This week I will discuss a common case of Lower Back Pain that has been ongoing for several years. The patient initially started to experience lower back pain 6 years ago and it gradually progressed into sciatic pain down the leg and into the ankle region. The sciatic leg pain symptoms were reduced overtime with rest from aggravating activities couple and ant-inflammatory medication. However the lower Back Pain continues to persist 6 years later. An MRI scan revealed a disc bulge between the Lumbar vertebra of L4 to L5 with potential to impinge on the L5 sciatic nerve root during. Listed below are the patient’s current symptoms;
Lower Back Symptoms
Tenderness on the lower spine when bending backwards with pain referring into right upper buttock
Soreness felt along the centre of the lower spine on side bending the spine
Lower Spine tenderness when standing
Sitting can be uncomfortable in the lower back
No Pain with walking, can walk 2 miles without any pain
Lower back feels good after walking and there are no painful symptoms for the rest of the day.
Treatment & Management
My treatment for the above Patient involved using rehabilitation exercises to strengthen and stabilise their very weak Lower Back. The spine is rehabilitated a neutral alignment position. This means that the neck, shoulder blades, rib-cage, and pelvic need to be in their neutral or centred position. In addition, a breathing technique is used to activate the very important transverse Abdominis muscle that stabilises the front of the lower spine. The exercises creates a corset-like affect around the spine by activating and strengthening the Erector Spinae muscle of the Lower Back, Glute Maximus muscles of the pelvis and the previously mentioned Transverse Abdominis muscle. The Patient is taught these exercises in clinic alongside graded manual mobilisation therapy of the spine. Once the exercises were performed correctly there was a marked reduction in Lower back Pain. At home the exercises were performed twice daily with advice for walking. So what has happened? The answer is that the spine has become stronger with real stabilisation around the previously excessively mobile L4/L5 vertebra, thus reducing disc irritation at this level.
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy (MIAPT) and is based in Thurles. Contact Number: 0504 26672
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Injury Solutions Clinic
Physiotherapy & Injury Rehabilitation Clinic in Tipperary