Physiotherapies Basic: The Management of Low Back Pain - Literature review Example

Literature Review xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Name xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Institution xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Lecturer xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Date Introduction According to Perreault (2008), low back pain is the pain and discomfort that is normally localized below the costal margin but above the inferior gluteal folds. Low back pain occurs as a result of discs within the spinal cord being injured or having undergone some degeneration which results in the pinching. This normally results in the application of pressures on the surrounding areas of injury triggering an inflammatory process that now leads to back pains developing. Low back pain tends to become worse when sitting, bending, lifting or twisting. Low back pain can either be chronic or acute basing on the duration of the pains persistence. Low back pain in the recent past has become the primary cause of disability amongst the adults who are younger than 45 years. Although low back pain is seen by many as a benign condition due to recovery being achieved within a few weeks, its persistence is a great cause of worry and concerned. When the low back pains become chronic (last beyond four months) various complications arise which generally affects an individual. The negative effects of low back pain to the affected individual would include pain, distress. Society as a whole will also be affected with effects being high costs of living and loss of productivity amongst the working community. Effects of low back pain are thus a great public concerned and this is the reason why majority of those who are affected seek physiotherapy interventions as a remedy to alleviate low back pain (Perreault 2008) Critical analysis Physiotherapies basic aim in the management of low back pain is to relieve pain and be able to improve the functionality of the affected individual. Physiotherapy will also be aimed at preventing the recurrence or chronicity of the low back pains. Physiotherapy is offered in session and will compose of activities such as stretching, postural control and muscle strengthening (Costa et al 2009). Avery & O’Driscoll (2004), states that various factors will tend to affect the out come of the use of physiotherapy in the management of low back pain. Factors that will affect the out come of the therapy will be grouped into two. This will include the intrinsic as well as the extrinsic factors. The intrinsic factors are individual related factors and they will involve the person who is undergoing physiotherapy for low back pain management. On the other hand the extrinsic factors will be those factors that result from the external surroundings or environment in which the person who is undergoing the physiotherapy encounters or faces (Avery & O’ Driscoll 2004). Intrinsic factors will include factors such as the degree of injury or condition the patient is having chronicity of the condition or co-morbidities which may be present within the same patient with low back pains. When the degree of injury is or condition is severe, the out come will also be affected. Severe injuries or conditions that tend to affect the spinal cord tend to take longer times to heal when compared to simple conditions. For instance, in the cases where the injury has affected most parts of the spinal cord, stability of the spinal column will tend to be very much affected. Effect on the stability of the spinal cord will often lead to excruciating pains to still emanate from the lower back. Patients with sever injuries will take longer periods under physiotherapy to gain full recovery since effect on stability will affect the healing process due to pressures being exerted on the spinal cord becoming un evenly distributed. Hence this would result to continual injuries even as the physiotherapy process is still on going. This might lead to longer periods of recovery or even detoriation of the condition in the cases where disc Herniation occurs (Kent & Keating 2005). Chronicity will affect the clinical out come of the patient who is on physiotherapy for low back pain management. Low back pains that are chronic would mean that the pains still persist for more than three months after the onset. Chronic low back pains would mean more complications arising in the patient. The chronic back pains will lead to most of the spinal column to be affected. Effect of chronic pains on the spinal column will trigger complications such as the cauda equina syndrome which is a serious neurologic condition that affects the spinal cord. Cauda equina would result form the spinal cord loss of function especially at the lumbar regions as a result of nerve compression. This would mean that the patient will now be hampered form the normal physical functions such as emptying of the bladder (Hayden JA et al 2010). Co-morbidities will also affect the out come of physiotherapy on low back pain management. Disease processes which will affect the spinal column will tend to slow the healing process when one is undergoing physiotherapy. Some of the co-morbidities that would affect out comes could include disease process such as tuberculosis of the spine which would also lead to further damages on the spinal column. For