Low Back Pain Therapy
Low back pain (LBP) is one of the most common reasons people seek health care. There are numerous causes of LBP, as well as several different ways to treat the problem. Incorporating the best treatment option will prevent long-term pain and disability. Problems occurring for more than 4-6 weeks increase the risk of chronic disabilities, persistent work restrictions and increased utilization of health care.
Research has provided us with information on the appropriate type of treatment interventions for each subgroup of LBP patients.
Extension exercises
Criteria:
•Symptoms distal to the buttock
•Symptoms centralize with lumbar extension
•Symptoms peripheralize with lumbar flexion
•Directional preference for extension
Treatment Approach:
•End-range extension exercise
•Mobilization to promote extension
•Avoidance of flexion activities
Flexion exercises
Criteria:
•Older age (>50y)
•Directional preference for flexion
•Imaging evidence of lumbar spine stenosis
Treatment Approach:
•End-range flexion exercises
•Mobilization or manipulation of the spine and /or lower extremities
•Exercise to address impairments of strength or flexibility
•Body weight-support ambulation
Stabilization Exercises
Criteria:
•Younger age (<40y)
•Average straight-leg raise (>91°)
•Aberrant movement present
•Positive prone-instability test
Treatment Approach:
•Exercise to strengthen large spinal muscles (erector spinae, oblique abdominals)
•Exercise to promote contraction of deep spinal muscles (multifidus, transverses abdominus)
Manipulation
Criteria:
•No symptoms distal to knee
•Duration of symptoms < 16 days
•Lumbar hypomobility
•Fear-Avoidance Beliefs
•Hip internal rotation range of motion> 35°
Treatment Approach:
•Manipulation techniques for lumbo-pelvic region
•Active lumbar range-of-motion exercises
Traction
Criteria:
•Symptoms extend distal to buttock(s)
•Signs of nerve root compression
•Peripheralization with extension movement; or positive contralateral straight-leg raise test
Treatment Approach:
•Prone mechanical traction
•Extension-specific exercises
Depending on your type or cause of low back pain, we can determine the most appropriate type of treatment for your problem. We will use your history and examination to choose the treatment intervention that you would most likely benefit from.
Source:
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Fritz JM, Cleland JA, Childs JD, Journal of Orthopedic & Sports Physical Therapy (2007): 37 (6): 290-302.
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Hebert J et al, Clinical Prediction for Success of Interventions for Managing Low Back Pain, Clinical Sports Medicine 27 (2008):463-479.