BACK / LUMBAR PROBLEMS

MUSCLE SPASM

  • Certain conditions of the spine can cause the muscles of either side of the spine to go into spasm which can cause severe pain and restricted movements of the spine.
  • Muscle spasm usually occur as a result of injury to a deeper structure of the spine, overuse injury, if the part is over stretched.
  • Chronic neck or back pain may also result in recurrent muscular spasm because of the development of the arthritic changes.
  • Muscle spasm is an alarming sign that indicates that either your body needs rest or there is more serious underlying issue in your spine.

Treatment

  • Cryotherapy or heat therapy
  • Electrotherapy modalities to reduce spasm
  • Proper rest and positioning
  • Muscle stretching
  • Soft tissue manipulation

FACET JOINT ARTHROPATHY

  • The facet joints of the spine can be sprained or become locked when placed under stress such as with extreme movements beyond the normal range or with poor posture or poor lifting technique.
  • The degenerative arthritis results in the breakdown of the cartilage between the facet joints resulting in mechanical pain and joint stiffness.
  • When facet joints are locked it results in restriction of movement  often only in one direction.
  • The pain gets worsened with movement (mostly bending backwards) and may be associated with muscle spasms and localised tenderness.
  • Aggravating factors- sitting and travelling, extension, side bending, improper lifting, prone lying on soft surface, slouched sitting.

Treatment-

  • Cryotherapy or Heat therapy
  • Electrotherapy for pain relief
  • Postural ergonomics with frequent rest intervals
  • Osteopathic or chiropractic manipulation
  • Lumbar stabilisation exercises

POOR/ FAULTY POSTURE

  • Prolonged sitting in poor posture is a very common cause of back pain in office workers. Sitting in a poor posture can actually put twice the amount of stress through the lower back compared to standing.
  • Poor posture results in muscular imbalances and shifting of the centre of gravity.
  • The pain worsens as the day goes on and can sometimes be relieved by stretching or exercises.

Treatment-

  • General body rehabilitation
  • Postural correction exercises
  • Stretching
  • Osteopathic and Chiropractic manipulation techniques.
  • Postural ergonomics

PIRIFORMIS SYNDROME

  • Piriformis syndrome is a condition characterised by pain in the buttock region causing spasm.
  • The piriformis muscle can also irritate the sciatic nerve and cause pain, numbness, and tingling along the back of the leg and into the foot.
  • Pain may worsen on sitting, squatting or walking.

Treatment-

  • Combined stretching exercises
  • Dynamic isometric exercises
  • Soft tissue manipulation to release tender point
  • Manual therapy techniques
  • Electrotherapy modalities
  • Piriformis rehabilitation exercises

SCOLIOSIS

  • It is the sideways (lateral tilt) curvature of the spine with vertebral rotation.
  • The curve is usually "S" or "C" shaped which may cause stress and pressure upon the spinal discs, nerves, ligaments, muscles or facet joints causing mid or low back pain depending upon the location.
  • It causes local inflammation around the strained muscles causing pain, difficulty in breathing in severe cases as the rib cage can twist and tighten the space available for the lungs.

Treatment-

  • Osteopathic and chiropractic manipulation
  • Combined manual therapy techniques
  • Postural correction
  • Ergonomics in Activities of daily living (ADL)

SCIATICA

  • Sciatica refers to the pain in the leg caused by the irritation of nerve roots of lower lumbar or lumbosacral spine where the sciatic nerve is located.
  • Symptoms of sciatica appear as numbness, tingling or weakness in the legs associated with burning sensation.
  • Constant pain only one side of buttock/ leg.
  • Pain worsens on sitting/ standing up/ coughing.

Treatment-

  • Electrotherapy modalities
  • Dynamic isometric exercises
  • Combined stretching exercises
  • Certain manual therapy techniques
  • Core muscle strengthening protocol

SPINAL INSTABILITY

Spinal instability usually refers to the abnormal movement between one vertebra and other, generally seen in cases of disc degeneration as the disc loses its turgor (tension), increasing the movement between the vertebra often leading to disc bulge.

Treatment-

  • Cryotherapy
  • Core muscle strengthening
  • Postural ergonomics
  • Manual therapy techniques

SPINAL STENOSIS

The narrowing of the spinal column or the narrowing of the opening where the spinal nerves emerges is known as spinal stenosis. The spinal canal narrows and compresses the spinal cord and nerves at the level of lumbar vertebrae.

Symptoms-

  • Burning pain or numbness in your back, buttocks, thighs.
  • Incoordination
  • Painful extension movement
  • Difficulty in prolonged standing and during travelling
  • Pain gets worsens on coughing and sneezing.
  • Local tenderness

Treatment-

  • Flexion bias strengthening exercises
  • Gait training
  • Range of motion and stability exercises
  • Postural re-education
  • Manual therapy techniques

SPONDYLOLISTHESIS

  • This is the anterior (forward) slipping of one vertebra over the other.
  • It could be a birth defect wherein the spine was damaged or by trauma, degenerative disc disease or arthritis.
  • It most commonly occurs in lumbar spine (low back) and may lead to squeezing or pinching of nerve roots leading to back pain, weakness or numbness in one or both legs.
  • It may cause limping in cases of overuse injury most likely seen in gymnasts and weight lifters.

Treatment-

  • Electrotherapy modalities
  • Postural re-education
  • Core muscle strengthening
  • Manual therapy techniques
  • Functional rehabilitation

OSTEOARTHRITIS OF SPINE

  • Osteoarthritis is the medical term for the thinning of bone tissue and bone density loss.
  • Osteoarthritis is a progressive disease, so it tends to worsen over time leading to faster degeneration.

