Low Back Pain Physiotherapy Treatment in Gurgaon

Ways to Investigate Low Back Pain

• X-ray; can show vertebral spaces, degeneration, or fracture
• CT Scan
• MRI; reveals disc bulge, muscle tear, lesion, etc.
• Blood test; for finding of any specific marker like HLA B27 in AS or any bacterial infection in Tb
• NCV test for neurological purposes
• Physical Examinations

Differential Diagnosis

• Mechanical Back Pain – This pain usually lasts for 4-6 weeks and can be resolved by only conservative and physiotherapy treatment. This pain is generally localised in your affected part or muscle and is less often radiated.
• PIVD - This can radiate your pain to your buttocks, thigh, or leg. Pain usually gets worse while walking and is relieved by rest. This usually restricts forward bending as pain may increase after that. It can be differentiated physically by SLR Test or Lasegue Test and also be differentiated through clinical findings like MRI.
• Arthritis – It is common in the old age group due to wear and tear of the bone and is characterised by dull aching pain. It is clinically found through X-ray findings which show narrowing of vertebral spaces and degenerations of margins of the vertebral body
• Scoliosis, Kyphosis, Lordosis – It is a generalised, dull aching pain that may be present throughout your back and is revealed best in X-Ray findings.
• Spondylolisthesis and Spondylolysis – Scottish dog appearance wearing a collar is a clinical feature in X-ray and MRI for Spondylolysis. Similarly, the head elongated from the neck of the dog is a characteristic feature of his thesis. Spondylolisthesis also shows Step-up deformity on physical examination. It usually restricts backward bending as the body may further slip on bending.
• TB Spine or Pott’s Spine – Pain is usually localised and associated with other TB features. Localised swelling can be seen physically and through MRI which is the cold abscess, a characteristic feature of Tb.
• Ankylosing Spondylitis –X-ray findings show squaring of vertebra and straightening of the spine which can be seen physically also. HLA B27 is a marker that can be tested in blood smears. This pain is usually worse in the morning and after rest and is relieved by walking or doing any activities
• Osteomalacia – Decreased bone density and lack of vitamin D
• SI joint pain - can be differentiated through bilateral SLR test and FABER’s test.

Physiotherapy Treatment For Lower Back Pain in Gurgaon

• Bed rest – Acute LBP can be treated with some positions of bed rest for a short period as in discal pain it increases with sitting and standing. Supine lying with pillows under your knees, and side-lying with knees and hip flexed are some suggestive positions.
• Cryotherapy – Cold packs are best advised in acute LBP for an initial 2 days as they decrease your spasms and inflammation better than heat.
• Thermotherapy – It also reduces pain, inflammation, and muscular spasms by increasing your circulation but in later stages or in chronic conditions. Moist heat packs or whirlpools can be used for about 20 minutes to relieve back pain.
• Electrotherapy modalities – US, TENS, IFT, Infrared rays, or Ultraviolet rays can also be used for deep heat or penetrations to your muscles or nerve endings to reduce your pain in both acute and chronic conditions. LASER treatment is also kept reserved for later stages of pain.
• Traction – Manual and mechanical Traction for various conditions prove to be very effective treatments used for stretching spinal muscles and thus decreasing pressure, distracting the vertebral bodies, and for straightening the spinal curve. It is used in conditions like; Disc protrusion, Spondylolisthesis, Scoliosis, Lumbar Spondylosis, etc.
• Lumbar belt or braces – It is also advised to patients for additional support, to recover the mobility of the spine, to maintain the curvature of the spine as in scoliosis, or to maintain the faulty posture and relieve pain.
• Spinal manipulations – This can be done once in a while to correct the misaligned vertebral segments and can be done by various techniques. It is completely contraindicated in severe osteoporosis, malignancy, or fractures.
• IASTM or STM – Soft tissue manipulation is also done either manually or instrument-assisted to relax the spasm muscle or to increase blood circulation in the desired area.
• Proper postural habits or back ergonomics for the work environment and proper use of chairs is also taught.

Exercises for Lower Back Pain Treatment at Home

There are different types of exercises like flexion, extension, or rotation exercises, and every exercise is not advised in all conditions so they are done and advised very precautiously. Each exercise is done with 5 repetitions once or twice daily.

1. Flexion Exercises – Done in cases like anterolisthesis, increased lumbar lordosis, AS, or if the patient feels pain while standing, walking, or backward bending. Some of the flexion exercises are:-

• Partial sit-ups in a lying position with legs straight
• Partial sit ups in a lying position with both knees bent
• Partial curl-ups
• One knee-to-chest stretch
• Both knee to chest stretch
• Toe touch in a long sitting position
• Back press in the lying position
• Cat and cow stretch
• Lion stretch
• Bilateral Straight leg raise
• Single straight leg raise

2.  Extension Exercises - These exercises are prescribed in cases like PIVD, and retrolisthesis, to maintain or decrease lumbar lordosis, to maintain mobility of the spine, and AS, and to decrease pressure on the Sciatic nerve. Some of the extension exercises are:-

• Prone on hands or prone on elbows
• Straight leg raise in prone lying
• Hand and leg raise in prone lying
• Superman poses in a quadruped position
• Pelvic bridging
• Plank or knee plank
• Side plank
• Swiss ball exercises

All these exercises are progressed according to the patient.

3. Rotation exercises – These exercises help in relieving the overall side muscles and stretch or strengthen the oblique muscles of your abdominals, like;

• Partial diagonal curl-ups
• Trunk rotations with both the knees bent
• Side crawling in lion’s pose
• Mobility Exercises – It also induce relaxation on overall spinal muscles and increase the mobility of your spine, like;
• Pelvic rotations in lying and sitting
• Chest roll on either side
• Dead bugs, they can be done in various forms

4. Stretching exercises – To relieve the contracted or spastic muscles;

• Gluteal stretch
• Piriformis stretch
• Hamstring Stretch
• Quadriceps Stretch
• QL stretch
• Paraspinal muscle stretch
• Iliopsoas stretch
• IT Band stretch