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.
To function normally in our daily activities we need our joints to perform through their normal full ranges, a requirement which does not make itself obvious until we have a problem. This is clearly illustrated by taking the shoulder as an example. The shoulder is an extremely mobile joint which allows us to put our hands in useful positions whilst our eyes are able to watch, requiring large movements of the arm behind the neck, behind the back and above the head. Illnesses and injuries can alter the joint by damaging the surfaces, causing laxity of a ligament or contracture of a joint from the healing process. Contracture involves the tightening up of ligamentous structures around a joint, limiting available movement.
At a point about two and an half weeks after an injury the healing scar of the damaged area begins to tighten and during this period doing movements to stretch the area gently stimulates length in the healing structures. It also stresses the scar so it remodels to a tissue more closely resembling the original than if it was left immobile and still. A restriction in joint movement can interfere significantly with normal abilities and also be painful. In our hands or our shoulders a restriction in joint mobility is very clear to us so we work on it, but in the back any joint stiffness is not that obvious so we don't notice it and don't do anything about it.
After an injury the healing process proceeds towards scar formation, which begins to tighten naturally after two to three weeks, indicating the need to get the area moving and stretching gently to maintain length of the structures. Stressing the healing scar encourages remodeling towards the original type of tissue suitable for that area, a process which occurs much less successfully with immobilisation and rest. Joint contractures can be very restricting, painful and limiting for functional activities. While shoulder or hand loss of movement is obvious and makes us take action, loss of spinal movement is more subtle, making it less noticeable and therefore we are less likely to take any action.
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.
If the joints are stiff they will move abnormally, changing the muscle patterns responsible for movement and stability in the whole spinal area. The lumbar spine is a complex movement and weight bearing machine which is easily disturbed into non-functional movement patterns, leading to weakness or pain problems with time. Another consequence of joint stiffness is that the movement restriction means that the next time we try and perform the movement which these joints participate in we will come up against the restriction. We might just remain restricted but we could also re-injure ourselves as the required movement is not available under stress.
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. - 14130
To function normally in our daily activities we need our joints to perform through their normal full ranges, a requirement which does not make itself obvious until we have a problem. This is clearly illustrated by taking the shoulder as an example. The shoulder is an extremely mobile joint which allows us to put our hands in useful positions whilst our eyes are able to watch, requiring large movements of the arm behind the neck, behind the back and above the head. Illnesses and injuries can alter the joint by damaging the surfaces, causing laxity of a ligament or contracture of a joint from the healing process. Contracture involves the tightening up of ligamentous structures around a joint, limiting available movement.
At a point about two and an half weeks after an injury the healing scar of the damaged area begins to tighten and during this period doing movements to stretch the area gently stimulates length in the healing structures. It also stresses the scar so it remodels to a tissue more closely resembling the original than if it was left immobile and still. A restriction in joint movement can interfere significantly with normal abilities and also be painful. In our hands or our shoulders a restriction in joint mobility is very clear to us so we work on it, but in the back any joint stiffness is not that obvious so we don't notice it and don't do anything about it.
After an injury the healing process proceeds towards scar formation, which begins to tighten naturally after two to three weeks, indicating the need to get the area moving and stretching gently to maintain length of the structures. Stressing the healing scar encourages remodeling towards the original type of tissue suitable for that area, a process which occurs much less successfully with immobilisation and rest. Joint contractures can be very restricting, painful and limiting for functional activities. While shoulder or hand loss of movement is obvious and makes us take action, loss of spinal movement is more subtle, making it less noticeable and therefore we are less likely to take any action.
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.
If the joints are stiff they will move abnormally, changing the muscle patterns responsible for movement and stability in the whole spinal area. The lumbar spine is a complex movement and weight bearing machine which is easily disturbed into non-functional movement patterns, leading to weakness or pain problems with time. Another consequence of joint stiffness is that the movement restriction means that the next time we try and perform the movement which these joints participate in we will come up against the restriction. We might just remain restricted but we could also re-injure ourselves as the required movement is not available under stress.
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. - 14130
About the Author:
Jonathan Blood Smyth is a Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiotherapists in Brighton.
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