Treatment-

  • Weight bearing exercises to increase bone density
  • Core strengthening exercises to support the spine
  • Functional rehabilitation programme

STRAIN

  • The most common cause of pain in the back is due to muscular strains generally caused by over-lifting of weights, or poor posture.
  • Pulled back muscles may lead to stiffness in back or restricted movements of spine.
  • It may resolve in few days or may take upto 3-4weeks.

Treatment-

  • Electrotherapy modalities
  • Gentle ROM exercises
  • Cryotherapy
  • Soft tissue manipulation
  • Functional rehabilitation

POTT’S SPINE

It refers to the tuberculosis of the spine where the intervertebral joints are affected. Tissue necrosis and breakdown of inflammatory cells results in paraspinal abscess.

Symptoms-

  • High fever with chills
  • Persistent back pain
  • Deformities like scoliosis/ kyphosis
  • Sensory defects
  • Spasticity
  • Muscle spasm
  • Disc space narrowing seen on x-ray or MRI

Treatment-

  • Trunk stabilisation exercises
  • Aerobic exercises
  • Pain management
  • Balance and gait training
  • Muscle re-education
  • Functional rehabilitation

ANKYLOSING SPONDYLITIS

  • It is a chronic generalised inflammatory disease of spine where the vertebras fuse with each other resulting in rigid spine, more common in males.
  • It has a strong association with HLA-B27.
  • It most commonly affects sacro-iliac joints

SYMPTOMS-

  • Backache worse in morning and at night or during rest
  • Stiffness
  • Intercostal muscles tenderness
  • Increase in thoracic curve and straightening of lumbar spine which may leads to stooped-over posture.

Treatment-

  • General body rehabilitation
  • Strengthening exercise protocol
  • Pain management
  • Postural correction
  • Correct breathing patterns

KYPHOSIS

It is the condition characterised by excessive rounded curvature of the spine, known as hunchback. It may be due to aging, muscular weakness in upper back, osteoporosis, bone degeneration, postural faults.

Treatment-

  • Postural correction
  • Strengthening exercise
  • Correction of muscular imbalances
  • Trunk stabilisation programme

PROLAPSED INTERVERTEBRAL DISC (PIVD)

  • This condition refers to the rupture of the gel-like substance of the disc present between two vertebras which acts as shock absorber for the spine.
  • The bulging disc material may cause pressure on nearby nerves causing pain and loss of function.
  • It is caused due to external trauma, heavy weight lifting, or hyper function of spine leading to low back pain with or without radiating to back of leg (sciatica) or front of thigh.
  • It is accompanied by numbness or tingling sensation travelling down the leg with muscle weakness or even difficulty in walking.
  • The pain gets worse at night or with prolonged standing or sitting or bending forward.
  • The pain may increase with coughing or sneezing.

Treatment-

  • Electrotherapy modalities
  • Cryotherapy
  • Abdominal strengthening exercises
  • Core strengthening exercises
  • Postural ergonomics
  • Manual therapy techniques
  • Dynamic isometric exercises
  • Combined stretching techniques
  • Kinesiotaping 

STRAIGHTENING OF LUMBAR SPINE

It refers to the abnormal inward curvature of the spine leading to flat back. It is the result of frequent muscular spasms as a result of poor posture and a main leading cause of back pain.

Treatment-

  • Postural correction
  • Muscle re-education
  • Manual therapy techniques
  • Core strengthening exercises

S.I. JOINT DYSFUNCTION

  • The condition resulting in dull, sharp-stabbing pain over the sacro-iliac joints, most commonly triggered when standing after prolonged sitting on the chair.
  • It may radiate to buttocks, thigh or groin region.
  • Pain is felt on one side of the lower back.
  • The pain gets worse in the morning and gets better during the day.
  • It may be caused due to excessive joint play or due to hypomobility or joint fixation as in ankylosing spondylitis.

Treatment-

  • Cryotherapy or heat therapy
  • Electrotherapy modalities
  • Manual therapy techniques
  • Stabilisation exercises
  • Osteopathic and chiropractic techniques

LOWER CROSSED SYNDROME

It refers to the weakness of lengthening of deep abdominal muscles and tightness or shortening of the spine extensors leading to muscular imbalances which results in forward tilt of the pelvis and generalised low back pain. 

 Treatment-

  • Muscle re-education
  • Postural correction
  • Pelvic tilt correction
  • Core muscles strengthening
  • Manual therapy techniques

MECHANICAL LOW BACK PAIN OR LUMBAGO

  • This condition of pain in low back is generally without any serious cause, mostly due to muscular imbalances or due to postural faults.
  • It is characterised by morning stiffness which lasts less than 30 minutes.
  • The pain may be increased on initiating the movement, forward bending or rotation and is relieved on rest.

Treatment-

  • Postural correction
  • Trunk stabilisation exercises
  • Core muscle strengthening
  • Manual therapy techniques

SPINA BIFIDA

It is a birth defect where the spinal cord fails to develop properly resulting in muscular weakness specially legs.

Treatment-

  • Gentle ROM exercises
  • Positioning techniques
  • Postural correction
  • Functional re-education
  • Strengthening exercises

POST-OPERATIVE CASES OF SPINE

Treatment-

  • Core muscles strengthening
  • Manual therapy techniques
  • Functional re-education

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