Low back pain is an epidemic in the U.S., with 50% of the population experiencing pain within a given year, and 80% experiencing low back pain within their lifetime. For most individuals, low back pain is a recurrent, episodic condition that gets worse over time, becoming more disabling or more intense as more episodes occur. Proper diagnosis of the back pain allows for individualized, specific treatment in order to get the patient’s back towards normal function with tools to self-manage future occurrences and understand their condition to decrease fear and activity avoidance.
Treatment for low back pain is not, and should not be, cookie-cutter. Each patient’s goals are specific to their life and aspirations, the history of their condition is patient-specific, and depending on the patient’s overall health, past medical history, age, beliefs, and symptom presentation, the treatment options are all very different. Two common diagnoses for low back pain are lumbar disc herniations and lumbar instabilities, both with significantly different patient presentations and initial treatment regimens.
Lumbar Disc Herniations
Lumbar disc herniations can result in a radiculopathy, where there is compression of 1 or more spinal nerve roots, and is characterized by radiating leg pain and paresthesia (numbness or tingling), as well as signs of neurologic impairment. Conservative treatment (i.e. Physical Therapy) is the primary recommendation for patients in early stages of lumbar disc herniation with radiculopathy. Also, imaging is not recommended for the first six weeks, secondary to high health-care costs from the imaging and the lack of correlation with actual clinical presentation in most low back pain cases. Early conservative treatment for lumbar disc herniation includes close monitoring of neurological signs, working on decreasing inflammation, education on posturing and appropriate activity-modification, and improving lumbar spine mobility (through manual therapy and exercise). As the inflammation decreases, and neurological signs improve, treatment may aim towards specific core stabilization and progressive functional exercises to get back to higher activity tolerance. Manual therapy to the lumbar spine, lower extremities, and/or thoracic spine help with improve posture and activity performance, to decrease overall stress to the lumbar spine and help prevent future occurrences.
Lumbar Spine Instability
Lumbar spine instability is defined as a loss of motion segment stiffness, which allows for greater displacement than what would normally occur in normal structures (simply meaning you have an area that moves too much in your lumbar spine). This area may become painful over time as movement is driven excessively through this one area, versus a small amount of movement being driven through all areas of the low back. It typically is associated with stiffness elsewhere in the body, possibly at adjacent lumbar segments, higher up in the thoracic spine or down lower in the pelvis, hips or other lower extremity regions. Treatment aims to improve core stabilization at the area which is moving excessively, improve mobility in the stiff regions affecting the instability, work on postural retraining, and then functionally progressive exercise prescription with the goal of returning the patient back to normal activities with minimal pain and disability.
At Life’s Work Physical Therapy, all our physical therapists are trained in orthopaedic manual therapy, focusing on accurate differential diagnosis of low back pain. Two of the therapists on staff are Fellows of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT), a distinction held by less than 0.5% of the physical therapists in the United States. We use evidence-based treatments known to be effective in managing low back pain, and work to self-empower our patients as we improve their function and get them back to their activity goals.
Whether your low back pain is discogenic in nature, degenerative, traumatic from an injury, or postural, success is possible with an accurate diagnosis, followed by an individual treatment plan with patient-specific goals. If you are experiencing low back pain, and are ready to get your symptoms under control, contact Life’s Work Physical Therapy for an evaluation.