As the week’s fly by, so do our blog posts! We hope you found the strengthening element of the rehabilitation and prevention process of lower back pain an interesting read. Alongside the strengthening element to our rehabilitation of LBP, we offer many other treatments to aid these processes.
We use a combination of different treatments depending on the needs of our patients. Each type of LBP will require a different line of treatment. All of our patients who are suffering from LBP will be prescribed a strengthening plan regardless, and certain treatment option will be used to aid our patients’ needs.
Below are the most frequently used treatment options by our therapists.
Massage therapy is widely used by our therapists as an effective treatment for LBP. Our therapists use massage therapy as a maintenance tool and initial aid for our patients. Initially, massage can provide pain relief for our patients, especially when the muscles are one of the major causes. Massage essentially helps relax the muscles, this can be effective when there is spasming in the muscles associated with the pain. Massage helps muscles stay flexible over time and decreases pain. As well as the mechanical effectiveness on the muscles it also has an effect of the hormonal system in the body, helping to promote the production of endorphins, which basically are chemicals produced by the brain which make us feel good. This process can help reduce pain and perception of the injury.
As we spoke about in our previous blogs an increase in flexibility can reduce the likelihood of sustaining another injury and also helps with the rehabilitation process. This is why our therapists stress the importance of maintenance, regular massages are always recommended by our therapists to maintain the flexibility of the muscles and to prevent further injury. It is important to remember however, that massage alone is not a cure, rehabilitation and maintaining strength is vitally important too.
Electrotherapy is used by our therapists to decrease pain. The most widely used form of electrotherapy is TENS. Electrotherapy stimulates the tissues its put on by working at different frequencies depending on the aim of the treatment. It is a modality to aid pain reduction by blocking pain signals and producing endorphins that are similar to those produced by massage (Vance et al.,2014).
TENS (Transcutaneous Electrical Nerve Stimulation)
TENS uses small electrodes on small sticky pads via a handheld device to target pain relief. These pads are placed in the area of pain. To target a reduction in pain through the theory of pain-gating, the device is set between 90-130Hz. The handheld devices then send electrical currents to the area of pain which create a tingling sensation which essentially decreases pain for the patient. The currents can be increased and decreased depending on the needs of the patient.
These devices can be therapist or patient controlled. TENS has proved to decrease pain initially and can be an ongoing therapy option for pain management to improve daily life and increase function (Vance et al.,2014)
On a personal note, I have recently suffered from acute LBP and I was unable to move effectively. I used TENS on my back, ironically whilst treating a patient for LBP, which reduced my pain and allowed me to mobilise more effectively. The noises that came from my back when I did mobilise would have been at home on a rifle range, but I experienced a drastic reduction in pain!
Electrical Muscle stimulation (EMS)
EMS uses electrical pulses just like TENS to stimulate the contraction of muscles. EMS can be used to help stimulate and contract weak or injured tissues. Just like the TENS, this is through electrodes stuck on areas of injury sticky pads, however, the frequency of the treatments differ to target different systems within the body. These effects can be useful for both patients and therapists during the early stages of injury and the initial phase of the strengthening plan. The contraction of muscles during the early phase of healing can help with the reduction of inflammation and helps prevent atrophy in the injured structures. These electrical impulses help reenact the stimulation from the brain to engage the muscles (Azman and Azman ., 2017).
The disadvantages of electrotherapy and in particularly in TENS are patients can become over dependant on these modalities to decrease pain, TENS and EMS are used by our therapists in the initial stages and decreased throughout the rehabilitation plans. As the treatment progresses strengthening, mobility and soft tissue work benefits outway the effectiveness of electrotherapy.
Mobilisation and Mobility
As previously mentioned mobility work and exercises are prescribed by our therapist in to aid flexibility and the efficiency of the muscles associated with lower back pain. Manual therapy mobilisation differs from exercise mobilisation in the sense that it is performed hands-on by the therapist. It essentially involves manually mobilising the structures associated with LBP, in particular, structures associated with the spine and surrounding joints. Manual therapy works through two protocols, manipulation and mobilisation.
Mobilisations are used by our therapists to decrease pain and increase flexibility in the joints and surrounding structures. The mobilisations involve a variation in pressure manually put upon a joint by the therapist. Essentially just like TENS, these mobilisations act by blocking the pain signals sent to the brain due to the frequency of the mobilisation. Mobilisations are graded. Grades one and two are aimed at decreasing pain by gently increasing movement in the joint. Grades three and four mobilisations are aimed at decreasing stiffness and increasing flexibility in a joint by moving a joint towards the end of range movement (Slaven at al., 2013). Grade three and four mobilisations are used when grades one and two are able to be completed pain-free.
Manipulations are used to increase range in joints, Manipulations just like grade three and four mobilisations are used by our therapist with LBP patients. Manipulations are used when there is more range needed that hasn’t be brought about through these mobilisations. These manipulations can create a “Crack or Pop” at the end of the movement which is normal, called cavitation, a release of gases from within the joint. If these audible sounds are not heard this does not mean the manipulation hasn’t been successful. These manipulations involve the therapist bringing these joints into a new range, in a safe and controlled manner. These manipulations should only be carried out by a qualified therapist and after completing a past medical history assessment which is completed with every patient at our clinic. Frequent manipulations have been proven to be a successful form of treatment in lower back pain and increasing joint ranges (Coulter et al., 2018), however, manipulation alone will not permanently solve an issue. Exercise-based rehabilitation is vital!
Lastly one of the most important treatments is core stability which we spoke about last week in great detail. Core stability exercises are an integral part of our treatments and they aid the effectiveness of the treatment. Please see last weeks blog post for more information about core stability.
We hope we have given you an insight to the different treatment options for LBP alongside strengthening, The treatments discussed are a vital aid in LBP recovery and prevention, these treatments are considered by our therapists and are appropriately chosen by them in our bespoke treatment and rehabilitation plans!
If you are interested in any of these treatments or feel some of these might benefit you, don’t hesitate and contact us here at BSc regarding the information provided or the different treatment options.
Next week we will bring you our final blog in this LBP series with arguably one of the most important aspects of rehabilitation and prevention of lower back pain. We will be providing you with excellent tips on avoiding lower back and preventing it from recurring!