Even the most diligent Physiotherapists can get lower back pain. We are constantly bending down or leaning over bodies all day. I had suffered a nasty bout of lower back pain after bending forward and lifting. I had a slight weakness there before but I had neglected it and hadn’t been keeping up with my exercise routine.  I feel stiffness and weakness if I don’t keep up with my routine of exercises. I know what keeps me out of trouble and this is what we strive to achieve with our patients.

After doing a quick review of good quality studies on lower back pain, there is evidence to support typical interventions such as manual therapy, acupuncture, and therapeutic exercise. The research also has helped us to categorize patients depending on their symptoms, so that we can choose the most effective treatment techniques. Categorizing patients, based on symptoms is especially useful because of the heterogeneity of lower back pain presentation and because we are all so unique. This is where a thorough biomechanical assessment is needed by a physiotherapist to determine what are the mechanical factors that are predisposing a patient to lower back pain. It is the combination of using the evidence from studies and a clinical assessment that is key to developing an effective treatment strategy.

Clinically, one common scenario I see are lower back, pelvis and hip weakness. All three areas are linked and a weakness in the gluteals and core abdominals can put more strain on the vertebral joints. Another common scenario is shortness in the muscles that act on the spine and pelvis. Over time this can lead to compression of the lower back and painful movement. One offending muscle group is the hip flexors which are shortened by sitting all day. These muscles attach onto the lower back and can cause shearing and compression. Another scenario in the middle age group is generalized stiffness in the spine caused by degeneration. This group will also display tightness of those muscles acting on the spine and pelvis.

We can prevent this middle age scenario by knowing how to look after our backs. If you are having regular lower back problems, I strongly suggest having it assessed and asking for a treatment plan, but also how to manage it yourself. The key ingredients are:  what type of exercises; how to do it correctly; and why is this exercise relevant. Education  will help to keep you out of trouble!  If you are suffering from lower back pain then a plan is needed to manage it, choose an approach that gives you this strategy. Occasionally a manipulation can do the trick but if it is something that keeps coming back then a longer term solution is needed.


About the Author

Damian Wyard trained is a Registered Physiotherapist and Stott Pilates Rehabilitation Instructor with 20 years experience in his field. He is the owner of Pilates4Physio in Toronto. You can reach him privately at info@pilates4physio.ca, or at his Pilates studio www.pilates4physio.ca www.facebook.com/pilates4physio