Dr. Steven Scappaticci, B.Sc. (Hons.), CSCS, DC, FRCms
The year is 1950 and you have low back pain. You go to the local doctor (or perhaps he makes a house call) and while smoking he tells you to lie in bed for a week to rest your back muscles. Fast forward to 2019 and your millennial grandchild has some low back pain. They go to the nearby chiropractor and after receiving some manual treatment and rehab exercises they are told to keep moving with relative rest as needed throughout the day. Two similar scenarios with different endings and differing subsequent outcomes. Why is this?
Well just like many aspects of health care, things change over time. New research and methods emerge and either dispels old ways of thinking or builds current models to strengthen them. Whether it is the medical practice of bloodletting that has been replaced with pharmacotherapy or the change in the management of low back pain or many of the other examples that exist in manual therapy & medicine, times change!
Low back pain can be tough! Not just for the patient experiencing the pain but also for the health professional managing the case. I’ve written a previous blog titled “Psych-aticia! How Low Back Pain Can Fool You!” which outlined nearly all the possible causes for “sciatic-like” symptoms and how they are all interrelated. Sometimes when a patient is in acute pain, it is difficult to truly find the source of pain when everything hurts! This is where the full clinical picture comes into play. That being said, sometimes the pain moves. It may start on one side and then be on both sides, you may see them on Day 1 of injury and then by the next time you see them things have worsened considerably just due to the pattern of their low back pain.
Pain aside, there are a number of ways to “categorize” back pain (and to some degree all joint pain). The classic way that is taught is flexion- vs. extension intolerant, meaning do they have pain when they bend forward or arch backwards? Similarly, the folks at Functional Range Systems (FRS) talk about opening angle vs. closing angle joint pain. It should be noted that depending on the nature of the pain/injury, one could experience pain in both directions as multiple tissues could be affected.
Assuming no red flags or need for outside management, a patient with low back pain can be treated with conservative care. The specific type of care is not necessarily what is important for this article but they may experience treatments including: myofascial release, spinal manipulative therapy, the use of a modality, rehabilitation, and/or even acupuncture. That being said, rehab is a huge component of a patient’s recovery and is the focus for this blog.
Every patient is different as is his or her presentation and pain. It only makes sense for their treatment to be unique and tailored to them. With that in mind, many principles of rehab can be applied to multiple patients. One example is if someone has back pain felt predominantly with extension (or even extension & rotation, such as a the lumbar Kemp’s Test). In this case, it would be beneficial for the patient to focus on exercises that promote controlled spinal flexion and depending on the assessment findings, some pelvic tilting exercises as well. A great exercise for this is the segmental cat-camel exercise, nicely highlighted by the group at FRS. The flexion-based exercises will help relieve the patients extension based pain. The flexion movement will help to gap the facet joints along the spine. Providing relief from over compression and irritation of the joints.
The same principle can be implemented with those suffering from flexion-based pain. If someone has “sciatica” or even a flexion induced muscle strain, performing multiple repetitions of extension-based exercises would be beneficial. Exercises such as the cobra/sphinx pose, McKenzie exercises, and even the segmental cat-camel stretch again this time focusing on the extended position. Of course, even with the exercises listed here there are ones to start with and ones to progress to.
One thing to remember is that once pain has decreased and functionality has increased, one should focus on improving all the ranges that were injured and the surrounding area.
So although the examples given may be a little more textbook and black & white than true clinical practice, as patients improve to transition to an active care model, exercises such as these can help their low back pain tremendously!
If you are in the Niagara Region and looking for evidence-based, effective care I can help. At the same time, if you aren’t from the Niagara Region, the Distance Rehab Program is available to you. You’ll have a personalized rehab program designed just for you, which you can perform in the comfort of your own home! Just email firstname.lastname@example.org for more.
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