Physiotherapy Management of Low Back Pain

low back pain is very common in population occurring at least once a lifetime in nearly 60-80% of population.
This presentation was presented as a webinar in coordination with ypta and serving hands on 12-8-2021.

1. MANAGING LOW
BACK PAIN
Dr.Maryam Nadeem
DPT, MS-SPT*
DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

2. Low Back Pain-Epidemiology
Low back pain (LBP) is the fifth most common reason for physician visits,
■Affects nearly 60-80% of people throughout their lifetime.
■Some studies have shown that up to 23% of the world’s adults suffer from chronic
low back pain. This population has also shown a one-year recurrence rate of 24% to
80%
■Some estimates of lifetime prevalence are as high as 84% in the adult population
■A systematic review demonstrated an annual rate of adolescents suffering from
back pain of 11.8% to 33%
DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

3. Examples of Lumber Pain Causes
DR. MARYAM NADEEM
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MaryamSportsPT

4. DR. MARYAM NADEEM
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5. DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

6. DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

7. DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

8. DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

9. DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

10. DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

11. DR. MARYAM NADEEM
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12. DR. MARYAM NADEEM
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13. Anatomy
DR. MARYAM NADEEM
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MaryamSportsPT

14. Common Impairments Related to Disk
Protrusions in the Lumbar Spine
■Pain, muscle-guarding
■Flexed posture and deviation away from (usually) the symptomatic side
■Neurological symptoms in dermatome and possibly myotome of affected nerve roots
■Increased symptoms (peripheralization) with sitting, prolonged flexed postures,
transition from sit to stand, coughing, straining
■Limited nerve mobility, such as straight-leg raising (usually between 30 and 60)
■Peripheralization of symptoms with repeated forward bending (spinal flexion) tests
DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

15. Common Impairments and Functional
Limitations Related to the Facet Joint
Pathology
■Pain: When acute, there is pain and muscle guarding with all motions; pain when
subacute and chronic is related to periods of immobility or excessive activity.
■Impaired mobility: Usually hypomobility and decreased joint play in affected joints;
there may be hypermobility or instability during early stages.
■Impaired posture.
■Impaired spinal extension: Extension may cause or increase neurological symptoms
due to foraminal stenosis; therefore, may be unable to sustain or perform repetitive
extension activities without exacerbating symptoms.
■Any functional activity that requires flexibility or prolonged repetition of trunk
motions, such as repetitive lifting and carrying of heavy objects, may exacerbate
symptoms in the arthritic spine.
DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

16. Common Impairments and Functional
Limitations Associated with Muscle and
Soft Tissue Injuries
Acute Stage
■Pain and muscle guarding
■Pain with contraction of the muscle or stretch on the muscle
■Interference with ADLs (rolling over, turning, sitting, sit to stand, standing, walking)
Subacute and Chronic Stages
■Impaired muscle performance
■Impaired mobility: may have contractures in muscle and related connective tissue or may
have adhesions at site of tissue injury
■Impaired spinal control and stabilization during functional activities
■Impaired postural awareness
■Limited IADLs, work, and recreational activities (difficulty with repetitive or sustained
postures, lifting, pushing, pulling, reaching, and holding loads)
MaryamSportsPT
DR. MARYAM NADEEM
Goodbye Pain, Hello Life

17. MANAGEMENT
GUIDELINES
DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

18. PRINCIPLES OF MANAGEMENT
Acute inflammatory stage.
The patient experiences constant pain, and there are signs of inflammation. No position
or movement completely relieves the symptoms. Medical intervention with anti-
inflammatory medications is usually warranted.
Acute stage without signs of inflammation.
Symptoms are intermittent and related to mechanical deformation. There may be signs
of nerve irritability when the nerve root or spinal nerve is compressed or placed under
tension. The patient may be categorized into an extension bias, a flexion bias, or a non-
weight-bearing bias based on the presenting posture, movement impairments, or
positions of symptom relief.
DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

