The causes of vertebral pain are numerous. Some studies have shown that only 20% of back pain is caused by a specific problem in the spine (spinal pathologies); the remaining 80% is caused by non-specific causes such as incorrect postures and movements, psychological stress, poor physical fitness and excess body weight.
There are two types of back pain: acute low back pain and chronic low back pain.
Acute low back pain is characterized by a type of pain, caused by a muscular, ligamentous, articular and discal lesion, which is accompanied by inflammatory phenomena. Inflammation and pain are part of the healing process and therefore cease to complete within 30 days.
The acute pain at the level of the spine is, therefore, an alarm signal for a successful injury, a defense reaction, a stimulus to change position; has a protective and adaptive role, serves to prevent movements that can further damage the spine.
The key to switching between acute and chronic back pain is secondary factors, pain maintenance factors even in the face of total healing of the injured rachiseal structures. These factors are called chronic risk factors and are both physical and, above all, psychic and social. Hence the definition of bio-psycho-social syndrome .
The physical risk factors are a previous low back pain, a long duration of the symptoms, an extended pain, an irradiated pain in the lower limbs, a limitation of joint mobility, an incorrect ergonomic management of the body, a low level of physical activity, overweight, smoking and other disorders of the musculoskeletal system. The psychic ones are stress, poor personal care, a self assessment of poor health, depression. Finally, the social risk factors are professional dissatisfaction, social distress, compensation syndrome.
Chronic low back pain, therefore, tends to make the pain last longer than 3 months even in the presence of a non-existent lesion. Chronic pain does not have a protective function, it becomes autonomous, harmful, reduces the functionality of the spine and promotes disability.
Objectives: recovery of low back pain
- Treat pain with means that reduce bed rest and drug addiction;
- Improve vertebral function and re-educate posture;
- Teaching correct vertebral ergonomics in daily life and work;
- Teach the patient self-management of chronic manifestations and instill confidence in their physical abilities;
- Fast return to normal work and home activities.
Acute low back pain (about 7 days)
The treatment in the acute phase is mainly based on physiotherapy and kinesitherapy, limiting bed rest to a minimum and taking drugs such as analgesics and muscle relaxants.
In this phase it is important to lead the patient to self-manage his body, reducing pain and preventing recurrence and chronicization.
Medical gymnastics must be precocious and go through these steps:
- relaxation and stretching exercises
- postural education exercises.
Here are two basic analgesic exercises, namely against pain, useful to perform even several times a day for both acute and chronic forms of low back pain:
Fig.1 Analgesic exercises: A, Psoas position; B, position of the Sphinx.
The Psoas position (A): allows the relaxation of the Ileo-Psoas muscle by reducing its traction on the lumbar vertebrae.
The position of the Sphinx (B): allows the centralization of pain in case of hernia or disc protrusion.
At the end of the acute phase, then at the end of the pain it is useful to start with the following work protocol:
- Strengthening exercises in isometry, initially in spinal discharge.
- Lumbosacral stabilization exercises.
- Gentle and progressive mobilization exercises.
Fig.2 Exercise for strengthening the static or dynamic abdominals.
The position of the lower limbs facilitates the retroversion of the pelvis.
From a dynamometric study on the function of the abdominal muscles it was found that subjects with chronic back pain showed a strength decrease between 48 and 82% compared to the control group (Smidt and coll).
In lumbalgic patients, however, the relationship between abdominal and extensor strength (3: 5) is similar to the control subjects, their fatigue is still greater (Suzuki and Endo).
These exercises must be performed daily, respecting the "no pain" rule for everyone.
The period ranging from 7 days to 7 weeks represents a very delicate moment of transition from the acute phase to the chronic phase that can be indicated with the name of sub-acute phase .
In case of improvement, a conservative rehabilitation treatment is recommended, similar to the methods used in chronic low back pain. In case of deterioration, however, further investigations will be carried out and different therapeutic solutions will be proposed, possibly surgical.
Chronic low back pain
The treatment at this stage has the following objectives:
Teaching proper column management;
To get a good functional training to carry out work and home activities;
Maintain a good general physical condition to prevent recurrences and able to guarantee a good quality of life;
Make the patient aware of the self-management of their problem;
In fact, reducing the importance of individual risk factors can affect the outcome of the therapy.
The methods used to teach the correct management of the spine are:
The Back School: provides useful information for the patient, for a correct use of his column, instills self-esteem and self-confidence.
McKenzie: uses the concept of centralizing the symptom, considering an improvement in the lumbar localization of pain and a worsening of the irradiation at a distance in the gluteus and in the lower limb.
Mezieres: uses practical stretching exercises maintaining a more correct posture, especially in static posture, sensitizing the patient to deeply perceive his body.
Souchard or Global Postural Re-education: derived from the Meziéres method and based on the treatment of kinetic chains.
Proprioceptive re-education: instills better postural control through maximal enhancement of proprioceptive afferents.
Motor-Sense Reprogramming: restores a correct motor action, through its cognitive and perceptive processing and a consequent normalization of static and dynamic automatisms.
Stabilization of the lumbar spine: it is based on the concept of maintaining the lumbar spine in a painless position for as long as possible during any activity of daily life.
Work Hardening: a systematic program of progressive activities with perfect body mechanisms, which reconditions the person's musculoskeletal, cardio-respiratory and psychomotor systems to prepare them for return to work.
To get a good functional training you must:
Constantly perform kinesitherapic exercises, even at home
Correct incorrect postures in work and in the home environment
Use vertebral discharge positions when possible
Make the patient aware of the self-management of their problem.
In conclusion, the analgesic and kinesiological exercises are a fundamental part in the preventive and conservative treatment of low back pain in order to keep the subject autonomous and active.
Bibliography
- AAVV, 2000, Human Anatomy and Histology, Minerva Medica Editions
- GREISSING H. ZILLO A., 1985, ZILGREI the method to eliminate pain immediately, Arnaldo Mondatori Editore
- MARTINI F., 1994, Fundamentals of anatomy and physiology, EdiSES
- PIROLA V., 1999, Cinesiologia, Edi Ermes
- RAGGI D., Teaching Material Pancafit Course Method Raggi
- TOSO B., 2003, Back School Neck School Bone School Planning Conducting Verification Organization, Edi Ermes
- TOSO B., 2003, Back School Neck School Bone School Specific work programs for diseases of the spine, Edi Ermes
- www.gss.it
- www.pancafit.net
- www.sportmedicina.com
