My friends, relatives and other people I know keep asking this to me all the time, “tell me some exercises for low back pain!!!”. They ask me in all weird ways such as over text message, facebook, phone etc and in unsuitable places such as while crossing a road, when meeting in social functions (wedding ceremonies, dance parties), an unexpected meeting in a loo etc. If your physio friend gives you some exercises, then it means that right away, your physio friend is either bugged with people asking him/her those exercises over and over again so he has a set of exercises to give it to you, or the physio doesn’t like you. I will explain the reasons why.
Exercise prescription for any musculoskeletal problem is not a set recipe as “making momos”. It isn’t true that every low back pain (LBP) or a knee pain has same set of exercises. Though the complaint of pain may be same ie “Low Back Pain”, but the hidden problem and causes for every individual can be different. This can be identified by an indepth interview and a careful physical examination.
(1) an in-depth interview with the patient which includes questions such as age of the patient, occupation, how the pain started, severity of pain, any other associated factors such as fever, history of trauma, radiating pain over lower limb, factors that increase or decrease pain, any other medical illness or problems for which some (or all) exercises may be harmful (contraindicated) or some precautions should be taken.
(2) physical examination which includes testing for neurological involvements (such as sensory loss/ deficit and muscle weakness, altered reflexes), movement tests, some specific tests to locate the source of symptoms (which could be muscle, spinal joints, hip joint, nerve etc), muscle flexibility, strength and endurance test etc.
Only when these two points (sometimes some diagnosis is clear from the history where a selected physical examination will follow after investigations) suggest if there are severe specific problems (example fractures, tumors, infections etc of the spine), investigations such as X-ray, MRI, lab tests, bone density scans, etc are required. A good physiotherapist (or any other medical professional) will go through this careful process before prescribing a medicine, or exercise (please remember that exercise is medicine which has to be correctly prescribed after examination and requires correct dose). Many of us who have LBP without any specific diseases and yet have psychosocial factors that may contribute to ongoing LBP which includes depression, anxiety, fear of movement, catastrophization, social isolation, stress at home or work etc. So, for these people only exercises do not help. Addressing these cause of LBP is really very important.
So here are the things to remember:
1) Examination of your LBP is important to rule out any specific disease such as tumors, infections, rheumatic diseases, fractures, nerve root compression etc. These are suggested by one or more of these symptoms: severe pain, night pain, constant pain, fever, other systemic problems, radiating pain to lower extremity etc.
2) Do not ask for exercises without having a physiotherapist examine you. If you hear a reply without being interviewed and examined, the physio doesn’t care about you. If you are not suited for those exercises, it may even harm you. Your specific causes of LBP may remain unrevealed which could be fatal. So, please do not ask for exercises, instead request to get examined.
3) Find a trustworthy physio for your exercise prescription.
4) Remember that exercise is medicine. You do not ask to a doctor to give you a paracetamol for your fever, instead you show your problem to a doctor so that the doctor identifies the cause of the fever for you. Identification of the problem before exercise prescription is key to successful recovery. Incorrect exercises or incorrect dose of exercises may cause harm.
5) Do not bed rest for LBP unless you are asked to. Resting for more than one or two days may cause more harm.
6) Remaining active and fit is the best way to cope up with your LBP. Similarly, be social, stay happy.
7) Do not worry too much about the pain. Some pain is normal after strenuous work.
8) If your LBP is recurring again, it does not mean that it is exactly the same problem you had before. It could be some other problem. But, it does not mean that it is severe problem or something to worry about.
9) Sometimes, you may be required to change your working posture, or work setting if your working posture or environment is contributing to on going problem.
10) Do not sit for long period of time (more than 20- 30 minutes). Prolonged sitting can be as dangerous as smoking. Keep moving.
Stay fit and stay happy to treat your low back pain. This is a brief summary of the evidences about low back pain.
This post is written by Saurab Sharma. You may put forward your comments and feedback.
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