Back pain: exercise-therapy and rehabilitation

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High, low, acute, relapsing: back pain affects most of us at least once in our lives. Let us examine here the causes and options for exercise-therapy and rehabilitation

I have a back pain. Why?

This is the first question we ask ourselves in the presence of back pain. Unless we have already been to the doctor or have already consulted a physical therapist, we often cannot give ourselves an accurate answer, especially when we have not suffered the classic air blow or an injury.

To tell the truth, even when we find ourselves in special conditions (the aftermath of an injury, a proclaimed pathology, a postoperative course, a pregnancy) we still often find it difficult to pinpoint precisely when back pain began. To date, back pain represents one of the most prevalent osteo-articular disorders, generating high demand for access to general and specialist medical services.

Back: structure and anatomy

We all know that the back is a complex structure: bones, muscles, joints and nerves are part of it. Frequently, to be affected by the pain is thelumbar area of the back (the lowest: in this case we talk about lumbago), with possible irradiation of the discomfort also to the buttocks of the lower limbs; less frequent-but still encountered-is the pain felt in the upper(back) part of the back: in this case it is called dorsalgia.

Back pain is mostly included in acute episodes, lasting several days or weeks; beyond these times, it is referred to as subacute even chronic pain.

Unless the pain is intolerable, we therefore often tend to live with back pain-and sometimes take compensatory attitudes to reduce its symptoms. But what are the causes of back pain?

Bad Back: organic, inflammatory or psychosomatic causes

From infections to inflammation (or inflammation), from aortic aneurysm to some benign and malignant tumors to psychosomatic disorders (stress, anxiety, and depression), there are several so-called “non-mechanical” causes that, in about 2% of cases, can cause even acute episodes of back pain.

The history and physical examination will be able to rule out or confirm these origins (although, in the vast majority of cases, back pain depends on mechanical causes, which we will see in a moment).

Traumatic or musculoskeletal bad back’s causes

Again, the objective examination, together with the medical history, will allow the mechanical causes underlying back pain to be identified already in the acute phase. Exertions, traumas and altered postures may in fact have caused tension, strain and stiffness of the structures connected to the spine.

In addition to any static and incorrect postures assumed for more or less prolonged periods of time, back pain of muscularor osteo-articular origin is in fact related to a number of risk factors:

  • heavy work
  • sedentary lifestyle
  • obesity
  • smoking
  • Frequent twisting and flexing of the torso

And to a range of diseases/disorders/injuries, such as:

  • disc herniation
  • Sciatic nerve impairment (resulting in low back pain and/or lumbosciatica)
  • osteoporosis
  • arthrosis
  • Degenerative processes in intervertebral discs
  • fractures or microfractures

Along with, unfortunately, pain (either excruciating and momentary or widespread and prolonged) back pain can result in a natural reduction in flexibility and movement of the entire body.

“How can I relieve the pain in my back?”

Back pain, rather than as a true pathology, thus presents itself as the symptom of a prior clinical circumstance.This is why, sometimes, a complete diagnosys can take a long time (especially if more in-depth instrumental investigations are needed. as X Ray or CT).

The good news? Most back pain recedes almost entirely within a few days of onset (pending the diagnostic process, the physician may recommend pain-relieving and/or anti-inflammatory pharmacological applications).

Once the pain is over, however, it is important to get the diagnosis and investigate the problem further, for many reasons, including:

  • Put themselves in a position to cope with possible recidivism
  • Preventive intervention on lifestyle habits to be corrected
  • begin a therapeutic course of treatment with the referral figures suggested by the physician, namely the physiotherapist and/or osteopath.

“Should I do rehabilitation?”

Surely, coping with a back pain of mechanical origin therefore means clinically intervening on the traumatic or musculoskeletal causes that we have examined.

Once the diagnosis and pathogenesis of back pain have been established and the acute pain phase has been remedied, in almost all cases rehabilitation is necessary in order to restore joint mobility that has been compromised.

In addition to supporting the remission of back pain, in fact, good physiotherapy treatment will enable the patient to:

  • mobilize the joints
  • expand the angles of movement of the spine and hip
  • Strengthen the muscles coinvolved in movements (quadriceps, hamstring, gluteus)
  • regain a correct posture
  • prevent eventual relapses

There are several phases which the patient will be confronted with along the physiotherapy treatment: from tecartherapy to hyperthermia, laser therapy to kinesiotherapy, and postural gymnastics, often associated with massage therapy.

Measuring motion

At almost all stages, it is extremely important to measure movement by performing current assessments and specific rehabilitative exercises; the objective data obtained accurately indicate the progressive improvement of the patient.

Therefore, many rehabilitation centers choose to equip themselves with devices that employ innovative biofeedback technologies, such as riablo.

Thanks to Riablo’s sensors and stabilometric platform, the patient can perform the exercises while getting real-time visual-auditory feedback, which allows him or her to improve back motor control as well as stay motivated while completing the exergame goal.

For back rehabilitation, in Riablo you can both initially assess joint range of motion (ROM) and build an exercise-therapy program, choosing from a library of more than 350 exercises, including:

  • SEATED TRUNK EXTENSION
  • LATERAL FLEXION WHILE SEATED
  • LATERAL FLEXION OF THE TRUNK

With the goal of working on:

  • Joints: spine, hip
  • Muscles: quadriceps, glutes, hamstrings, calves

Riablo’s database allows the set up of a program for spinal rehabilitation that will also allow the patient to work on core stability, with more than ten movements comparable to the classic plank(static plank, plank on fitball, and plank with single-podal support) while controlling:

  • the rotations of the trunk
  • The alignment between the trunk and lower limbs
  • The detail of the knee flexion.

In addition to planks, there are other exercises in Riablo that are particularly useful for back rehabilitation, such as bilateral and unilateral bridge and gluteal movements that help restore or strengthen the lumbar girdle.

Riablo also allows you to work on balance, with numerous exercises that take advantage of the proprioceptive version of the stabilometric platform.

You can, in addition, assess the incoming patient with a balance test, then have him or her work on load transferor stability control, always keeping an eye on the correct trunk and lower limb position while performing the movement.

Effective even in the acute phase of back pain and combinable with specific instrumentation such as fitballs or proprioceptive cushions, other examples of exercises for spinal rehabilitation in Riablo are:

  • Weight lat transfer – right-to-left load transfer with control position “forced” by offsets measured by sensors on knees and trunk
  • Weight transfer on lat wobble – transferring load from right to left by physically moving the platform and always maintaining control of trunk and knees;
  • Weight mono lat-transfer– unilateral load transfer at practitioner’s choice with trunk and knee control.

Finally, there are numerous exercises in Riablo’s catalog for spinal mobility, both standing (with load control thanks to the platform) and sitting.

“After back pain, how do I demonstrate to the patient his level of recovery?”

This question is frequently asked among movement professionals. Why? At the end of an averagely long rehabilitation such as that of the back, they need to provide the patient with data supporting the effectiveness of the course undertaken, beyond the general improvement certainly found.

When physiotherapy therapy draws to a close, Riablo is then able to objectify the patient’s degree of recovery, thanks to an accurate and repeatable final evaluation, which is done through a battery of tests dedicated to the spine and nearby joints:

  • Lumbar ROM
  • Hip ROM
  • Cervical ROM
  • Shoulder ROM

investigating articulatory capacity and compensation control, offering immediate comparison with normative data broken down by age group and ge.

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