Chronic low back pain is defined as back pain lasting more than 12 weeks and it affects more than 50% of the general population. As much as 80% of Indian population and 60% of general population experience acute Low back Pain someone in life. Complaints of low back pain with or without radiation are the second most common reason. Prolonged poor posture and a sedentary lifestyle often cause chronic pain. The treatment of low back pain remains as controversial today as it was fifty years ago. Physiotherapy plays a major role in management of Low Back Pain. Exercise is one of the most frequently used modalities in the rehabilitation of patient with low back pain. Yoga is now emerging as a recognised means for effectively treating chronic back pain. Studies have shown that physiotherapy and yoga can significantly improve pain and functional disability in low back patients.
What all causes low back pain?
Low Back Pain could result from various causes hence it is necessary to identify them before starting treatment. Mostly it is unknown cure. Low Backache can be congenital or degenerative as well. Other less common causes include traumatic, metabolic, circulatory or because of some infections of spine like tuberculosis, psychoneurotic problems like tensions and anxiety can lead to back pain as well. Now a days poor postural alignment is emerging as one of the major cause for low back pain, which can be corrected with the practice of yoga and physiotherapy.
Discogenic - Involvement of the disc.
Congenital-By birth (bony malformations of vertebrae).
Traumatic-Falls, accident, injury.
Degenerative-Osteoarthritis, Spondylosis, spondylolysis, spondylolisthesis.
Infections - TB, Pyogenic infections.
Neoplastic - Tumors.
Metabolic - Osteoporosis.
Circulatory-Vascular insufficiency, varicose veins.
Toxicity-Radium poisonings, severe anemia.
Psychoneurotic problems- Anxiety, tension.
Low Back Pain Management Aims
• Pain reduction.
• Posture correction.
• Strengthing of weak muscle.
• To improve mobility and flexibility.
• Relaxation of tight muscles.
• To improve endurance.
• To decrease mechanical stress to spinal structures.
• To improve fitness level to prevent the recurrence.
Physiotherapy is widely recommended and effective conservative treatment option for back pain. Various studies has shown its efficacy in pain reduction, strengthens weak muscles, improving mobility and flexibility of tight spinal muscles hence improving poor posture, the main culprit in low back pain. Also regular physiotherapy treatment decrease mechanical stress to spinal structures and improve overall fitness level of the individual therefore prevents recureence of back pain.
Physiotherapy for Pain reduction: Currently , several noninvasive modalities are widely used to treat low back pain such as Ultrasound, TENS, IFT, Cry therapy, Moist Heat, Electro acupuncture, Diathermy, stimulation, massage etc. these provide only temporary pain relief.
Physiotherapy for Posture correction: In order to achieve this we have to introduce the 'slouch-overcorrect' procedure. The patient must sit slouched on a backless chair or stool, allow the lumbar spine to rest on the ligaments in the fully flexed position, and permit head and chin to protrude. Then he must smoothly move into the erect sitting posture with the lordosis at its maximum and the head held directly over the spine with the chin pulled in. This sequence should be repeated in a flowing rhythmical manner.
Flexion exercises are used to open intervertebral foramen hence reduce compression on the nerves, stretch tight back extensors, strengthen abdominal muscles and to increase the endurance of abdominal muscles. Extension exercise promote normal physiological Lumbar curve of the spine, increase strength of the extension muscles of the spine, unload the disc and improve mobility of the spine. General stretching and Specific tightening is either performed manually or with the help of various positions assumed by the patient to stretch the tight structures particularly muscles and thereby improve posture.
Spinal Traction: Traction procedures relaxas the tight muscles and tautening of the viscoelastic ligaments. It increases the intervertebral distance causing reduction of the disc protrusion and relieves pressure on the nerve roots and their dura.
Spinal support: Enhances the natural splint age effect as it maintains the physiological Lumbar Curve, which is the basis of treatment of Low Back Pain these days. Provides partial immobilization and thus protects the spine from stress of movements, Facilitates early ambulation, Provides support and reassurance to the patient, Uplifts and supports the abdomen thereby unloading the effects of gravity on the disc.
Now days, physiotherapists are recognizing yoga as a form of treatment for musculoskeletal and cardiorespiratoy conditions.
Frequently and widely practiced yoga asans for low back pain are Surya Namaskara & Bhujangasana
Surya namaskara: On the principles of physiotherapy, this is a flexion and extension exercise of spine. Flexion strengthen the musculature of abdomen and back and helps in low backache. Extension part of suryanamaskar corrects the alignment of intra vertebral spaces.
1. Bring your palms together in prayer position.
2. Exhale as you inhale, raise your arms overhead, keeping your palms together.
3. Exhale and then bend forward until your hands touch your feet as you inhale, step the right leg back, arch back and lift your chin.
4. Exhaling, step the left leg back into plank position.
5. Keep your spine and legs in a straight line and support your weight on hands and feet.
6. Retaining the breath, lower your knees, your chest and then your forehead, keeping your hips up and toes curled under inhaling, stretch forward and bend back.
7. Keep your arms straight.
8. Exhaling, curl your toes under, press down into your heels, and lift your hips.
Bhujangasana: With the physiotherapy point of view, this yoga posture helps in strengthening of back extensor compartment muscles which relieves low backache.
1. Bend the arms at the elbows and place the palms besides the lower chest at the level of the last rib exerting least pressure on the palms
2. Keep the elbows close to each other and let them not spread out
3. Inhale and come up
4. Arch the dorsal spine and neck backwards as far as you can
5. Keep the body below the navel in touch with the ground
6. Maintain the final position with normal breathing for one minute with least pressure on the palms
7. While exhaling come back to normal position and relax.
Puran shalabh asana and Arth shalabh asana are performed in later stages and further Bhujang asana and Shalabh asana should be progressed to Nauka asana.
DAV Institute of Physiotherapy and Rehabilitation,
Mahatma Hans Raj Marg, G.T. Road,