy in patients with non-specific chronic low back pain: a randomized controlled trial. Eur J Pain. 2013;17(6):916-928. doi:10.1002/j.1532-2149.2012.00252.x
  10. Malfliet A, Kregel J, Coppieters I, et al. Effect of pain neuroscience education combined with cognition-targeted motor control training on chronic spinal pain: a randomized clinical trial. JAMA Neurol. 2018;75(7):808-817. doi:10.1001/jamaneurol.2018.1107

The information provided is for educational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Seek the advice of a doctor with any questions you may have regarding a medical condition. Never delay seeking or disregard professional medical advice because of something you have read here.