Low Back Pain and the Role of Physiotherapy in It’s Management and Prevention
Overview of World Physiotherapy Day
World Physiotherapy Day, observed on September 8th annually, celebrates the essential role of physiotherapy in health and wellness. This day, first observed in 1951 and designated as World PT Day in 1996, aims to raise awareness about how physiotherapy contributes to overall wellbeing of health and to recognize the valuable work of physiotherapists globally.
Importance of Physiotherapy in Modern Healthcare
Physiotherapy plays a vital role in contemporary healthcare by addressing various health issues through non-invasive techniques. Some key areas where physiotherapy plays crucial role include:
- Chronic Pain Management:
Physiotherapy helps to manage chronic pain, reducing reliance on painkillers and the need for surgical interventions. - Injury Rehabilitation:
It aids recovery from injuries, surgeries, and sports-related conditions, restoring functionality and promoting healing. - Preventive Care:
Physiotherapy prevents injuries, improves mobility, and enhances overall well-being by promoting physical activity and healthy habits. - Chronic Disease Management:
Conditions like diabetes, heart disease, and respiratory illnesses can be managed effectively through physiotherapy. - Mental Health:
Physiotherapy positively impacts mental health by reducing stress, anxiety, and depression through physical activity and pain management. - Aging Population:
Older adults benefit from physiotherapy through improved mobility, balance, and independence, reducing the risk of falls and other age-related issues. - Sports Performance:
Athletes use physiotherapy to enhance performance and prevent injuries. - Workplace Wellness:
Physiotherapy improves workplace ergonomics, reducing work-related injuries and promoting employees’ well-being. - Pediatric Care:
Physiotherapy supports children with developmental delays, congenital conditions and injuries, promoting normal growth and development. - Accessibility:
Physiotherapy is widely accessible, making it a viable healthcare option for various populations. Focus of World Physiotherapy Day 2024: Low Back Pain
World Physiotherapy Day 2024 focuses on the prevention and management of low back pain, a condition that impacts 60-80% of people globally at some point in their lives. The Global burden disease 2021 data emphasizes the need for comprehensive public health strategies to address the burden of low back pain. This includes promoting physical activity, weight management, and mental health support. Early intervention and access to appropriate medical care are also crucial in reducing the long-term impact of low back pain. Among the various districts of sikkim, the prevalence of low back pain in the West District of Sikkim; according to the recent census from August 2023 to August 2024; is 1,368 cases documented across the District Hospital and all Primary Health Centre (PHCs).Low back pain is the second most common reason for seeking medical attention, often linked to risk factors like smoking, obesity and sedentary lifestyles. The causes of low back pain vary, ranging from musculoskelatal pain to chronic conditions such as spondylosis,PIVD , and degenerative disc disease. In many instances, the pain is non-specific, with no clear underlying cause.
Low Back Pain in Sikkim: Contributing Factors for low back pain in sikkim are:
- Geographical Terrain:
Navigating the mountainous terrain of Sikkim requires significant physical exertion, particularly during daily activities that involve walking uphill and downhill. When walking uphill, your body naturally leans forward, which can strain the muscles in your lower back. Conversely, walking downhill places stress on the lower back as the muscles and joints work to control the descent, potentially leading to overuse or strain. Both of these activities can contribute to muscular imbalances and poor posture, which in turn increase the risk of developing low back pain. - Agricultural Work:
A significant portion of Sikkim’s population is involved in agriculture, which often involves repetitive bending, lifting, and manual labor. These activities can lead to muscle strain and chronic back issues, particularly when performed without proper warm-up routines. Even with a healthy body mass index (BMI), inadequate preparation combined with physical exertion increases the risk of developing musculoskeletal problems, especially in the lower back.
- Ergonomics:
Many people in Sikkim, particularly in rural and some urban areas, may lack access to ergonomically designed furniture at workspaces. This absence can contribute to poor posture and lower back strain over time.
- Traditional Lifestyle:
Traditional practices such as squatting or sitting on the floor for prolonged periods can strain the lower back, especially if done regularly.
Clinical Guidelines
Clinical guidelines emphasize early non-pharmacological treatment for non-specific low back pain. This includes patient education, self-management strategies, and exercise. A thorough history and physical examination are crucial to recognize radicular features and screen for “red flags” to exclude serious pathologies.
Physiotherapy’s Role in Management and Prevention
1.Patient Education and Self-Management: Educating patients about the nature of low back pain is crucial, often reassuring them that most cases are not severe and tend to improve over time. Patients are encouraged to stay active, avoid bed rest, and maintain normal routines as much as possible, with advice on posture correction, exercise therapy , and activity modification.
- Exercise Therapy: A general exercise program combining muscular strength, flexibility, mobility, breathing exercise , core stabilization and aerobic training is recommended. Tailored programs are developed based on the patient’s specific condition, functional limitations, and goals.
- Ergonomics Advice: Consulting a skilled physiotherapist can be highly beneficial for addressing ergonomic issues. They can provide guidance on ergonomic design and recommend strategies for performing activities more effectively. This approach helps in reducing the risk of musculoskeletal problems by ensuring that tasks are carried out with proper posture and technique.
- Cognitive Behavioral Therapy (CBT): CBT aims to modify how you perceive and react to pain, which can lead to improved overall function and quality of life. By addressing and altering pain-related thoughts and behaviors, CBT helps in managing chronic low back pain more effectively.
5.Modalities and Adjunct Therapies: Heat and cold therapy, along with electrical modalities such as Transcutaneous Electrical Nerve Stimulation (TENS) and ultrasound therapy, are used as adjuncts to reduce pain.
- Guideline-Based Care: physiotherapy management for low back pain in India typically follows the guidelines set by the Indian Society of Physical Medicine and Rehabilitation (ISPMR) and the Indian Orthopaedic Association. These guidelines generally emphasize a holistic approach that includes patient education , exercise therapy and psychological intervention .
This comprehensive approach aims to not only relieve pain but also enhance overall function and prevent future issues.
Last but not the least, physiotherapy plays a crucial role in managing and preventing low back pain, especially in regions like Sikkim, where various environmental and lifestyle factors contribute to the prevelance of the condition . Through a combination of education, exercise, manual therapy, and psychological support, physiotherapy helps reduce pain, improve function, and prevent disability. Physiotherapists are now available in all districts and PHCs across Sikkim. This expansion will greatly enhance access to care for low back pain and other physiotherapy needs, ensuring proper rehabilitation and management tailored to individual conditions.
Dr.Birendra khatiwoda(PT)
Physiotherapist
District Hospital Gyalshing
