Common back pain: recurrent idiopathic symptom / pathology affecting the lumbar spine, characterized by pain and functional limitation.
Common low back pain accounts for 80% of low back pain cases. It is the most common disease in the working population and is the most common cause of absence from work in western countries.
Types of lower back pain
Local: if caused by irritation of the nerve endings of the rachis skeletal muscle structures;
From defensive muscular contracture;
Radicular: by stretching, compression or irritation of the nerve root;
Reported: if it comes from extravertebral organs.
Risk factors for low back pain
The risk factors that predispose individuals to back pain are numerous: the sedentary life, previous osteomuscular traumas or caused by the lifting of heavy and voluminous objects from the ground, the movements of pulling, pushing and rotating, the decrease of the force of the trunk musculature, an imbalance between the anterior and posterior trunk muscles, loss of lumbar lordosis in a sitting position, poor physical condition, obesity, drug abuse, drugs and alcohol.
Prevention of low back pain
Primary prevention (before the symptom arises): with an educational intervention that leads to learning correct habits of life.
Secondary prevention (after its appearance): with a re-educational intervention interpreting the "pain" of the subject.
Anamnesis of the lumbago subject
Onset methods, worsening circumstances and improvement;
Type, severity, intensity, time and duration of pain;
Precise localization and irradiation of pain; concomitance with other symptoms;
Possible presence of connective, metabolic, cardiovascular, neurological and gastrointestinal diseases.
Guidelines for the rehabilitation of low back pain
Evaluation of physical conditions;
Study of the anatomy of the spine;
Physical treatments for painful symptoms;
Streching exercises, improvement of flexibility and stabilization;
Recovery of physical condition and muscle balance
Development of an exercise program to continue at home;
Education for a correct lifestyle to prevent trauma
Objectives of physical activity in a spine rehabilitation program
Maximize physical functionality
Improve muscle-tendon and tissue elasticity;
Balance the muscular forces (with particular attention to the abdominal and lumbar groups);
Improve aerobic capacity and physical condition;
Ergonomics education in everyday life activities.
Sign of the extended leg extension (SLR: straight leg-raising): this movement evokes pain in the back or limbs and is similar to that complained of by the subject (L5, S1, sciatic)
Pain can be accentuated by dorsiflexion of the foot
The maneuver can also be performed when the patient is seated
Abdominal musculature :
plays a fundamental role in stabilizing the spine and, in relation to its topographical location, it significantly conditions the lumbo-sacral tract.
The muscles of the abdominal wall act as stabilizers with synergistic action to the rachid musculature and to that of the lower limbs (flexors / extensors of the hip, abductors / adductors of the thigh) which proximally insert themselves on the pelvis, conditioning their balance.
Tonicity and tropism of the abdominal muscles
Necessary condition for a correct movement dynamics;
It promotes motor coordination and synergy between the muscles of the abdomen, those of the lower limbs and those of the spine, limiting the appearance of overload disorders such as pubalgia and low back pain.
The abdominal musculature (rectus of the abdomen) limits and contrasts an excessive hypertension of the lumbar musculature
A properly strengthened abdominal belt allows to discharge about 40% of the weight on the lumbar vertebrae
The function of the rectum of the abdomen
The rectum of the abdomen is an antagonist of the paravertebral musculature which acts with an antiversion action on the pelvis and hypertension on the lumbar spine. The most common pathological situation is that which contrasts the hypotonia of the abdominal wall musculature to the hypertonia of the paravertebral wall.
Function of the torso flexor muscles and thigh extensors
They rotate the pelvis in retroversion, therefore they have a delordosizing action for the lumbar spine.
Their weakening involves an anteroversion of the pelvis and consequent accentuation of lumbar lordosis.
Function of the extensor muscles of the torso and the flexors of the thighs.
They tend to rotate the pelvis in anteroversion, therefore they have a lordosizing action for the lumbar spine.
Keeping them elastic can counteract this action.
Respiratory technique
Inhale during the passive phase of the exercise (body alignment), filling the lungs up to just over half; in this way it is possible to expel all the air in the following active phase (closure of the body);
Begin the exhalation phase from the beginning of the active movement phase (beginning of body closure); in this way the diaphragm can rise immediately and does not hinder the closure of the trunk;
Strive to continue exhaling constantly throughout the active phase of the movement; in this way the shortening of the involved musculature is constant;
Make sure you have completely emptied your lungs a moment before the end of the active phase of the movement, only in this way is it possible to have the certainty of obtaining the maximum muscle shortening and of having involved not only the properly motor abdominal muscles (oblique and / or rectum) but also the transversus muscle.
Techniques used for the treatment of low back pain
Mc Kenzie Method;
Mézières method;
The back school
The Mc Kenzie method
It recognizes a mechanical and non-inflammatory cause in disorders of the spine and identifies the predisposition to low back pain in two factors linked to lifestyle:
incorrect sitting position;
frequency of flexion
This method allows the therapist a careful mechanical evaluation in order to identify two categories of patients; one that responds to self-treatment and prophylaxis techniques, the other that requires additional manual therapy
The Mézières technique
It is based on the principle according to which the muscles responsible for statics must be stretched with exercises in eccentric isotonic contraction, maintaining the elongation for as long as possible.
The eccentric isotonic contraction causes the lengthening of all the connective tissue and, at a physiological level, causes an increase in the number of sarcomeres and the replacement of the fibrous tissue.
It is also based on the principle that the rigid muscles deform first and to a greater extent than the elastic muscles.
The objectives that characterize it are: to inhibit the retroaction of the posterior muscles, to try to recall them in their globality for the motor activities, to take advantage of the exercises of correction of the curves, to facilitate the deep diaphragmatic inspiration.
The 3 principles of the Mézières technique
Since each individual is unique, we must treat sick and non-sick;
Since each individual is indivisible, each treatment must be global;
Any treatment can and must be traced back to the cause of the disease.
The Back School
It includes exercises in respiratory education, postural education, mobilization exercises, stretching, decompression, stabilization and balance of the spine.
All the exercises are done very slowly, following the rhythm of the breath.
