Physiotherapy has major role in treatment and recovery of Back pain It teaches how to condition your body to prevent further injury and help in recovery of painful episode . There are a variety of physical therapy techniques.
Passive and active treatments Passive treatments relax your body and include deep tissue massage, hot and cold therapy, electrical stimulation (TENS), Ultrasound and Hydrotherapy. Active treatment involves active stretching and strengthening exercises trunk stability , core strengthening
a. Massage Therapy
Massage is a popular therapy used to relieve muscle tension, spasms, inflammation, fluid retention, aches, stiffness, and pain. Other benefits include improved circulation (blood and lymph), general flexibility, range of motion, and increased tissue elasticity (e.g. scar tissue).
During treatment, the physical therapist may include localized massage (e.g. low back or neck) as a prelude to exercise. Massage increases circulation and warms muscles and other soft tissues (e.g. tendons, ligaments). Other types of massage include full-body massage, which often leaves the patient feeling relaxed and free of anxiety.
As the therapist uses their hands or specialized tools to rhythmically knead, rub, and stroke (effluerage) muscles, circulation is stimulated. Blood flow delivers oxygen and nutrients, and is key to helping muscles eliminate waste products, such as lactic acid, that may collect in muscles from spasms causing pain.
b. Hot and Cold Therapy :
Both hot and cold therapies offer their own set of benefits, and your physical therapist may alternate between them to get the best results. This reduces inflammation, muscle spasms and pain.
c. Hydrotherapy :Gently relieves pain and relaxes muscles.
d. TENS (transcutaneous electrical nerve stimulation)
Uses electrical current to stimulate your muscles and reduces muscle spasms and isgenerally believed to trigger the release of endorphins, which are your body’s natural pain killers.TENS works to decrease pain perception and may be used to control acute and chronic pain. It may also be used with other treatments, such as exercise.
Transcutaneous (through the skin) electrical nerve stimulation sends a painless electrical current to specific nerves. The current may be delivered intermittently. The mild electrical current generates heat to relieve stiffness, improve mobility, and relieve pain. The treatment is believed to stimulate the body’s production of endorphins or natural pain killers.
The physical therapist applies electrode patches to the skin in the area to be treated. The mild current runs from the stationary stimulator through these patches.
TENS is also used to deliver topical steroid medication through the skin to treat acute episodes of pain. This treatment is called Iontophoresis. The mild current causes the medication to migrate into soft tissue serving to reduce inflammation.
The portable stimulator is a small battery-operated device that can be worn around the waist. The unit can be turned on or off as needed for pain control.
Patients with pacemakers should avoid TENS because the electrical current could interfere with the operation of a pacemaker
Ultrasound equipment generates high-frequency sound waves that are transferred to a specific body area via a round-headed probe. The sound waves travel deep into tissue (e.g. muscles), creating gentle heat.
The old version of today’s ultrasound was termed short-wave diathermy. This is seldom used today.
ltrasound is a passive modality: a supplement to the primary treatment (e.g. exercise). Passive modalities typically are used to relax the patient, as a distraction from pain, and/or to warm muscles for exercise.
The physical therapist usually applies a hypoallergenic gel to the skin, which creates a friction-free surface. Using gentle, circular motions with the probe, the therapist administers the treatment, which lasts several minutes.
Ultrasound can also be used in phonophoresis. This treatment involves the application of a topical anti-inflammatory. The anti-inflammatory medication can be mixed with the ultrasound gel and applied to the area using the probe. The ultrasonic sound waves force the medication to migrate into the tissues reducing inflammation.
Does the treatment hurt?
No. The patient will feel a tingling sensation in the treated area.
As the probe glides over the skin’s surface, sound waves penetrate the skin’s surface causing soft tissues to vibrate, creating heat. In turn, the heat induces vasodilation: drawing blood into the target tissues. Increased blood flow delivers needed oxygen and nutrients, and removes cell wastes.
The heat helps relieve pain and inflammation, reduce muscle spasms, and accelerate healing. Depending on the treatment area, range of motion may be increased.
f. Traction :
Reduce the effects of gravity on the spine. the intent is to reduce the disc herniation and is usually performed in the cervical or lumbar spine.
Help to reduce recurrent pain but will also benefit your overall health.
a. Core stability :
Many people don’t realize how important a strong core is to their spinal health. Your core (abdominal) muscles help your back muscles support your spine. When your core muscles are weak, it puts extra pressure on your back muscles. Your physical therapist may teach you core stabilizing exercises to strengthen your back.
b. Flexibility :
Learning proper stretching and flexibility techniques will prepare you for aerobic and strength exercises. Flexibility helps your body move easier by warding off stiffness.
c. Muscle strengthening :
Strong muscles are a great support system for your spine and better handle pain.
3. The McKenzie Method
The McKenzie Methodis not merely extension exercises. In its truest sense, McKenzie is a comprehensive approach to the spine based on sound principles and fundamentals that, when understood and followed accordingly, are very successful. In fact, most remarkable, but least appreciated, is the McKenzie assessment process.
Unique to the McKenzie Method®is a well-defined algorithm that leads to the simple classification of spinal-related disorders. It is based on a consistent “cause and effect” relationship between historical pain behavior as well as the pain response to repeated test movements, positions and activities during the assessment process.
A systematic progression of applied mechanical forces (the cause) utilizes pain response (the effect) to monitor changes in motion/function. The underlying disorder can then be quickly identified through objective findings for each individual patient. The McKenzie classification of spinal pain provides reproducible means of separating patients with apparently similar presentations into definable sub-groups (syndromes) to determine appropriate treatment.
McKenzie has named these three mechanical syndromes: Postural, Dysfunction, and Derangement.
• Postural: End-range stress of normal structures
• Dysfunction: End-range stress of shortened structures
• Derangement: Anatomical disruption or displacement within the motion segment (All three mechanical syndromes, postural, dysfunction, and derangement, occur in the cervical, thoracic, and lumbar regions of the spine.)
Each distinct syndrome is addressed according to its unique nature with mechanical procedures, utilizing movement, and positions. The Derangement syndrome where the phenomenon of “centralization” occurs is most common.
McKenzie treatment uniquely emphasizes education and active patient involvement in the management of their treatment in order to decrease pain quickly, and restore function and independence, minimizing the number of visits to the clinic. And if a problem is more complex, self-treatment may not be possible right away. However, a certified McKenzie clinician will know when to provide additional advanced hands-on techniques until the patient can successfully manage the prescribed skills on their own.
Patients gain an experiential education learning to self-treat the present problem. The management of these skills and behaviors will minimize the risk of recurrence and allow patients to rapidly manage themselves when symptoms occur.