Chronic Non-Specific Low Back Pain – Control Impairment
Patients who suffer more than three months of low back pain are diagnosed with “non-specific” chronic low back pain (NSCLBP), regardless of the radiological findings. It is not uncommon for these patients to find that the initial diagnosis may no longer be what’s causing their low back pain.
Patients with NSCLBP who do not have the ability to move their lower back independently, without moving other parts of their body is said to be ‘control-impaired’. This ‘control impairment’ or inability to isolate the body’s movement leads to mechanical faults, which eventually causes more loading and compression of the joints resulting in pain. Imagine if your back is stiff and it feels like just one part of the back is supporting all the stress when you move, how much better will it feel when the back is ironed-out and relaxed?
Typically, patients complain of pain when performing the following movements:
- Movement through range
- Static loading tasks such as standing or sitting without support
- Repetitive strain to end of range both in static and dynamic positions
Patients with“non-specific” chronic low back pain have lost the awareness of their body’s position in space (proprioception) and tend to adopt positions that increase stress on the tissues. To aggravate matters, the lack of control prevents them from moving into a position that alleviates the pain.
What are some of the signs we are looking for?
- Chronic pain of more than 3 months with/without an initial radiological finding e.g slipped disc injury
- Localised pain with or without referred pain, such as shooting or pulling pain down the legs
- Gradual onset of pain from repeated or sustained strain, such as lifting or standing for long periods
- Lack of awareness of what causes the onset of pain
- No impaired movement in the direction of pain
- Fear and avoidance of activity that brings on pain
How can physiotherapy help?
Patients with “control impairment” disorder typically take a longer time of rehabilitation due to the nature of the disorder. A lot of time is required to alter the motor control to help offload the painful joints and tissues that are involved.
Your physiotherapists will designed a motor control programme that aims to change the behavior of the muscles to improve stability and awareness of the lumbo-pelvic region. This is different from a strength conditioning programme, where you want to increase the strength of the muscles.
Behavioral interventions, manual therapy including joint mobilisations and manipulations as well as soft tissue release will be used together with the motor control programme to improve joint movement. If there is a deficit, this will help facilitate and restore muscle balance to improve activation of the targeted muscles. Whenever necessary, electrophysical agents will be used for temporary pain relief.