World Physical Therapy Day 2024:

Understanding Low Back Pain

Most LBP is nonspecific, meaning that no single structural factor can be identified as its primary
cause and that there isn't a severe underlying illness. LBP can also be defined as pain above
the inferior gluteal lines and below the costal margins, often including leg pain.
Overall, it is the most common and severe type of dysfunction for which physical
therapy is effective.
Other conditions that may lead to this condition include poor posture, inactivity,
wrong lifting methods, or even conditions like disc herniation, spinal stenosis, or
degenerative disc diseases. Some studies indicate that approximately three-quarters
of the human population will develop low back pain at some point in their lifetime.

Low back pain is among the leading causes of disability, affecting people of all age
groups, from schoolchildren to young adults and the elderly. It is a chronic
condition that has a high impact on everyday functioning, work, and quality of life.
On World Physical Therapy Day 2024, the objective is to raise awareness of the
role of physiotherapy in managing and preventing low back pain. The following
article aims to highlight a few of the roles of physiotherapy in preventing and
managing low back pain.
Research has shown that physiotherapy effectively treats pain and prevents lower
back pain. Physiotherapy offers a promising approach to managing and preventing
this condition by educating people, encouraging exercise, and implementing
lifestyle modifications.

The Role of Physiotherapy in Managing Low Back

Physiotherapy plays a crucial role in effectively managing low back pain. Physical
therapy not only treats the symptoms of back pain, but aims to find out the root
cause and treats the same to have a long-lasting impact on treatment. This is
achieved via manual therapy, exercises, patient education, and ergonomic
education, which work together to reduce pain, improve mobility, and prevent
future episodes of low back pain. Physiotherapists use evidence-based approaches
when treating patients. The specific causes of discomfort, joint compression, joint
dysfunction, and muscle strain can be determined by assessing the patient's
posture, movement patterns, and lifestyle factors. After assessment and differential
diagnosis, a personalized treatment plan is developed based on this assessment.

1. Treatment Modalities
Manual Therapy: Various hands-on techniques, including myofascial release,
spinal mobilization, and manipulation, can help reduce pain and improve spinal
alignment. It is a structured approach to delivering hands-on physical therapy
within a biopsychosocial framework.

Therapeutic Exercise: Strengthening exercises focus on the core, back, and hip
muscles, along with stretching the specific muscles essential for supporting the
spine and improving stability.

Pain Relief Techniques: Physiotherapists may also use heat, cold, and various
electrotherapy units, such as electrical stimulation, ultrasound therapy,
transcutaneous electrical nerve stimulation, interferential therapy, and short-wave
diathermy, to alleviate pain.

2. Education and Lifestyle Modification

Educating patients on the importance of proper body mechanics, posture,
and ergonomics is crucial for long-term management. This education helps
patients change their daily habits, such as sitting with proper lumbar support,
lifting objects safely, incorporating regular physical activity into their
routines, using ergonomically fit office chairs and tables, and maintaining
body weight.

Recent Advances in Low Back Pain Management

1. Pain Neuroscience Education (PNE)

chronic pain is not viewed as a result of unhealthy or dysfunctional
tissues. Instead, it is due to the brain's plasticity that leads to
hyperexcitability of the central nervous system, known as central
sensitization. The ultimate goal of Pain Neuroscience Education (PNE) is
to increase pain tolerance with movement, like performing exercises with
mild discomfort, reducing any anxiety associated with movement, and
reducing central nervous system hypersensitivity. In practice, this often
involves using educational pain analogies, re-educating patients'
misconceptions about the pathogenesis of the disease, and providing
guidance on lifestyle and exercise changes that can be implemented.

2. High-Intensity Laser Therapy (HILT): High-intensity laser therapy

(HILT) has been advanced as a new noninvasive technique for managing
low back pain. Numerous investigations have established that HILT can
help alleviate pain and functional deficits, thus preventing inflammation
and enhancing tissue remodeling.
Work: When the light source is placed against the skin, the photons
penetrate several centimeters and get absorbed by the mitochondria. The
energy fuels many positive physiological responses, restoring normal cell
morphology and function but at an enhanced rate. Targeted in
hemoglobin and cytochrome oxidase, the high-power diode laser could
help in respiration and then, in a result, have a good performance therapy

3. Telerehabilitation: Physiotherapists use telehealth to communicate

with their patients and attempt to alleviate low back pain and various
physical conditions. With the advancement of information technology,
digital therapeutics, and the recent emergence of telemedicine, especially
during and after the COVID-19 pandemic, patients can receive
instructions and a customized exercise program by virtual means.
Telemedicine methods for persistent low back pain may, at times, be just
as effective as standard personal treatment.

