Low back pain affects 8 out of ten people at least once in their adult life. Due to the nature of chronic non-specific low back pain, many medical practitioners feel that the best approach is to offer tools that empower the patient to self-manage pain relief and get back to their daily routine. AposTherapy offers a viable self management option that seamlessly fits into the patient’s daily life. Treatment establishes postural control and improved movement patterns in a correct spinal alignment. This retrains the muscles to reduce the vulnerability of the spine and prevent the condition from becoming chronic.
In the UK alone, 5 million days per year are lost through absence from work due to low back pain, with an estimated 1.6 billion pounds per year spent on the treatment of low back pain in the healthcare sector. Low back pain also carries a significant burden for the individual; often severely reducing their quality of life and impacting on social and family relationships. 90% of low back pain cases are not due to a serious disease or apparent injury and so are labelled “non-specific”, in other words no specific pathology can be determined as the cause of pain. Doctors think that multiple mechanisms in the body could contribute to low back pain, including irritation at intervertebral joints, changes in the intervertebral discs, irritation of nerves, inefficient muscle activities and ligaments surrounding the joints.
Non specific low back pain (NSLBP) is diagnosed through a process of elimination, checking-off specific pathologies that could otherwise explain symptoms. An insidious onset and diffuse presentation, without any red flags (neurological symptoms, fractures or malignancy) being noted would suggest NSLBP. Generally, evidence from research and the UK National Clinical Guidelines discourage the use of X-rays as a diagnostic tool for NSLBP. This is because X-rays can’t provide any greater clarity in cases of NSLBP and the referral for such investigations can fuel psychosocial aspects of the condition. For many people not knowing the cause, or source of their pain is unsettling. Psychosocial factors have been shown to significantly affect the chronicity of the condition. It is thought that NSLBP is a predominately self-limiting (self-healing) condition, where 90% of acute suffers will recover within 6 weeks. Reviews of treatment options strongly support addressing the mechanisms of pain and psychosocial influences as an effective method to reduce the chances of the condition become chronic (more than 3 months) and recurrent.
Following the initial onset of back pain, the body has a protective muscular response in which the tension increases in the muscles surrounding the spine - often referred to as guarding or bracing. This type of muscular activity causes muscle fatigue, dispersed achiness, muscular spasms and reduced control of the spinal joints. Due to the reduced control, all structures around the spine are more vulnerable to further injury. It is therefore, important that after an episode of low back pain, the muscles are retrained to ensure efficient control of the spine.
Only when severe or progressive neurological symptoms (red flags) are experienced should scans be performed. MRI or CT scans will establish if surgery is necessary to prevent any long-term neurological damage. Red flag symptoms include bilateral numbness, tingling, pins and needles, pain, weakness and loss of bladder and bowel control.
One of the most important aspects to address when considering NSLBP is posture. This includes the way the body is held while sitting, as well as the maintenance of a stable, neutral spinal posture while standing or walking. Passive supports, such as the use of an ergonomic office chair, can be beneficial in ensuring alignment, whilst reducing the onset of muscle fatigue during prolonged sitting. Performing day-to-day routine actively trains postural muscles and encourages correct alignment, reducing the vulnerability of spinal structures.
Research indicates active therapies are far more effective than passive therapies in the treatment of acute and chronic low back pain. Although bed rest used to be the most commonly prescribed treatment for low back pain, it is now strongly discouraged following evidence that staying sedentary can have a detrimental effect on the condition. Instead, evidence supports activity and exercise as the most effective method of treatment. Medicated pain management, progressing from paracetamol, to non steroid anti-inflammatory drugs and finally using muscle relaxants and opioids can have adverse side-effects and may not be suitable for everyone. There is also some evidence to support the use of cognitive behavioural therapy, educational programs and spinal manipulation to reduce symptoms and prevent chronicity so these treatments should be considered if previous interventions have failed. Notably, there is no evidence to support the use of steroid injections, lumbar support belts or traction as an effective intervention for non-specific low back pain.
AposTherapy has been demonstrated to be effective to provide pain relief and improved mobility in patients with non specific low back pain. It can be implemented during the acute and chronic phases of low back pain and after a thorough assessment and diagnosis of the condition has been completed. AposTherapy ensures loading of the spine remains central throughout treatment to reduce muscular activity and bracing, preventing fatigue and spasm.
After the acute episode has passed the function of muscles around the spine, posture and problematic muscular habits must be assessed. AposTherapy reduces the vulnerability of the spinal structures by addressing the root of the problem, the muscle dysfunction. The aim is to retrain the muscular patterns during daily activities to provide better spinal movement control and alignment. AposTherapy also overcomes the challenge of how to teach the body to use the improved control patterns and maintain postural alignment whilst completing daily activities. AposTherapy has been used successfully in many cases of NSLBP because the treatment takes place during the patient’s normal routine and introduces optimal patterns of motion into the patient’s everyday life.