There are conservative as well as surgical solutions to low back pain.
Due to the complications associated with surgery, conservative treatment is often attempted first.
First line practitioners
Physiotherapists are 'first line practitioners' – that is, you don't need a referral to consult a physiotherapist – you can simply call and book and appointment. Physiotherapists can facilitate the healing process as part of the conservative management.
What will the physiotherapist do?
As first line practitioners, physiotherapists are capable of making a diagnosis and treating autonomously.
Physiotherapists, working as part of the patient's medical team, can refer a patient for
X-rays, refer a patient to a medical specialist and issue sick notes.
The scope of a physiotherapist, as defined by the Health Professions Council of South Africa, includes the scientific use of movement techniques based on physiological principles.
This will be supplemented when necessary by massage, manipulation, electrotherapy and other physical and supportive measures. An important part of the physiotherapist's function is to advise and educate the patient, for the prevention and treatment of injury, disease and disorders, and the facilitation of normal physiological processes and functional activities. These are used to assist rehabilitation and restoration of function, including the achievement of personal independence.
Physiotherapists have a biopsychosocial approach to the management of low back pain: bio refers to the biological systems, the actual structures; psycho refers to the psychology and the influence it has on the biological systems; and social refers to the social circumstances which the patient is part of and its impact on how the condition is perceived.
Your physiotherapist performs an assessment which includes an interview and some physical tests.
During the interview, they’ll ask a series of questions strategically aimed at unearthing the cause and contributing factors, and also at identifying the presence of serious pathology.
Physical tests may include observation of posture and gait (how you walk), active movements, muscle length and muscle strength tests, and feeling for muscle spasm and joint movements.
You may have to take your shirt off and roll your pants up for the session, but your physiotherapist has lots of experience in covering up what needs to be covered up!
After the assessment, the physiotherapist will formulate a treatment plan based on your individual needs.
Treatment may include passive and/or active modalities
Passive modalities encompass soft tissue release such as massage and trigger point release, while active modalities include exercise prescription.
We urge you to do your exercises! Carefully following your home exercise programme is vital to maintaining the short term relief that you will get from attending physiotherapy in the long run.
Acute vs chronic
There are different approaches to treatment for acute/sub-acute (less than 3 months duration) and chronic low back pain (more than 3 months duration).
Treatment for acute/sub-acute low back pain focuses more on the physical or anatomical structures and prevention of recurrence, while the approach to chronic low back pain involves a lot of pain education, aiming to improve your self-efficacy and adaptation to functional activity loads.
In cases of non-specific low back pain, your physiotherapist will advise you to avoid bedrest, as the inactivity associated with bed rest is not good for your back or your psyche. Obtain appropriate pain relief medication from your health care provider or pharmacist.