Case Study 症状別事例

Low back pain is one of the most common injury in the world.

Why so may people are struggling with this impairment?

The reason is that main causes in 90% of low back pain are unknown.

What is Lower Back Pain?

Firstly, lower back pain is divided into two types, specific and non-specific low back pain.

Specific low back pain has clear pathophysiological mechanism causing symptoms, such as herniation or fracture. Non-specific low back pain does not have clear changes around lower back, but causing pain there.

A research reported that 90% of all low back pain is non-specific low back pain. (Koes, 2009)

There are examples of the differences in the two types of low back pain.

If a patient has low back pain and took MRI scan. It revealed herniated disc at lumber spine and diagnosed as lumber disc herniation. This is a specific low back pain.

On the other hand, a patient has low back pain and nothing found on MRI and X-ray scan. It is not clear what makes this low back pain. This is a non-specific low back pain.

There are very simple examples of two types of low back pain. Therapists often treat more complicated cases at practice. Some patient has herniated disc and no pain or another patient has similar herniated disc and no pain with pins and needles on legs.

This is particular features of low back pain. Symptoms are completely different each patients and pathophysiological changes are not always connected with pain and other symptoms.

This is why doctors and therapists are struggling with finding main causes of low back pain to fix it.

Diagnosis

Usually one of three medical scans are selected to check your low back in a hospital. Depending on your symptoms, doctors choose the best scan to picture different types of soft tissue related with your symptoms.

In addition to the medical imaging, physical and muscular tests are also combined to increase the accuracy of diagnosis.

X-ray

X-ray is the most popular medical scan and it it used to check bony conditions. X-ray cannot show soft tissue like muscles and ligaments. This imaging is also not expensive compared with other imagines, so commonly used at private hospitals and clinics.

CT

CT scan show bony conditions clearer than X-ray scan. This imaging can highlight even bone fiber of each bone, so very useful to find a small changes like stress fracture.

MRI

MRI scan is different from X-ray and CT scan to as this is an imaging to check any soft tissue pathologies. Muscles, ligaments, blood vessels and swelling, MRI scan is very helpful to find out local abnormalities.

Physical Examination

This is the check tests for physical function and movement analysis. For example, Straight Leg Raise test for sciatic nerve impairment and manual tests for sacroiliac joint.

X-ray（radiopedia）

CT（Cedars-Sinai）

MRI（radiopedia）

Due to the innovation of modern technology in medical environment, there are many useful examination methods to test low back pain.

However, only 10% of low back pain can be diagnosed as specific injury or disease. This is the fact of low back pain right now and limitation for providing effective treatment.

Symptom

Symptoms of low back pain are not only the pain.

Difference of the symptoms help medical teams to assume which soft tissues are influenced by the condition, so it is very important to recognise exactly what your symptoms like.

Pain

Of course, pain is the most major symptom of low back pain.

Almost all back patients have pain on low back, but types of pain are different.

Is it sharp pain or dull pain?
Pain on the morning or after long sitting?

In case of sharp pain, muscular injuries are suspected. Dull pain is often caused by compressed nerve. There are a lot of patterns of pain depending of injured area and tissues. If you can tell doctors what type of pain on your low back, it is helpful information to identify the cause of back pain.

Pins and Needles

Pins and needles sensation is often seen in the patients with low back disc herniation.

The most common area people feel insensitivity is back of thigh. Sometimes, pins and needles go to toe and hip.

This sensation impairment tell us your nerve root is compressed somewhere around low back. Depending on the injuries such as disc herniation or sciatica, affected area is clearly different. Therefore, therapists are able to suspect what kind of injury you have by the area affected by pins and needles.

Cause 

Many patients are annoyed by low back pain and do not understand why they got it.

However, cause of back pain is usually very simple.

Posture

Posture is the most major cause of low back pain.

Low back located at the centre of upper and lower body. Whenever the posture, standing or sitting, low back always bear the gravity and weight of upper body and head.

If your head position is moved forward over shoulder, thoracic spines have to make a big curve backward to keep a balance with the head. This type of posture is often seen in people with desk work and using PC for a long time.

