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Chronic Non-Specific Low Back Pain – Movement Impairment

Have you ever been told not to bend forward after getting a slipped disc injury? And after a while, pain seems to persist.

Chronic Non-Specific Low Back Pain (NSPLBP) is a term used for clients who have had at least three months of low back pain, regardless of radiological findings such as X-Rays and MRIs. NSCLBP patients with loss or impairment of normal movements in their low back, usually worse in the painful direction are said to have ‘movement impairment’.

This group of patients often complain of tightness and stiffness around their low back, restricting them to move their back into one or more direction. The muscles become tight and stiff from lack of movement during the early stages of low back pain, usually a result of trying to avoid sharp and severe pain. Physiotherapists refer to this behavior as “muscle guarding”. This behavior or mindset is also encouraged when patients are told not to move in the direction of pain by healthcare professionals in the acute phase of their injury. Despite this discomfort, if the painful movement is performed slowly and under supervision, the patient may find that they can actually perform the movement with minimal pain.

While it is important to allow healing to take place in the initial phases of an injury, some are unaware of the time frame required. Abnormal stability eventually develops in the low back due to co-contraction of the surrounding muscles, which in turn leads to large amounts of compressive loading on the joints and surrounding tissues. For example, a patient who complained of pain when bending forwards may now experience pain in other direction of movement, such as bending backwards due to the mechanical faults in the joints.

What can physiotherapy do?

Fear is usually the primary driver of pain in this particular group of patients. At this stage, even the slightest bit of pain may be uncomfortable for the patient, as pain is perceived as damaging. Education about pain is necessary to change their mindset regarding movements. Your physiotherapists may employ manual techniques such as joint mobilisation, soft tissue release, joint manipulation to alleviate stiffness in the joints to facilitate the process of normalizing movements in the low back. Whenever necessary, electrophysical agents will be used for temporary pain relief.

The later stages of rehabilitation comprises mainly of motor control and postural re-education. The ability to move the low back in isolation to the pelvis is important for postural correction to prevent future occurrences of low back pain.

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