Lowback Pain/Sciatica/Disc herniation
As a new Physio grad I was always scared to treat low back pain because I struggled to understand the nature of pain and outcome was very poor. Patient would get better after a couple sessions but would complain of some residual pain or would come back after couple months with another episode of low back pain. I took this seriously and wanted to look for best available treatment and also started searching for latest research and evidence-based practice. I found out that the best available treatment is Mckenzie technique so decided to pursue my certification in Mckenzie treatment and assessment called MDT.
In last 12 years of experience as a physiotherapist I learnt a lot about low back pain, I want to list some over here hoping this would help some of my readers.
- According to some research 80% population goes through low back pain one or more times in their lifetime.
- Low back pain is a 60 Billion dollar industry in North America alone- treatment and disability claims included.
- Low back is one of the leading causes of disability worldwide.
Low back pain is a very vast topic which could take multiple books to describe different symptoms, causes, diagnosis and treatment.
In my twelve years of clinical experience:
Most common symptoms of low pain are:
- Pain in low back
- Pain in one or both hip with or without low back pain
- Pain in buttock one or both sides, with or without low back pain
- Pain below low back and radiating up to one or both feet/toes, with or without low back pain
- Pins and needles, which can be present in one or both legs and could affect some part of the leg/legs or whole lower extremity.
- Numbness of leg/legs
- Weakness of leg/legs
Nature of Pain:
Usually, patient complaints of constant or intermittent pain at low back which could also radiate down to leg/legs.
Most common causes of low back pain:
- Derangement: in my clinical experience I have seen that 70-80% patients fall under this umbrella.
- Dysfunctional or postural back pain.
- Spinal stenosis.
- Chronic low back pain syndrome
- Psychological or central sensitization.
- Fracture spine
FYI: Most of the alternative health practitioner will blame muscle weakness as a cause of low back pain which is less likely the cause of low back pain.
Now a days it is trend to blame glut or gluteal muscle for everything that is wrong with the back and also poor posture and flat feet so clinic can make $500 making you wear unnecessary insole which research does not support have anything to do with back pain.
- Again, this is based on my clinical experience, best diagnosis for low back pain is physical examination done by health practitioner, I personally do not have big faith or trust on x ray or MRI
- Other diagnostic tools include: Xray, MRI, CT Scan, Ultrasound.
Low back pain treatment is not as complicated as it sounds. When I have a low back patient and if it is their first experience with back pain, the first question they always ask is will it get better?
Low back treatment is very simple if we diagnose it correctly. Most of the time people suffer low in pain for years or go under the knife due to wrong diagnosis.
In my clinical opinion some of the exercises do wonders and it as below.
Exercise for derangement syndrome, most common exercise for derangement syndrome is low back extension exercise.