Following on from my last post on low back pain treatment options where we considered the use of manipulation, today we’ll look at some specific types of exercise
If your physiotherapist finds three or more of the following factors then a good choice for treatment would be stabilization or core exercises. The factors associated with success in this treatment group were: age less than 40, presence of abnormal active movement patterns, straight leg raise of more than 90 degrees and a positive lumbar prone instability test. The participants in this study attended therapy twice per week for 8 weeks of supervised exercises and also performed home stabilization exercises prescribed by a physiotherapist. Two thirds of the group showing three or more prediction factors, benefitted from the stabilization exercises. This seems low but when this treatment was applied across the board only 1/3 of participants benefitted. In the clinic the success rate could probably be increased by adding additional treatments such as joint mobilization or manipulation, education regarding positions to avoid and review of their movement and positioning habits at work.
Mechanical Traction & Extension Exercises
The profile of the treatment group who responded well to mechanical traction followed by extension exercises, was that they had symptoms below their buttocks (pain, tingling or numbness), signs of nerve root compression (reduced or absent reflex, sensation and or muscle weakness, straight leg raise less than 45 degrees), improvement of symptoms with extension exercises or extension positions and reproduction of back pain when the therapist performed a passive straight leg raise on their opposite side. This treatment was also combined with extension exercises.
A Canadian physiotherapist, Audrey Long of Alberta published a research paper in 2004 showing that the type of exercises prescribed combined with the participant’s individual assessment findings predicted treatment success in a group of patients with low back pain. Eric Parent and a group of physiotherapy researchers from the University of Utah looked specifically at predictors of success with extension exercises. They found that physiotherapy consisting of 2-3 visits per week for up to one month and focusing on extension exercises improved function by at least 50 % in 87 % of patients who had four out of 6 of the following factors: no additional health problems limiting their function, restriction of active motion towards the painful side, no signs of nerve root compression on the painful side, no limitation of hip mobility when the foot was placed on the opposite thigh and the knee pushed towards the floor, symptoms worsened with repeated forward bending , symptoms improved with passive or active backward bending.
This line of research is exciting for therapists and people with low back pain. The bottom line is that your physiotherapist should be taking a thorough history and performing a detailed physical examination prior to deciding the best treatment for you. Please be aware that even if you don’t fit one of the patterns described here, there is a strong probability that you can benefit from physiotherapy. If you have more questions feel free to contact one of our highly trained team of physiotherapists at West 4th Physiotherapy.