Low back pain

Question 1

what is low back pain?

Answer 1

Pain or ache in lower region of the back varying in intensity.
Can be specific and have a known cause or can be non-specific.
Specific e.g. sciatica

Question 2

What are contraindications in low back pain?

Answer 2

These conditions should be ruled out before prescribing exercise:
- Spinal fracture – history of major trauma
- Infection – fever, diabetes, recent infection.
- Cancer - >50yrs, history of cancer
- Cauda equina syndrome- ask about bladder and bowel control, sensation loss in saddle region, sexual function.

Question 3

What is sciatica?

Answer 3

Sciatica refers to radiating pain along the course of the sciatic nerve from the lower back or buttock to one or both legs or an associated lumbosacral nerve root

Question 4

What assessments may be conducted for low back pain?

Answer 4

Observations: posture, movements, leg length discrepancy
Lumbar AROM - possibly with over pressure
Hip AROM/PROM
Hip strength
Functional and frank neuro
PSLR
Slump test
Palpation of spinal processes and muscles

Question 5

What are possible mobility exercises for the lower back?

Answer 5

Encourage further walking
Spinal roll downs
Child pose - add hand movement
Cat / cows
Pelvic tilts
Knee hugs
Lumbar extensions
Bridge with pelvic curl

Question 6

What is the arm from mobility exercises for low back pain?

Answer 6

General theme of increasing pelvic and lumbar spine dissociation to encourage greater control and movement

Often lower back pain result of tight paraspinal muscles so movement aids with this

Question 7

What are possible strengthening exercises for low back pain?

Answer 7

Jefferson curls - progress weight and to doing on a step
Bridges - progress to weighted
Deadlifts with exercise band
Step ups with weight or without
Lunges with spine twist
Squatting
Trunk rotation with band and stable pelvis
Aerobic swimming

Question 8

What activity recommendations can be made for self-management?

Answer 8

Walking
Swimming
Exercise bike
Dancing, yoga or pilates (all recommended by NHS website)

Question 9

What general self-management should be provided in low back pain?

Answer 9

Encourage to continue work as able
- Can help to distract from pain but wont make worse
According nhs website ppl less active and more depressed when not working which can further feed into back pain.

Question 10

What should patients with low back pain be educated on?

Answer 10

Provide information on nature of lower back pain / sciatica
- Explain spine designed to move

Breathing techniques to help keep calm

Explain graded exercise
To do stretches and exercises after activity

NICE guideline 1.2.1 suggests education on nature of low back pain and sciatica and encouragement to continue daily activities as able
Discourage prolonged bed rest- normal back movements may produce pain but this is not harmful if activities are resumed gradually.
Offer advice on meds for pain from GP.
Psychological support
Group exercise classes

Question 11

Why should group exercise be used in low back pain?

Answer 11

Helps pts to eventually carry out exs more independently and individualy

NICE guideline 1.2.2 recommends group exercise adapted to patient needs

Question 12

What exercises can be used for group low back pain classes?

Answer 12

Warm up and cool down - lumbar ROM stretches and pelvic tilts

Bike cycling
Sit to stands / squats / with weights
Lateral weight movement
Bridges with weight
Marches
Lunges