Lower Back Pain - The importance of Treating Restricted Vertebra Movement
Restricted or tight vertebra known as hypomobile lesions are commonly seen in people who present with Lower Back Pain. The pain may be coming from a disc bulge or facet joint irritation in the lower spine but restricted vertebra segments with poor mobility are located above the painful site. For example a person can have a disc bulge at the L5 vertebra level with restricted vertebrae above L5 vertebra such as at L3 and L4. In particular I see this restriction or hypomobility frequently in patients with ongoing lower back pain who have poor posture. Relieving the symptoms of a disc of facet pain is important but it is equally important for treatment to be focused on creating increased mobility in the surrounding restricted lumbar vertebra of the lower spine.
Common Signs & Symptoms with ongoing Lower Back Pain
Onset of Lower back pain can occur either suddenly or over a period of time
Achy Pain that can be described as minor or severe in nature
Achy pain felt in the lower back, occasionally into the buttocks and sometimes referring down the leg
Lower back pain aggravated by walking, standing for prolonged periods.
Constantly extending the lower spine backwards such as moving from a bending to an upright position can aggravate lower back pain
Patients offer report that symptoms are worse in the evening time than the morning
Patient can very often trace the original of the onset of the Lower Back Pain to activities that that involved constant twisting and bending
Sidebending the spine to one side is restricted and tight with pain
Management & Treatment
When patients present with these symptoms, I firstly need to diagnose if the problem is disc related or facet joint (joints that join together each vertebra) related. If there is lower back pain on standing or walking for long durations then this would suggest facet joint irritation. Pain when sitting or bending forward suggests bulging of the lumbar disc. Again further examination testing will confirm the exact location of the facet or disc and the vertebra segments causing restriction. Initial treatment is focused on reducing the pain stemming from the dysfunctional facet or protruding disc, however emphasis needs to placed on increasing mobility into the restricted vertebra segments through graded mobilizations so that full painfree sidebending movements are achieved.
Tomás Ryan is a Registered Physical Therapist (MIAPT) with The Irish Association of Physical Therapy and is based in Thurles.
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