All Posts Tagged: Lower Back Pain

lower back pain

Low Back Pain – What To Do Immediately (Part 2)

This article is part 1 of a 2-part series. For part 1, Click Here.

As previously stated, low back pain (LBP) can affect most (if not all) of us at some point in time. Learning what to do when the warning signs appear is important to prevent an LBP episode disabling you. We started the discussion in the previous article about providing ways to manage the LBP using activities to stop and reverse a potentially serious degree of LBP. We offered ways to stretch from a seated position that could be done in public. Here are some exercise options from a standing position…

EXERCISE C: THE HAMSTRING & GROIN STRETCH: from the standing position, 1) place your foot on a seat, bench, chair, railing pipe, or anything about knee level (it doesn’t have to be too high). If your balance is not very good, be sure to hold onto a wall or counter in order to maintain your balance. 2) Keep your knee bent 20-30 degrees and arch your lower back by sticking out the buttocks until you feel the hamstrings (back of the leg) pulling or stretching. 3) Slowly straighten the knee (keep the buttocks stuck out and the lower back arched) and you’ll feel the hamstrings getting tighter slowly. 4) Adjust the knee angle and/or the amount of low back arch / pelvic tilt to adjust the strength of pulling in the hamstrings. Continue this stretch for 15-30 seconds, or until the muscles are loosened. 5) Remain in that EXACT SAME POSITION and twist your body inwards (toward the leg on which you stand) until you feel the tug moving from the hamstrings to the groin (to the inside thigh) muscles. You may also go back and forth between the hamstrings and the groin (adductor) muscles and continue the exercise until the back of the leg and groin feel sufficiently stretched (usually 5 to 15 seconds / leg).

EXERCISE D: THE HIP FLEXOR STRETCH: 1) step forward with one leg and stand in a semi-long, steep stride position (one foot before the other). 2) Rotate the pelvis forward on the back-leg side until the hip lines up with the front leg hip (or square pelvis). 3) Add the pelvic tilt (tuck in the buttock / pelvis or flatten the low back). 4) Lean backwards (stretch low rear) holding the position above. When you extend backwards, feel deep within the upper front of the thigh / groin area for the stretch. You can alter the hip flexor to release and re-stretch between the third and fourth steps. Continue stretching for 5-15 seconds or until you feel stretched and repeat on the other side. This one takes a little work but you’ll understand why it’s so good once you feel it!

EXERCISE E: THE ADDUCTOR STRETCH: As an alternative to the second part of EXERCISE C (step 5 of the standing hamstring stretch), stand fairly wide apart with your legs spread. Shift your pelvis from side to side (left then right) and feel in the inner thigh / groin area for the stretch. You should increase the stretch by applying a lean to the side you shift the pelvic to. Try to hold the stretch for 5-15 seconds and alternate 5-10 times between the sides.

Such activities are intended to take place in public, WHEN you need to stretch. Stop the vicious cycle from getting out of control by STOPING, STRETCHING and, if you can, resume your activity!

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low back pain

Can Back Pain Outcome Be Predicted?

Patients with low back pain (LBP) are often nervous and worried about responding to the treatment — especially when it comes to getting out of pain and returning to normal activities. Osteopathic care has been shown by a variety of studies to be an effective option for the LBP patient, and although there is no “crystal ball,” there are some tests that Osteopaths can perform during an exam that can help predict results.

A meta-analysis of data from 43 studies published since 2012* indicates that centralisation and directional choice, which may be present in 60-70 percent of LBP cases, provide significant prognostic clues. Directional choice means that the body can be moved in a way that makes the patient more comfortable than others. Centralisation means moving in a way that reduces the spread of pain to a given region.

Let’s say an LBP patient shows up with radiating leg pain from their lower back with numbness and tingling in both leg and foot. The emphasis is on seeking a movement that REDUCES the pain / numbness of the legs, and their Osteopath asks the individual to lean upward, backward and sideways and twist their body, searching for which position is preferred, i.e. lateral inclination. When pain decreases, and AND centralises (leg pain disappears), then the directional preference is the extension.

If centralisation happens, this is a positive prognostic sign indicating that positive change can be expected. Likewise, if all positions or directions raise pain in the legs, this is a bad prognostic sign, which means this is potentially a more difficult situation.

