Back pain Prevention

The majority of patients responding to basic extension and flexion principles of treatment have been educated in the means of achieving pain relief and restoring function. They have carried out the self-treatment procedures and have to a large extent become independent of therapists. Following successful treatment it requires little emphasis to convince patients that if they were able to reduce and abolish pain already present, it should also be possible to prevent the onset of any significant future low back pain.

Of all the factors predisposing to low back pain only postural stresses can be easily influenced and fully controlled. We must develop this potential ingredient of prophylaxis to the full. The patient must understand that the risks of incurring low back pain are particularly great when the lumbar spine is held in sustained flexed positions; and that when the lordosis is reduced or eliminated for prolonged periods, he must at regular intervals and before the onset of pain make a conscious effort to interrupt flexion, restore the lordosis and accentuate it momentarily to the maximum. It is essential that the patient knows the reasons for doing this, and therefore we must explain to him in lay terms that on restoring the lordosis the intradiscal pressure decreases, the nuclear fluid moves anteriorly and the posterior stresses in and around the disc are reduced.


Briefly summarised, the following prophylactic measures should always be taken:

  • Prolonged sitting requires (a) maintenance of the lordosis by muscular control of the posture or, preferably, by insertion of a lumbar roll, (b) hourly interruption of sitting by standing up, walking around for a few minutes and accentuating the lordosis by a few repetitions of extension in standing (Proc. 6).
  • Activities involving prolonged stooping require (a) interruption of stooping at regular intervals by standing upright, (b) regularly reversing the curvature of the lumbar spine, restoring and accentuating the lordosis by a few repetitions of extension in standing (Proc. 6).
  • Lifting requires (a) the use of the correct lifting technique. Generally, if the object to be lifted exceeds fifteen kilograms, the strain must be taken with the lumbar spine in lordosis and the lift must be performed using the legs. If the object to be lifted weighs under fifteen kilograms less care is necessary, unless one has been in a bent or sitting position for some time prior to the lift. In the latter case the same rules apply as for lifting weights exceeding fifteen kilograms, (b) accentuation of the lordosis before and after lifting by a few repetitions of extension in standing (Proc. 6).
  • If inadvertently pain has developed during sitting, stooping or lifting, the patient should immediately commence extension in lying (Proc. 3).
  • Extension in standing (Proc. 6), very effective in preventing the onset of pain, is less effective when used to reduce present pain. Extension in lying (Proc. 3) is the technique of first aid for back pain.
  • Recurrence: At the first sign of recurrence the patient should immediately commence the procedures which previously led to recovery. Although an episode of low back pain can commence suddenly and without warning, many patients are aware of a minor degree of discomfort before the onset of severe pain. If this type of warning is given, the patient has an excellent chance to prevent the development of symptoms, provided the appropriate procedure is applied immediately.

It is not possible for patients to remember all verbal instructions and advice given during the first treatment. To avoid tedious repetition and to ensure the necessary information is conveyed to the patient, a list of instructions is supplied on the first visit. This list firstly deals with information for patients in the acute stage of low back pain, and secondly provides information required once recovery has taken place. These instructions form an important part of self-treatment, because when followed properly they will help in reduction of present symptoms and prevention of their recurrence.

ASSESSMENT OF PAIN Pain gives the body warning and often is accompanied by anxiety and the need to relieve the pain. Pain is both sensation and emotion. As noted earlier, it can be acute or chronic. Health-care professionals may find the following mnemonic tool useful for assessing a client in pain: P = place (client points with one finger to the location of the pain) A = amount (client rates pain on a scale from 0 to 10 ) I = interactions (client describes what worsens the pain) N = neutralizers (client describes what lessens the pain) The scale of 0 to 10, as described in the mnemonic, is a useful method of assessing pain. Further pain assessment skills include observing the client’s appearance and activity. Monitoring the client’s vital signs may be of value in assessing acute pain but not necessarily chronic pain. To assess the pain of children or those with some cognitive dysfunction or dementia, a “smiley face” model often proves beneficial. The first smiley face shows a happy face...
Back pain. The Cause of Pain THE NOCICEPTIVE RECEPTOR SYSTEM Most tissues in the body possess a system of nerve endings which, being particularly sensitive to tissue dysfunction, may be referred to as nociceptive receptors. The free nerve endings of the nociceptive system provide the means by which we are made aware of pain. Wyke describes the distribution of the nociceptive receptor system in the lumbar area: it is found in the skin and subcutaneous tissue; throughout the fibrous capsule of all the synovial apophyseal joints and sacro-iliac joints; in the longitudinal ligaments, the fiaval and interspinous ligaments and sacro-iliac ligaments; in the periosteum covering the vertebral bodies and arches, and in the fascia, aponeuroses and tendons attached thereto; and also in the spinal dura mater, including the dural sleeves surrounding the nerve roots. The nociceptive innervation of the spinal ligaments varies from one ligament to another. The system is found to be most dense in the posterior longitudinal l...
The Dysfunction Syndrome The word ‘dysfunction’ chosen by Mennell to describe the loss of movement commonly known as ‘joint play’ or ‘accessory movement’ seems infinitely preferable to the terms ‘osteopathic lesion’ and ‘chiropractic subluxation’, neither of which means anything and both of which mean everything. ‘Dysfunction’ or ‘not functioning correctly’ at least acknowledges that something is wrong without going through the sham procedure of pretending that only those who belong to the club really understand the terminology. For years osteopaths and chiropractors have claimed that only the people, properly trained in their particular calling, have the necessary knowledge to understand their terminology. There may be some truth in that. Although I believe that the term ‘dysfunction’ as used by Mennel does not strictly cover the loss of movement caused by adaptive shortening, I have chosen to use this term instead of repeatedly referring to ‘adaptive shortening’. Essentially, the mechanism of pain prod...
Deformities of the spine: Lordosis, Kyphosis, and Scoliosis ICD-9: 737.20 LORDOSIS ICD-9: 737.10 KYPHOSIS ICD-9: 737.30 SCOLIOSIS Video: How to Correct a Scoliosis With Exercise and Stretching Description ⚡ Lordosis ⚡ is an abnormal inward curvature of the lumbar or lower spine. This condition is commonly called “swayback.” Kyphosis is an abnormal outward curvature of the upper thoracic vertebrae. Commonly, this curvature is known as “humpback” or “round back.” Scoliosis is an abnormal sideward curvature of the spine to either the left or right. Some rotation of a portion of the vertebral column also may occur. Scoliosis often occurs in combination with kyphosis and lordosis. These three spinal deformities may affect children as well as adults. FIGURE. Spinal curvatures Etiology Lordosis, kyphosis, and scoliosis may be caused by a variety of problems, including congenital spinal defects, poor posture, a discrepancy in leg lengths (especially in scoliosis), and growth retardation or a vascular disturbance in the epiphysis of th...
Examination of Back Pain Having digested the information supplied by the referring doctor, extracted as much relevant information as possible from the patient, and checked the radiologist’s report, we may proceed to the examination proper. If the patient is able to do so, we should make him sit on a straight backed chair while taking his history. During this lime he will reveal the true nature of his sitting posture. When the patient rises to undress after the interrogation we should observe the way he rises from sitting, his gait, the way he moves, and any deformity that may be obvious. We will record the following: I. POSTURE SITTING If the patient has been sitting during history taking, we already have a good impression of his posture. We now ask him to sit on the edge of the examination table with his back unsupported. In the majority of cases the patient will sit slouched with a flexed lumbar spine. Some patients are more aware of the relationship between their posture and pain. They have discover...