19. Subacute stage.
Usually at this stage, certain movements and postures with some instrumental
activities of daily living (IADLs) still provoke symptoms, such as lifting, vacuuming,
gardening, and other activities requiring repetitive movement of loads so a basic
lifestyle cannot fully be resumed. A more thorough examination is conducted to identify
impairments that could be interfering with recovery.
Chronic stage.
When this stage is reached, emphasis is placed on returning the patient to high-level
demand activities that require handling repetitive loads on a sustained basis over a
prolonged period of time (from heavy material handling, to repetitive household
activities that include lifting small children, to strenuous athletic activities).
DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

20. Physiotherapy Goals
■Pain
■Function
■Reintegration
■Prevent recurrence
DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

21. Management-Impaired Posture
Develop awareness and
control of spinal
alignment in a variety of
positions
Learn awareness
between posture and
pain
Increase mobility in
restricting muscles,
joints, fascia
Develop neuromuscular
control, strength, and
endurance in postural
and extremity muscles
Learn safe body
mechanics
Learn to correct stress
provoking
postures/activities
Learn stress
management/relaxation
Improve aerobic capacity
Develop healthy exercise
habits for self-maintenance
DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

22. MANAGEMENT GUIDELINES—Acute
Spinal Problems/Protection Phase
Educate
Decrease acute symptoms
Demonstrate safe postures
Control of stabilizing muscles
Teach awareness
Teach safe performance of basic ADLs; progress to IADLs
DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

23. MANAGEMENT GUIDELINES—Subacute
Spinal Problems/Controlled Motion Phase
Educate
Progress awareness and
control of spinal
alignment
Increase mobility in tight
muscles/joint/fascia
Teach techniques to
developstrength, and
endurance
Develop cardiopulmonary
endurance
Teach techniques of stress
relief/relaxation
Teach safe body
mechanics and
functional adaptations.
DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

24. MANAGEMENT GUIDELINES—Chronic Spinal
Problems/Return to Function Phase
Emphasize spinal control in high-intensity
and repetitive activities
Increase mobility in tight
muscles/joints/fascia
Improve muscle performance; dynamic
trunk
and extremity strength, coordination, and
endurance
Increase cardiopulmonary
endurance
Emphasize habitual use of
techniques of stress
relief/relaxation and posture
correction
Teach safe progression to high-
level/high intensity
activities.
Teach healthy exercise
habits for self-maintenance. DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

25. Correcting Lateral Shift
DR. MARYAM NADEEM
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26. EXERCISES TO REDUCE
PAIN
DR. MARYAM NADEEM
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MaryamSportsPT

27. Exercises if back pain is eased by
standing or lying down
DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

28. DR. MARYAM NADEEM
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MaryamSportsPT

29. DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

30. DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

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Goodbye Pain, Hello Life
MaryamSportsPT

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Goodbye Pain, Hello Life
MaryamSportsPT

33. DR. MARYAM NADEEM
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MaryamSportsPT

34. DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

35. Exercises if back pain is eased by
sitting down
MaryamSportsPT
DR. MARYAM NADEEM
Goodbye Pain, Hello Life

36. DR. MARYAM NADEEM
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MaryamSportsPT

37. DR. MARYAM NADEEM
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MaryamSportsPT

38. Exercises when no position eases back
pain
DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

39. SOME MORE
EXERCISES
DR. MARYAM NADEEM
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MaryamSportsPT

40. DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

41. DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

42. DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

43. DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

44. DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

45. DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

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Goodbye Pain, Hello Life
MaryamSportsPT

47. DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

48. DR. MARYAM NADEEM
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MaryamSportsPT

49. ERGONOMICS
Correct Body Mechanics
DR. MARYAM NADEEM
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MaryamSportsPT

50. DR. MARYAM NADEEM
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51. DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

52. DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

53. DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

54. DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

55. DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

56. DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

57. DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

58. DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

59. DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT

60. DR. MARYAM NADEEM
Goodbye Pain, Hello Life
MaryamSportsPT