LOW BACK PAIN Low back pain is a common musculoskeletal condition that can affect people of all ages, often interfering with daily activities and reducing quality of life. The lower back region comprises lumbar vertebrae, surrounding muscles, ligaments, fascia, nerves, etc., Generally, it comprises all the structures in the region between the 12th rib and pelvis.PREVALENCE 85% of the population suffers from low back pain at some point in their lifetime. The majority (70-80%) improve from an acute episode over 3 months, and about 50-80% will have at least one recurrent episode. About 20-30% of LBP can become persistent and disabling. CAUSES AND RISK FACTORS Non-specific LBP No pathoanatomical causes that correlate with clinical presentation Possible reasons for non-specific low back pain: Psychological factors: Fear-avoidant behavior, stress, depression, anxiety, and social support Lifestyle factors: Low physical activity, smoking, obesity, poor sleep, and being tired Other factors: Age, gender, socioeconomic status, genetics, habits, and diet Biomechanical factors: muscle imbalances, impaired muscle activation LBP With Specific pathology Fracture (traumatic / stress) Disc prolapses Spondylolysis or spondylolisthesis Vertebral endplate edema (Modic type 1 changes) Spinal canal stenosis Serious or systemic pathology Spinal infections (e.g., discitis, vertebral osteomyelitis) Primary spinal tumors or metastases (e.g., from prostate, breast, or lung cancer) Vertebral compression fractures Inflammatory conditions like spondylarthritis (e.g., ankylosing spondylitis) Vascular causes like Abdominal aortic aneurysm (AAA) Cauda equina syndrome Rheumatological disorders (e.g., rheumatoid arthritis, lupus) Referred Pain from Visceral Organs (e.g., pancreatitis, kidney stones, or pelvic inflammatory disease) Red Flag Symptoms Age <20 or >50 with new-onset pain. History of cancer, trauma, or immunosuppression. Unexplained weight loss, fever, or chills. Neurological deficits (e.g., weakness, incontinence). Severe night pain unrelieved by rest. WHAT ARE THE POSSIBLE TREATMENTS FOR LOW BACK PAIN? Management of Low back pain depends on the duration (acute, subacute, or chronic) and underlying cause. Most treatments are non-invasive, including physical therapy, and pharmacological management. Surgical interventions are reserved for specific cases, such as structural abnormalities or severe neurological deficits. PHYSIOTHERAPY TREATMENT Physiotherapy is a cornerstone for managing low back pain and includes: Exercise Therapy: Structured strengthening and flexibility exercises, particularly for chronic low back pain, have strong evidence of effectiveness. A Cochrane review (2019) highlighted their superiority over usual care. A structured exercise program, combined with patient education including reassurance, addressing fears, and building confidence, is a robust treatment option for both acute and chronic low back pain. Lifestyle modifications, such as regular physical activity, quality sleep, balanced nutrition, adequate hydration, and maintaining a positive mood, play a crucial role in managing chronic low back pain. Click here to explore exercises designed to relieve low back pain. For a personalized and tailored program, book an appointment with us here. Manual Therapy: A systematic review by Rubinstein et al. (2019) found that Spinal manipulation may offer short-term pain relief but is not better than exercise therapy. It lacks strong evidence as a standalone treatment for chronic low back pain. Pain Modulation Techniques: American College of Physicians guidelines highlight that passive modalities like ultrasound and electrical stimulation lack sufficient evidence for long-term pain relief or functional improvement. Kinesio taping: A systematic review by da Luz Júnior et al. (2018) concluded that Kinesiology taping shows no significant advantage over other interventions or placebo for nonspecific low back pain. It is not supported as a treatment for chronic low back pain in clinical practice. Dry needling: A systematic review by Hu et al. (2018) found that Dry needling may reduce pain and disability in the short term, but its effectiveness compared to other treatments is unclear. PHARMACOLOGICAL TREATMENT Qaseem et al. (2017) in their clinical guidelines stated that NSAIDs and muscle relaxants provide short-term pain relief in acute lower back pain. However, their prolonged use is not recommended due to potential side effects like gastrointestinal issues and dependency. For chronic cases, the evidence supporting pharmacological treatments like opioids or antidepressants is weak, emphasizing the importance of non-drug options. SURGICAL TREATMENT Evidence for surgery in managing non-specific chronic low back pain is weak. The Spine Patient Outcomes Research Trial (SPORT) found that while surgery may provide faster relief in some cases, long-term outcomes are often no better than conservative treatments like exercise for lower back pain or physiotherapy. Moreover, surgeries carry risks such as infection, prolonged recovery, and adjacent segment disease. Due to these risks and the lack of strong evidence, clinical guidelines recommend surgery only when conservative treatments have failed, and the condition severely impacts the patient’s quality of life. HOW TO PREVENT LOW BACK PAIN? Many cases of low back pain can be prevented by addressing and minimizing various risk factors. However, some instances, such as those resulting from injuries, accidents, or serious underlying medical conditions, are unavoidable. To prevent the low back pain, certain lifestyle modifications will be helpful. Given below are a few preventive strategies. Strengthening the core muscles that support the lumbar spine (lower back)- abdominal, back, and pelvic floor muscles. Maintaining a healthy weight Practicing proper lifting techniques Avoiding sedentary behaviour Quitting smoking HOW TO STRENGTHEN LOWER BACK? Strengthening the lower back involves targeting the muscles that support the spine and pelvis, including the erector spinae, glutes, and core. Improving the load tolerance required to carry out daily activities without discomfort. A well-rounded routine combines strengthening exercises, mobility exercises, and enhancing functional capacity. WHAT ARE THE EXERCISES FOR LOW BACK PAIN? Breathing exercise - Core breathing Mobility exercise Cobra to child's pose Posterior pelvic tilt Supine scorpions Prone scorpions World's greatest stretch Upward to downward facing dog Strengthening exercises Curl-ups Bird dog beast hold Dead bug Side plank Banded core rotationOUR APPROACH Our Best Treatment Approaches for Low Back Pain involves Step 1: Comprehensive Assessment Begin with a thorough evaluation of the patient, not just the condition: Collect detailed history. Assess fear of movement and psycho-social factors. Identify root causes and risk factors for low back pain. Diagnose accurately with clinical correlation. Step 2: Patient education Effective communication fosters better understanding and recovery: Explain the condition simply as "low back pain"; avoid complex diagnostic terms. Maintain positivity and reassure the patient about recovery. Clearly outline the rehabilitation process and educate about pain. Educate about the importance of lifestyle modification. Step 3: Tailored Treatment Plan Design a plan that addresses both physical and psychological aspects: Focus on the root cause and psycho-social factors. Reduce session frequency, as recovery can take time. Use active approaches to improve spinal mobility and core strength. Provide home exercises that enhance overall physical and mental health, not just the back. A thorough assessment, clear communication, and individualized treatment ensure lasting relief and better outcomes. For a personalized and tailored program, book an appointment