It helps doctors better advise patients about their condition and what to expect from treatment in both the short and long term so that the patient can make REALISTIC goals and plans in time. Directional preference also helps Osteopaths to decide which type of treatment should be emphasised. For example, if the patient feels comfortable bending backward and leg pain disappears, the Osteopath may approach care from that direction with exercise suggestions.

Patient education is an important part of treatment, and educating patients on how to predict the outcome of treatment instils confidence and puts realistic goals in perspective so patients know what to expect. This improves both the health care provider and the patient’s respect for care and trust.

*Ref: https://annals.org/aim/article-abstract/718375/meta-analysis-exercise-therapy-nonspecific-low-back-pain

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Lower Back Pain

Swiss Ball Exercise Program for Lower Back Pain

Today, we will look at why employing a Swiss ball could be more beneficial for the back-pain patient than simply doing floor-based exercises.

In a study back in 2015 published in the journal of Science and Medicine, researchers assigned twelve chronic lower back pain (cLBP) patients to perform either floor, or ball-based exercises, 3 times a week for 8 weeks, performing 4 different motions or exercises.

Whilst subjects in both groups enjoyed progression, the gains witnessed were much greater for those using the Swiss/gym ball in terms of functional improvement. CT scans of partakers in the ball group also found an increase in the cross-sectional area of the deep low back stabilising multifidus (MF) muscles.

The question is, why did the Swiss ball patients gain better outcomes? A likely probability is that the use of an unstable device like a gym ball, promotes the neuromuscular system to work harder to maintain balance.

This process not only improves proprioception i.e. the body’s ability to sense where its varying parts are in relation to one another for purposes of movement and balance, but it also works out additional muscle groups that are involved in normal everyday movement that may not be activated when exercising from the floor or another stable surface.

The four Swiss ball exercises included in the study:

1) Bridge-1: Lay face up (on your back) with the ball under your upper back and bring one knee toward the chest to a 90/90° hip/knee angle; hold ten seconds and repeat five times with each leg.

2) Bridge-2: Lay face up with your upper back on the floor with the ball under the pelvis; push down into the ball with the pelvis for ten seconds and repeat five times.

3) Bird-dog (kneel on all-fours—quadruped position): Place a small ball (4-6”) under one knee (kneel on it) and slowly lift and straighten the opposite leg and balance for ten seconds and repeat ten times with each leg.

4) “See-Saw:” Lay on your stomach with the ball under the pelvis/hips, balance on the forearms, raise the legs, and do a scissors-kick (as if swimming) for ten seconds ten times with each leg.

We encourage proper form and working safely within “reasonable pain boundaries” that you deem acceptable. Gradually increase reps and sets as you improve.

If you would like to learn more or feel a visit to your Osteopath could be beneficial, book online at www.cramosteopaths.co.uk/book-online

We look forward to seeing you!

Adapted article, credit: https://www.drmatthewdunnonline.com/1263/exercises-on-a-swiss-ball-help-back-pain-patients-/

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low back pain

Tingling in your leg?

When considering low back pain (LBP), you may imagine someone bent over rubbing the sore point on their back. Many of us have experienced low back pain at some stage in our life, so we can relate to an episode and recall how restricted we were during the acute stage of our last LBP occurrence. However, when the symptoms connected to LBP are contrasting, such as tingling or a sharp pain down one leg, it can be confusing and concerning. To best understand where these symptoms derive from, we need to look at the anatomy of the low back.

In the front of the spine, the part mainly on the inside of our body, we have the large vertebral bodies and shock absorbing discs that support about 80% of our bodyweight. At the opposing side of each vertebrae you’ll find the spinous and transverse processes that are connected to the muscles and ligaments in the back, to the spine. Between the vertebral body and these processes are the tiny bone parts called the pedicles. Where the nerves exit the spine, the length of the pedicle partially controls the size of the holes.

When the pedicles are short, the exiting nerves can be compressed due to the narrowed opening; this is known as foraminal spinal stenosis. This compression generally happens as we age, when osteoarthritis and/or degenerative disc disease progressively crowds these “foramen” where the nerves exit the spine.

Likewise, short pedicles can narrow the “central canal” where the spinal cord travels up and down the spine from the brain. As we get older, the effects of the narrow canal plus disc bulging, osteoarthritic spurs, and/or thickening or calcification of ligaments can result in “central spinal stenosis.” The indicators linked with spinal stenosis include difficulty walking due to a gradual increase in tingling, heavy, crampy, achy and/or sore feeling in one or both legs. The tingling in the legs associated with spinal stenosis is called “neurogenic claudication” and must be segmented from “vascular claudication”, which feels similar but is caused from lack of blood flow to the leg(s) instead of to the nerve.