instance, tuberculosis of the spinal column would lead to the displacement of the spinal cord. This displacement will lead to the instability of the spinal column discs which will now over ride each other leading to further damage on the spinal column. This will make the condition of the patients to detoriate even though he or she is undergoing physiotherapy for the management of the low back pain of the spinal column. Co-morbidities will thus lengthen the healing process if not worsening the damages of the spinal column (Grotle M et al 2005). Bhargavaa et al (2006) postulates that Age of the patients will also affect the healing process. Low back pains tend to be common among the elderly population due to the bones undergoing degeneration. As one ages, the discs of the spinal cord degenerate. The degeneration is brought about by the dehydration of the spinal cord discs thus losing their ability to become shock absorbers due to supporting the weight or pressures being exerted on them. When a patient is elderly, the low back will tend take a longer time to heal due to the patient still getting pains that result from degeneration of the bones of the spinal column. Hence as the treatment goes on, a fraction of pain will still be felt as a result of this. Aging tends to slow down the healing process due to the degeneration process of the bones (Tveito et al 2004). Extrinsic factors will also have tremendous effect on physiotherapy patients having low back pains. For instance work related issues will either enhance a good or bad out come. At the working place, patients with low back pain that undertake light work tend to have a better out come when compared to those who do heavy work such as lifting of weights . Light work facilitates healing while heavy work simply strains the spinal cord and hence affects the healing process by either slowing the healing or even making the condition worse over time (Tveito et al 2004). Low back pains affects activities of daily living of patients who are affected. Low back pains make them not to participate or undertake all activities of daily living such as bathing or even lifting of some objects or items. Some of the activities they are expected to perform will thus not be realized due to the effects of low back pains. These patients will thus require assistance in the management of some activities they will have difficulty in performing. In the cases where assistance is not given to these patients, the healing tends to take a longer while due to the straining of the patient while performing the tasks or activities. Patients with low back pain who are on physiotherapy should avoid activities that stress the back if efficient and timely healing is to be achieved (Tveito et al 2004). According to Hurley et al 2004, general health status of patients undergoing spinal management by physiotherapy can be measured through several ways. The 36-item short –form health survey (SF-36) which is composed of 8 scales. These scales will include physical, bodily pain, general health status of the patient, vitality, social function, and emotional as well as mental health. Basing on the 36 short form surveys, patients are generally assessed on their physical and mental well being. In mental health, vitality, emotions, social health will be evaluated whereas on physical health, physical function, bodily pain and general health are assessed. Patients with consistency of higher than 15 items of the 36 items have a better out come. The effect of intrinsic and extrinsic factors will directly influence the consistency of the scores per item when using the SF scale hence one is likely to have scores of less than 15 hence poor outcomes will be appreciated. SF-36 will be effective in instances where the analysis of not only the patient’s physical well being but also the patients mental and emotional health will be required to enable a possible outcome to be determined (Hurley et al 2004). On the other hand, Oswestry back pain disability index will be vital in assessing the patient’s disability as well as his or her functionality. Oswestry back pain disability index will also have 10 items which will assess the level of interference of the patient’s physical activities such as pain intensity, lifting and travelling. These items will result in establishment of a disability score which will be used in showing the progress of the patient. Patients will fill in the questioners which contain 5 points per item of the total 10 items and the score will thus be made to be a percentage, thus the lower the percentage the poorer the outcomes. Due to the effect of both the intrinsic and extrinsic factors, patients will tend to be hampered in their physical activities and this will affect the disability index score. When the patients have their physical activities severely impared, the scores in such a case would be low hence the likely hood of poor out comes will be expected. Oswestry disability index will only be effective in the assessment of the functionality of the patients due to only linking the pain with the effects it has on the patients well being (Hurley et al 2004). The Roland and Morris development questioner will also be vital in the evaluation of the patients with low back pain. The questionnaire is aimed at establishing the disability level of the patients and hence vital in determining the out come