Physiotherapy and Back Exercises

The cost of low back pain to society is very great, with high financial costs in terms of lost income, lost production and time off work and the costs of medical and physiotherapy and other treatments. This is apart from the personal consequences of the loss of one’s work or job role, loss of the ability to do normal activities and the pain itself. Many back pain treatments have been developed, most of which do not have high levels of effectiveness, and much is down to self management. An exercise programme has been shown to be an important aspect of this and this includes stability work, gym or aerobic exercise and lumbar and pelvic ranges of movement.

Joint ranges of movement are not obvious to most of us but are vital to our ability to perform day to day activities. The shoulder is an important example of a highly functional joint which allows us to place our hands in front of our vision so we can perform precise actions. To do this it has a very large range of movement, allowing us to put our arms behind the back, behind the neck and right above the head. A joint can change due to illness or injury with various effects from loss of joint movement, looseness of the ligaments or damage to the joint surfaces themselves.

Injured joints go through the inflammatory process with a gradual formation of scar tissue over six weeks, the maturing scar beginning to contract around two to three weeks after injury. At this stage stretching and movement are important to maintain the length of the healing tissues and stimulate remodeling in these healing tissues closer towards the original type for the structure. Restriction of joint mobility can cause pain and limit everyday actions and functions we want to perform. If we lose movement in our shoulder or in our hand we have a problem as it gets in the way, but spinal loss of motion is less evident and we are more likely to accept it by default.

Abnormal joint movement and muscle activation can result from, amongst other things, stiff joints, muscles and other soft tissues. The complex movements and stability function of the lumbar spine allows controlled movement under load but is interrupted and changed for the worse by the dysfunction of the injured area. Pain and increased movement loss can develop as time goes on. With the stiff area reaching its limit more quickly than surrounding joints when a movement is performed, there is a risk of re-injuring this joint when forces are put upon it. It is worthwhile to work on pushing back these restrictions of joint movement.

Stiff joints cause alteration in muscle activation and joint movements, changing the way the complex interplay between muscle patterning and stability work in the spine.  The coordinated weight bearing and movement functions of the spinal system are altered by the dysfunctional patterns of joint activity, leading to difficulties with pain and loss of function over time. If the joint stiffness remains there is a risk that the next time a movement is attempted the joint will be stretched to or beyond its stiff limit and could be re-injured. This is a good reason to try and loosen up these restrictions.

A physiotherapy approach to having a fit and fully functional lumbar spine has to include working at different aspects of spinal fitness which includes developing a good level of muscle endurance and power, lumbar stability and a full joint range of motion. Physiotherapists or other treatment professionals are qualified to treat patients with endurance and strength exercises, pain reduction techniques, spinal stability work, joint mobilising exercises and functional work. Daily performance of joint mobility work is encouraged to stretch out tight structures.

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