When we are younger, tingling in the legs can be caused by either a bulging or herniated lumbar disc or it can be referred pain from a joint – usually a facet or sacroiliac joint. The main difference in issues between nerve vs. joint leg tingling sensation is that nerve pinching from a deranged disc is found in a specific area in the leg, such as the inside or outside of the foot. So, the tingling can be identified pretty much exactly in the leg. Tingling from a joint is often named as a deep, “inside the leg,” generalised aching and tingling that can affect the whole leg and/or foot, however it’s harder to describe by the patient as it’s less specific in its whereabouts.

Osteopathic management of all these conditions offers a non-invasive, sufficient form of non-drug, non-surgical care and is the recommended in LBP guidelines as an option when treating these issues.

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Low Back Pain and Nerve Flossing

A patient can feel severe discomfort when the sciatic nerve is pinched or pressed. A tingling feeling, a lack of sensation, deadness, and even frailty in the hip, buttock and leg can be symptoms witnessed. For under 60-year olds, the customary cause of sciatica is a herniated disc.

For older adults, the most likely source of sciatica is spinal stenosis which is a narrowing of the openings of the spine the nerves travel through, and spondylolisthesis, which is when one vertebra slides forward on the neighbouring vertebra.

The sciatic nerve is made up of five nerve roots that exit the spine in the lower back. They then merge into one nerve that travels through the buttock and down to the leg. At the back of the knee, the nerve divides into two nerves. These two nerves are the tibial and common peroneal, that travel into the inner and outer lower leg and foot.

In most instances, a nerve root moves freely in and out of the spine through holes located between each vertebra. Tthese are known as intervertebral foramen (IVF). Exercises such as hamstring stretches or kicking a rugby ball create resistance within the sciatic nerve and pull the nerve roots out of the IVFs. Likewise, when we stand upright and stare at our toes, this pulls the spinal cord upward and the nerve roots move into the IVFs.

When undertaking management of sciatica, osteopaths will make use of an approach named nerve flossing. Similarly, with flossing teeth, the forward and backwards movement of the dental floss is theoretically the same move as the back and forth motion of the five nerve roots, that combine into the sciatic nerve. To draw the nerve roots out of the IVF, extend the head and neck skyward and then bend the foot/ankle skyward in addition (toes toward the nose). To flex the nerve back into the IVF, aim the foot/ankle down while the head/neck flexes progressively (chin to chest). Replicate several times as long as pain or other symptoms are not exacerbated. The concept underlying this is to relieve the nerve root by minimising sticking in the IVF.

Nerve flossing is generally conducted by an osteopath to ensure it is well tolerated and safeguarded, so that the patient can carry out the movement at home multiple times a day. Studies suggest that this method helps minimise stress on the sciatic nerve whilst pulling on the hamstrings, which are invariably tight in patients with low back pain.

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Low Back Pain

Ongoing low back pain also known as chronic low back pain is a common occurrence in the world today. Statistics have suggested that low back pain has been experienced by 80% of the UK population (1).

Below we will look at some strategies to help.

In a recent study researches looked at treating 3 groups of patients with spinal manipulation (2).

1) received ‘fake’ spinal manipulation for 12 treatments

2) received spinal manipulation for 12 treatments

3) received spinal manipulation for 12 treatments and fortnightly visits of spinal manipulation for the next 9 months

Group 1 reported no relief from treatments

Groups 2 & 3 reported significant relief

Further research has determined spinal manipulation and adjustments to be safe and a successful way of treating chronic low back pain (3), 

Joanna and I regularly use Spinal Manipulation to treat low back pain. We can also provide advice on self managing your back pain which can really make a difference to your day to day life.

If you have not used osteopathic care your for symptoms. Give it a try, the evidence supports it and so do our patient reviews.

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Osteopath Glasgow

Osteopathy: Osteopathic Treatment for the Management of Lower Back Pain in Pregnancy.

400 pregnant women with the complaint of lower back pain were evaluated for the efficacy of OMT (osteopathic manipulative treatment). The women were between 18-35 years and had attained the 30th week of gestation. Initially 2 or 3 visits may be required to reduce the pain but at the late stages of the treatment, the symptoms completely disappear.
Evidence-based Practice, January 2017
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