An estimated 80% of individuals experience low back pain at least once in their lifetime. Each year 15-20% of people in the country complain of low back pain. Millions of workers suffer injuries on the job which can cost billions of dollars annually to companies. However, there is an exceptional chance that you will recover from low back pain that you may be experiencing. Medical research suggests that active exercise programs can reduce disability and can prevent future pain episodes. The lumbar spine is a beautifully constructed masterpiece composed of bones, joints, discs, tendons, ligaments, muscles, and nerves. The three main functions of the spine are to connect the pelvis to the trunk and head; house and protect the spinal cord; and provide balance, stability, flexibility, and mobility so that we can perform our daily activities. A closer look at the lumbar spine reveals five stacked vertebrae with a fluid-filled disc in between them. The lumbar spine is a hollow c-shaped curve called the lumbar lordosis which balances tremendous forces on the spine. Within this hollow is the spinal cord which is made up of nerves that are wired to the brain to tell them when to contract. These nerves also provide the sensation of touch, pain, temperature, etc. Between each vertebra is a fluid-filled disc that is similar to a jelly donut. Healthy discs provide the necessary height and cushion to the spine while absorbing shock and distributing forces. There are many ligaments associated with the lumbar spine which attach bones together. There are almost 150 muscles in the spine that work together to move and stabilize the spine.
Mechanical low back pain can occur from a trauma, twisting, prolonged poor posture, mental stress, fatigue, slipped disc, aging, degenerative diseases, congenital defects, poor flexibility, etc. Acute low back pain is activity intolerance due to low back or leg-related symptoms for less than three months. If the problem lasts longer than three months, it is considered to be chronic. Pain is most likely caused from soft tissue damage including muscles, ligaments, discs, tendons, joints, etc. that can be on one side of the back or can radiate across the back or into the buttocks or leg(s). Cramping or muscle spasms can also occur with low back pain.
The focus of treating low back pain is to promote healing of the damaged soft tissue. First, the area of damaged tissue must be protected with rest and positioning to prevent further damage. Pain management techniques can also be used at this point. Next, increasing circulation and mobility is key to deliver proper nutrients to the affected area. These goals are achieved though walking and performing pain-free range of motion, strengthening, and stretching. Lastly, the dysfunctions, such as posture, flexibility, and weakness need to be corrected for long-lasting effects. A large misconception about low back pain is that the problem is fixed when there is no longer pain present. A solid 12 weeks or more is needed for proper muscle strengthening and repeated practice holding appropriate posture and using body mechanics are crucial to maintain a pain-free, active lifestyle.
A lumbar laminectomy/discectomy is a common surgical procedure performed to remove pieces of a herniated disc that are problematic. A surgeon makes an incision just off centerline of the spine and then will remove a small piece of the vertebra (laminectomy) and reflect ligaments and nerves in order to remove the extruded disc fragments (discectomy). Physical therapy is critical after this type of procedure to restore flexibility, strength, and range of motion to promote proper function. Research studies show that individuals have better outcomes from these procedures if physical therapy treatment is provided after surgery.
Scoliosis is a lateral curvature of the spine where one curve is present (C –curve) or two curves are present (S-curve). Ten to twenty degrees is considered mild scoliosis, twenty to forty degrees is considered moderate scoliosis and more than forty degrees is considered severe scoliosis. Scoliosis is idiopathic (no known cause) is most cases and affects males and females equally of all age groups, although females patients tend to see more a progression with the disease. Symptoms can include pain and fatigue as well as difficulties with breathing, digesting, and walking. Bracing is typically recommended for moderate scoliosis and surgery for severe scoliosis. Physical therapists can provide a customized exercise program to help decrease pain, stretch muscles, and strengthen the core.
Multiple sclerosis (MS) is a central nervous system disorder where the body’s immune system attacks the covering over the nerves resulting is a disruption flow of information within the brain and between the brain and the body. There is currently no known cause for MS, but it is believed that certain people are predisposed to the development and that environmental risk factors exist that can trigger the onset of symptoms. Symptoms can include blurred vision, loss of balance, poor coordination, slurred speech, tremors, numbness, extreme fatigue, memory/concentration problems, paralysis, blindness, etc. The most common symptoms are overwhelming fatigue, visual disturbances, altered sensation, and mobility difficulties. These symptoms can occur at any age but are primarily in the 20-50-year-old age group and are twice as common in women than in men. Physical therapy treatments such as gait training, strengthening, and endurance activities are helpful for individuals with MS as well as a wheelchair mobility evaluation if needed. Physical therapy patients with MS generally have a better response if they go to treatments in the morning before excessive fatigue occurs.
Spinal stenosis is the narrowing of the spinal canals. It can involve the canal that houses the spinal cord or the canals housing the spinal nerves. This condition is most often the result of aging and associated degenerative changes, such as disc height collapse, stiff ligaments, and the formation of bone spurs. Other medical conditions (such as spondylolisthesis) or trauma can also cause stenosis. Patients with lumbar stenosis can have severe back pain as well as radiation of pain into the buttocks and thighs with associated tingling/numbness/weakness in the legs. Standing, walking, or leaning backward can exacerbate pain related to stenosis while sitting and leaning forward can relieve pain. A trademark sign of stenosis is the inability to tolerate prolonged walking. Physical therapy treatments can consist of stretching, strengthening, spinal mobilization, and activity modification.