of the patients. The questionnaire normally relates the patient’s physical well being with the daily activities. In the Roland and Morrison Maximum score is 24 while the minimum is zero. Patients with scores below 14 normally have poor outcomes. In the Roland and Morrison questionnaire, patients with extrinsic and extrinsic effects will tend to be independent and will have their physical as well as daily activities impared and this will lead to scores that are towards the minimum. These scores will thus indicate the likely hood of poorer outcomes in these patients. Roland and Morris development questionnaire will thus be effective when analyzing the patients physical well being as well as daily activities (Hurley et al 2004). Summary of implications Physiotherapy in the management of low back pain out come is affected by both the extrinsic and intrinsic factors negatively. These effects would either worsen the out come or slow down the healing process. Some of these factors effects can be limited. For instance, the activities of daily living effects on physiotherapy out come in patients who have low back pains. In this case, the patients will require assistance in carrying out of various activities that could lead to the stress or putting strain on the spinal column. Also the working conditions for the patients with low back pains should be looked into. These patients should be exempted form heavy work for this will facilitate the efficiency of physiotherapy on low back pains to be high. On the other hand commodities should also be diagnosed and managed on time to avoid aggravation of low back pain in this patients as these tends to affect the out come (National Health and Medical Research Council 2003). Conclusion There is urgent need to make the entire process of the management of low back pains to be patient centered. Needs of the patients with low back pains on physiotherapy should be given key consideration hence good communication among the patient and the health care providers is essential. Measures of outcomes as well as the effect of intrinsic and extrinsic factors will also have to be considered. This is because most patients are not fully made aware of the options to take while in need of the management of low back pain. The family and the society should be made aware that these are a special group for persons who will need there assistance until when they can be independent (Henschke et al 2006). Therefore a lot of cooperation should be enhanced towards these patients. For instance in the carrying out of activities of daily living or even at the work places, they should be given priority while distributing work so that they do not stress their backs. On the other hand, the assessment and imaging processes need to be comprehensively designed to enable the diagnosis of the various causes of low back pain for this will make the management of low back pain to become effective. Patients with low back pain under physiotherapy management should adhere to the sessions which have been set and avoid defaulting once they get some relief from the pain. This is to avoid the recurrence of the condition in future and facilitate the management of the condition to avoid chronicity as well as the complications that could arise. Physiotherapists should also be trained on better ways of managing of patients who have more than one cause of the low back pain. This can be achieved through education of the health care professionals on the components of care on low back pain (Henschke N et al 2008). References Kent P. and Keating J 2005, Epidemiology of low back pain in primary care, Biomed central limited , Melbourne, Australia. Bhargavaa A 2006, Physical therapy for low back pain, Lippincott Williams & Wilkins, U.S.A Perreault K 2008, Linking health promotion with physiotherapy for Low Back Pain, Laval university, Quebec. Tveito TH et al 2004, Low back pain interventions at the workplace, Occup Med (Lond) ;54:3-13. Avery S and O’Driscoll M, 2004, Randomized controlled trials on the efficacy of spinal manipulation therapy in the treatment of low back pain; physical therapy review 9:146-52. Hayden JA et al 2010, what is the prognosis of back pain? Best Pract Res Clin Rheumatol , 24(2):167-179, Elsevier ,Philadelphia , U.S.A. Henschke N et al 2008, Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study, 337:a171, BMJ Publishing Group Ltd, Sydney Australia. National Health and Medical Research Council 2003, Evidence-based management of acute musculoskeletal pain Canberra: National Health and Medical Research Council, Canberra, Australia. Costa et al 2009, Prognosis for patients with chronic low back pain: inception cohort, George Institute for International Health, University of Sydney, BMJ Publishing Group Ltd Sydney Australia. Grotle M et al 2005, Clinical course and prognostic factors in acute low back pain: patients consulting primary care for the first time, Section for Health Science, University of Oslo, Norway, BMJ Publishing Group Ltd Sydney Australia. Henschke et al 2006, Prognosis of acute low back pain: design of a prospective inception cohort study, Back Pain Research Group, School of Physiotherapy, University of Sydney, Australia. Hurley et al 2004, A Randomized Clinical Trial of Manipulative Therapy and Interferential Therapy for Acute Low Back Pain, Lippincott Williams & Wilkins Inc, U.S.A Read More