Back Pain: Home Managements - An Introduction (Physiotherapy Treatment)
Many patients who have recovered from acute episode of low back pain are candidates of it's recurrence. After the first episode of back pain, even though the symptoms have subsided, the factors that were responsible for it may remain as such. If these factors are identified and dealt with, the recurrence of low back pain may be prevented to a great extent. Of these factors some may be beyond the control of the patient and hence cannot be dealt with. Any way,the factors that can be controlled, if identified, can be addressed to.
Immediate aims of exercise programs in Back Pain
80% of the patients will recover from an acute episode of low back pain within three days to three weeks irrespective of what treatment he had.Early intervention and management of low back pain is required to speed up recovery so that the following objectives may be achieved. The objectives are
1. Relieving pain.
2.Restoring mobility of the low back.
3. Restoring the strength of the muscles of the low back
4. Minimizing residual impairment and disability.
5. Prevention of recurrences of low back pain.
6. Preventing the acute low back pain progressing into chronic pain and disability.
Long-term aims of exercise programs in Back Pain
The exercise program aimed at
1. Regaining and acquiring adequate flexibility of the muscles and ligaments of the low back.
2. Regaining and acquiring the strength of the muscles of the low back.
3. Learning and implementing the correct body mechanism to carry out every day activities like standing, sitting, lying, carrying, pulling, pushing etc.
4. Learning and maintaining the correct posture while carrying out everyday activities.
5. Inducing confidence and psychological support to the patients.
General rules of exercises in Back Pain
General rules to be followed by the patient while doing the exercises are as follows.
1. Do the exercises on a hard surface.
2. Do each exercise slowly and gently. Bouncing movements must be avoided.
3. Each exercise must be done five times initially and may be progressed slowly to ten times.
4. Do exercise ten to fifteen minutes daily, twice a day.
5. Do the exercise everyday without fail.
6. Avoid painful exercise from the exercise program.
7. Prior to the exercises, hot water fomentation may be given to the area to relax the muscle and to reduce the pain.
8. Hold in the stretched position for at least for five seconds before coming back to the starting position.
9. If the patient has severe acute back pain avoid exercises altogether.Complete bed rest is essential. Bed rest may facilitate healing process. The patient lies with the hips and knees flexed and the low back in a slightly flexed position. This position is called " modified Fowler " position.
10. If the patient has severe acute pain local application of ice is highly beneficial.Ice acts as the analgesic and also reduces muscle spasm. It acts as an anti inflammatory agent and also reduces swelling. It also helps to stop bleeding, if any. Icing is done in the form of brushing. I prefer prolonged icing. Ice cubes wrapped in a thick towel is placed over the back in the following manner.
15 minutes icing - 10 minutes break - 15 minutes icing x thrice a day.
Some prefer application of heat to application of ice.
11.Care should be taken when coming to sitting or standing from the "modified Fowler " position.
- Do not come to a straight sitting position from the resting position in one stroke.
- Roll over to one side using the arms and keeping the hips, knees and low back flexed.
- Put the legs down the bed and assume the sitting position with the help of hand.
- Now the patient sits with his feet flat on the ground.
- He leans forward until his body is directly above his feet.
- He swings forward and slowly gets up and maintains a straight standing position.
12. Choice of exercise is very important. Seek advice from a qualified physiotherapist.