New Research Shows Effective Conservative Treatment for Low Back Pain
By Dr. Jeff Lewandowski
(Published in the Johns Creek Herald, Spring of 2007)
Patients with lower back pain (LBP) have been conservatively treated by physical therapists for many years. It has long been known that strengthening is an essential component in treating all LBP. However, it has recently been shown that the deep lower back muscles (called the multifidus) quickly become smaller and weaker in response to LBP, and that they remain in that state even after the LBP has resolved. Evidence shows that an exercise program developed to strengthen the multifidi, along with other spine stabilizing muscles, will significantly decrease LBP, and will decrease the chance of recurrent LBP from 85% to 30%.
New research now shows that better outcomes are derived by placing and treating patients with lower back pain into specific sub-categories. This is in direct contrast with the previous view which was to treat all LBP the same. Most people with LBP fall into one of three basic sub categories: hyper mobility, hypo mobility, or disc herniation.
Hyper mobility: As we age, our lower back discs degenerate bringing the vertebra and back joints closer together. This places the ligaments in the spine on slack, leading to hyper mobility or too much movement between the vertebra. These patients are best treated by exercises designed to strengthen deep back muscles that stabilize the spine. As these muscles are strengthened they help control movement and stabilized the hyper mobile segments, thus decreasing back pain.
Hypo mobility: As the spine continues to degenerate, the joints between the vertebra become compressed which eventually leads to arthritic changes and subsequent joint stiffness. These changes cause decreased movement or hypo mobility. Patients with this kind of LBP benefit most from joint mobilization, possible mechanical traction, and exercises to loosen the stiff segments as well as strengthen the deep back muscles.
Disc Herniation: As the disc degenerates it can also become herniated. Disc herniations can be mild or severe and can cause pressure and compression on the nerves. Studies showed that these patients tended to respond better to exercises that included repeated movements of the spine, along with strengthening of the deep back muscles. An excellent research paper published in the Journal of the American Medical Association compared disc surgery to conservative treatment including epidural spine injections and physical therapy. This study concluded that two years later, both the surgical and non-surgical groups had similar outcomes.
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Jeff Lewandowski DPT, SCS, ATC, MTC
SportsCare Physical Therapy
6920 McGinnis Ferry Road, Suite 320
Suwanee, GA 30024