As long as you cannot hold “S” shape of your spine, low back takes a lot of burden to hold upper body.

Long sitting or standing

If you do not move around and keep the same posture for long time, low back has got big pressure and cause pain.

Keeping the same posture make muscles around low back very tight. Muscles are flexible and stretchable soft tissue. If muscles cannot change their length for long time, they loose flexibility and become shooter.

Shortened muscles create spasm at muscle fiber and it cause pain.

It is important to move and stretch low back every an hour not to tighten muscles on low back.

Treatment

To treat low back pain, the most important thing is to fix your body and posture.

Massage or pain killer can give you temporal pain relief. However, it does not last long because pain is result of the cause which is often bad posture or weak muscles.

If you do not change your body, it is impossible to cure low back pain. Changing body by stretching and exercising is not easy choice for most of people, but if you really want to graduate from back pain, please step forward and push yourself to obtain grateful future without pain.

Exercise

Exercise is the most useful and effective physiotherapy for low back pain.

“Exercise” does not mean to work our hard and get 6 pack abs. In fact, strength training to get 6 pack is not helpful to relieve low back pain. Exercises to cure back pain are not so hard and exhausted workout. It is a lessens how to use appropriate muscles to realign good posture.

There are 4 different abdominal muscles in human body. Rectus abdominis is the most superficial and strong muscle. Internal and external oblique muscles are attached at side of trunk and they rotate trunk side to side. Transversus abdominis is the the most deep and surrounding lumber spine.

To improve low back pain, activating transversus abdominis is the most effective exercise. The most important function of transversus abdominis is to support lumber spine and increase inter abdominal pressure. If this muscle is well activated, low back can keep ideal position in standing and sitting.

To activate transversus abdominis, draw-in exercise is the best method. At first, lying on your back and bend both knees. From this position, try to squeeze your deep stomach and press the ground. Keep pressing the floor for 10 seconds and relax for 2 seconds, and squeeze stomach 10seconds again. 3 times of squeezing for 3 sets with 1 minutes of intervals is the ideal programme for the 1st week.

Stretching

Stretching should be started with muscle activation exercises.

To correct bad posture, combination of muscle activation and stretching provide you the best results. Low back pain is often caused by bad posture and postural abnormality is usually caused by weak muscles and tight muscles. Weak muscles need to strengthen or activate. Tight muscles are released by stretching.

The target muscles to stretch are depending on the types of low back pain. If you have curved upper back, stretching for pectorals muscles is very effective. If you have curved lower back, stretching for psoas and quadriceps muscles is useful.

Due to the variation of low back pain in each individual condition, there is no perfect stretching programme for all low back patients. It is very important to seek the advice from professional physiotherapist or other therapists to find out what is the best stretching for your body.

Not recommended

① Massage

Massage for low back can give you temporal pain relief, but only for few days.

This is because massage can relax tight muscles, but cannot remove the causes of tightening muscles. If you do not change your body and fix posture or incorrect movement patterns, pain alway comes back unfortunately.

② Pain killer

This is completely the same as massage. No any positive effect to cure low back pain.

Furthermore, pain killer can mask the back pain, so you can move around without feeling of back pain. After the effect of pain killer, you would feel much more pain than before taking the pills.

This is the risk of pain killer that you move hard and worsen the low back pain because you do not feel the pain while pain killer is working.

Conclusion

Low back pain is very popular injury around the world.

Because 90% of back pain are still unknown causes after medial examination.

Finding appropriate and specialised treatment method for each individual low back pain is the most important.

Understanding your own cause of back pain and fix the problem is the only way to cure back pain.

Do not rely on temporally pain relief like massage or pain killer, change your body and obtain painless condition.

Lifelong is your private physiotherapy clinic

Lifelong provide order-made physiotherapy to treat any types of low back pain.

Exercise therapy, such as stretching and muscle activation, improve posture, joint mobility and muscle functions to cure pain on your body forever, not like symptomatic treatment.

Removing “cause” of pain rather than “pain” itself, can provide you painless body and also prevent from future degeneration.

Please do not hesitate to contact us, experienced physiotherapist studied and worked in Europe is here to sincerely support you.

Best wish for you healthy and happy future life.