4. CBT and Multidisciplinary Approaches Interventions

Combining CBT with physical therapy for chronic low back pain was
considered valid. Coordinated pain management incorporating physical
therapy, psychology, and medication has improved pain relief while
reducing disability.
Cognitive behavioral therapy is a form of psychotherapy that has been
documented to be effective in treating anxiety, insomnia, depression,
addictions, and other mental disorders. It has also been utilized in the
treatment of chronic low back pain. Researchers found a solid therapeutic
effect of psychological interventions on the treatment of CLBP. CBT was
noted to be particularly effective.
CBT represents a family of therapies that are effective for a wide range
of problems, many of which coexist with and influence CLBP. Focused
CBT can improve each of the variables. Early, widespread adoption of
CBT in treating and preventing CLBP is recommended.
 5. Method of Rehabilitation Employing Exercises and Wearable
Integrated Gadgets:
In rehabilitation, wearable devices that track posture, exercise, and
muscle activation are now used. These devices allow users to finally get
feedback on their form during exercises, which is crucial to avoid
worsening and improving the condition. The use of sensor-based
devices today represents a highly beneficial alternative to the
rehabilitation of lost functions, facilitating both the work of
physiotherapists and maintaining the active attention of the
patient during a rehabilitation session. Sensor-based devices
help patients’ functional rehabilitation, adopt a new approach to
medical rehabilitation, and use advanced technology, which
keeps patients’ attention throughout a rehabilitation session.
Along with various neurological conditions, research has high
evidence of sensors and wearable gadgets on LBP.

EVIDENCE-BASED-PRACTICE

1. Core Stability Training

Core Stability Training exercises have been repeatedly used to help alleviate
low back pain and its effects on functional status. Based on this, a meta-
analysis of randomized controlled trials demonstrated that core-focused
exercises were superior to general exercise for disability and pain in patients
with chronic LBP. Over the years, the concept of core stability
has changed, And authors have highlighted the significance
and contribution of the Transverse Abdominus muscle,
especially in lumbopelvic stability. Upon this basis, it has now
become an essential part of the management of spinal stability
and exercises orientated upon the activation, recruitment, and
strengthening of the core are a common avenue of treatment [.

2. Manual therapy with exercise

A recent systematic review noted that manual therapy in combination with
exercise was more effective than using any of them as a single technique.
These changes have also been ascertained to positively impact the reduction
of pain severity, enhanced function, and early recovery among patients with
acute and chronic low back pain.
 3. Multimodal therapy: Exercise, Manual Therapy, behavioral interventions,
patient education and medication are recommended treatment options for
managing CLBP. Global multimodal therapy is recognized as the most
effective. The latest clinical guidelines call for these interventions for long-
term management and prevention. Thus, multidisciplinary regimen is most
effective in treating chronic low back pain

4. Trunk Integration and Control Exercises are called TIC Exercises, in

contrast to classical calisthenics, which are repeated, voluntary tonic
contractions. These are designed to improve the tone and function of the
muscles that support the spine and pelvis. For improved posture and
stability, these exercises use the back, hip, and abdominal wall muscles.
Because TIC exercise can give the lumbar region more stability, it can help
relieve back tension and improve the biomechanical quality of motion,
which makes it especially beneficial for people with LBP.

Preventing Low Back Pain

Physiotherapy plays a crucial role in treating LBP; however, the social focus
should be preventing the issue. Therefore, physical therapists should actively
participate in the informed dissemination of preventive measures for a healthy
spine.

1. Postural awareness: Poor posture is one of the main causes of low back
pain, and it affects most people. Physiotherapists advise their clients to stand or
sit with proper posture at work, in the classroom, at home, and during other
activities. Adopting proper posture can alleviate pressure on the spinal column
and prevent strain on the lower back's musculature and ligaments.

2. Regular Exercise: Physical activity that exercises the core, back, and hip
muscles reduces the risk of low back pain. Pilates, Yoga, and certain strength
training exercises can be particularly effective in enhancing flexibility and
strength of the core muscles, which are essential in supporting the spine.

3. Ergonomics: To avoid ailments like lower back pain, one should utilize
appropriate lifting and bending techniques as well as ergonomic workplace
design. Other back-supporting measures include using a lumbar cushion,
 getting up from a desk, and occasionally stretching and adjusting chair
height accordingly.

4. Lifestyle Factors: To prevent lower back pain, people should avoid

smoking, gain weight, or exercise frequently. Smoking damages the spine by
depriving the spinal tissues of blood, and excess weight is also hard on the
spine.

Conclusion: This is World Physiotherapy Day. We acknowledge the contribution

of physical therapists to the treatment and prevention of back pain. Through
manual therapy, specific exercises, patient education, and other non-
pharmacological interventions, physical therapists help their patients take control
of their well-being and quality of life. Understanding how physiotherapy can help
treat and prevent back pain can go a long way in assisting people in utilizing
services to improve their spinal health, thereby reducing the global prevalence of
the disease.

References:
 Pubmedia Jurnal Pendidikan Olahraga Vol: 1, No 4, 2024, Page: 1-14
 World Physiotherapy Day: Know History, Theme and Significance. https://drishtidarshan.com/world-physiotherapy-day-know-
history-theme-significance-and-more-details/
 Laser Therapy - Mirka's Massage and Laser serving Oshawa, Durham. https://mirkasmassageandlaser.com/laser-therapy/ Szabo, D.,
Szabo, D., Neagu, N., Teodorescu, S., Apostu, M., Predescu, C., Pârvu, C., & Veres, C. (2023). The Role and Importance of Using
Sensor-Based Devices in Medical Rehabilitation: A Literature Review on the New Therapeutic Approaches. Sensors, 23(21), 8950.