The role of Physiotherapy in the management of lower back pain

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Introduction

Over the last couple of months, I have noticed a significant increase of patients suffering with lower back pain in my Herne Hill Clinic. This appears to have been caused by the reduced daily activity of patients and by the often poor sitting arrangements in their homes.

Back pain is the largest single cause of disability in the UK, with lower back pain alone accounting for 11% of the total disability of the UK population NHS England » The National Back Pain Pathway

According to NICE guidelines in 1998, up to 40% of individuals had suffered with lower back pain, lasting more that 1 day over the last 12 months Low back pain: Final scope (nice.org.uk)

Interestingly many of my Herne Hill clients have developed such issues only over the last couple of months, and had no previous history of lower back pain.

This seems to suggest that the reduced physical activity linked to working from home, the prolonged static positions in often poorly set up environments, has created additional microtrauma affecting their spinal structures.

What are the Physiological effects of decreased movement on the deep abdominal and spinal muscle systems

Reduced movement has been shown to have an adverse effect on the deep abdominal system and deep spinal structures.

Research has demonstrated that reduced movement (gravity) has a significant effect on the spine muscle support system, such changes include:

1-Muscle atrophy (reduced cross section of the muscles)

2-Changes to the physiology of the muscle (from slow twitch endurance muscle fibbers to a more fast twitch muscle fibbers type)

3- Changes to the ability of the muscle system to activate in good coordination with ones physical demands.

In practical terms the muscles become weaker and less able to provide us with support during our every day tasks.

 

 

The effects of excessive sitting and reduced movement on the hips and gluteal muscles

Further to the above mentioned issues, I have found that many of my Herne Hill clients will often present with shortening of their hip flexors musculature and stiffening of the thoracic spine. These secondary changes will also contribute to the increased loading forces on the lower back spinal structures. Furthermore they will reduced musculature efficiency of the gluteal muscles, which have an important supporting role for the spine.

 

The role of Physiotherapy in reversing these changes

Physiotherapist will be able to provide you with a targeted exercise programme to try and minimise some of these changes. I have founf this to be extremely effective in treating my Herne Hill working from home clients. Such strategies may include:

1-Core stability exercises

2-Thoracic mobility exercises

3-Hip flexor stretches

4-Gluteal activation exercises

5-Ergonomical advise

 

The role of manual therapy in treating lower back patients

I have found that regular manual therapy, including manipulation and deep tissue massage, can also be very helpful in providing better tissue mobility and soft tissue relaxation in my Herne Hill clients. Soft tissue techniques specifically administered to the less mobile parts of the body like the hip flexors and thoracic spine, combined with strengthening of the gluteals and core make a significant difference to patients with back pain.

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020 7459 4692

Solomon Canevaro Physiotherapy

1 Elmwood Road

Herne Hill, London SE24 9NU