Low Back Pain

[bernard]

A simple exercise for low back pain

Examination; often thoracic breathing, tight and sore low back, tight gait with reduced arms balance. Decrease or absence of voluntary motion on low back and abs.
pain: often in low back, also legs problems (hip, knees).
Behaviors: fear of movement because all motion is felt as painful.

position; Patient is lying back on a table, knees bent comfortably.

Begin with abdominal breathing.

Then I continue with a leg, gentle moving like walking and say to patient again to feel movement from a first person experience (focused and attentive to movement). Then I mobilize the other side. Patient ever relates a major difference already between the two sides; more supple. They almost begin to sense their back, a kind of ability to move?

Then, knee bent and grasped with my arms close to my chest, I say to patient to push me, as they wanted to put their feet on the table. They must sense all the slow movement in each direction. 4/5 times.

Advise: neurodynamics come there. Some of important injuries may have engaged nerve lesions and after a session, patient feels better and is now pain free at rest but feels some pain while moving and uniquely in a few degrees of motion.
Nerve lesion demands time to relieve.

[emad]

Hi Bernard:

Good practical session ,
Bernard
uasually , i lead pateint to rest pain free status , but usually , all consumers have yellow flags , i mean thier work , they can not decrease work effort /its time , so to go withe work...
i will put this a new topic .
cheers
emad :lol:

[nari]

Bernard

Your Rx plan sounds great.

Education, neurodynamics, information to the brain that legs, pelvis and spine can move without pain - and the various stations change signals.

Write it up for future reference -and for others to note.


Nari

[bernard]

Nari,

Education, neurodynamics, information to the brain that legs, pelvis and spine can move without pain - and the various stations change signals.

The big surprise for me is that almost all patients can't do this movement actively before my intervention! It hurts them badly and of course they are afraid of this kind of action.

Ian would say that is placebo, Nari would say that is neurodynamics, Diane would say that is brain?

I'm focusing attention of patients to the fact that they are the directors of the movement and they control it totally. If they move slowly, they'll be warned if something may fail!

More they do it with strength, more easily the pain disapears!

In my view, the movement erases the anticipation component of pain?

[nari]

Bernard,

To your last sentence re anticipation of pain - Yes.
Overcoming anticipation of pain is an important aspect of movement.
In a way, that is education - controlling fear of pain, and even thought of pain (which is a very strong pain inducer).

Nari

[nari]

Doesn't that make one cranky - the GPs who hang onto patients but are not able to do as much for them as PTs?

We have that problem, on a big scale too. They often have difficulty deciding who is appropriate for PT and who is not, and we do not know what their criteria for referral is - it is very inconsistent.


Nari

[bernard]

Somasimplers,

Here is the realization of the movement. The blue arrow shows the force applied by the patient, the resistance is of course in opposite direction.

http://www.somasimple.com/flash_anims/LBPmover01.swf


flash version (http://www.somasimple.com/flash_anims/LBPmover01.swf)
html version (http://www.somasimple.com/flash_anims/LBPmover01_test.html)

You can enlarge the view by clicking on flash version!

Hope it help some to try it?

[bernard]

I tried during my holidays to make some little statistics about this exercise.
It was tried on 86 patients since January.
All had an improvement over pain and they feel all an enhancement during the daily life.
In this group, I had one patient which could not perform the requested movement (concurrent knee problem).
The majority of patients were painfree with 3/5 sessions.

Total average (VAS scale) actually is 1.37 (n=86)

Poor results n=11
Average (VAS scale) is 5.0

Within these 11 patients, there was

1 victim of sexual abuse
2 non cooperative patients (one of them prefer pills!)
1 divorcing woman
3 aged patients (> 92 yo)
2 polyarthritis
1 fibromyalgia (scared by her GP)
1 associated problem (knee)

So we can say that I had 75 good or excellent results 87%
VAS score is under 1.5 for all these patients.

I treated indifferently chronic or acute problem in the same manner.
Those whom have a little pain have frequently roots problems since a long time. But they all say that if the discomfort remains like that, it is not a problem for them.

I will, now, collect VAS score at every session.

[emad]

hi Bernard :

very good ideas and statistics , yes the more important , the end overall outcome for the technique which is used.

I think u have used in conjunction with ,teaching :arrow:
pain
relaxation
using assurance.

cheers
emad

[bernard]

The beginning of movement

http://www.somasimple.com/images/lbp001.jpg

[bernard]

Then patient moves isotonic contraction.

http://www.somasimple.com/images/lbp002.jpg

[bernard]

Then patient moves until this position.

http://www.somasimple.com/images/lbp003.jpg

[bernard]

Then patient relaxes slowly to the rest position.

http://www.somasimple.com/images/lbp002.jpg

[bernard]

Then patient relaxes slowly to the rest position (she is pushing against me, less and less).

http://www.somasimple.com/images/lbp001.jpg

[Diane]

Bernard, nice pictures. In Somatics, that sequence would be called "pandiculation of the erector spinae muscles."
Cheers,
Diane

[bernard]

Diane,

It is derivative from the Somatics Book.
THe important thing is to avoid legs extension. It hurts in that cases.
This exercise is a perfect revelator of scars on nerves (it hurts only on a centimeter).

[fapt]

Diane,


This exercise is a perfect revelator of scars on nerves (it hurts only on a centimeter).

Why?
I don't understand....
This exercise can correct the spine position which is caused by weakness of lower abdominal muscle.

[bernard]

Hi Somasimplers,

This exercise can correct the spine position which is caused by weakness of lower abdominal muscle.

1/ No, the exercise is not intended to correct a spine position but much more a imbalance in muscle activity. (It reduces/suppresses the anticipation factor of activation).

2/ The abdominal muscles are not actived in this trial and have not to to contracted.

[nari]

Good visuals, Bernard.
Sounds an interesting way to retrain, in a way. an otherwise simple movement.

Nari

[bernard]

Nari,

Thanks,
visuals are necessary to brain and words are visuals too!

[fapt]

[quote=bernard]Diane,


This exercise is a perfect revelator of scars on nerves (it hurts only on a centimeter).

Why?
I can't figure out?

[bernard]

Lin,

After a nerve injury and also in many LBP, the muscles are very tight in all the lumbar area. This exercise is a good one to release these tight muscles and then, while moving the legs passivly, the patient can feel if a high spot remains while moving (the scar is hurting something).

[canuckpt]

Bernard,

Interesting technique. Are you taking the knees into flexion during this technique? Are you finding a point of restriction into flexion and then applying a hold relax stretch? Are you attempting yo achieve further flexion each rep?

This reminds me of a bent SLR that Mulligna recommends for highyl sensitive LBP patients with positive SLR less than 30 degrees. Perhaps the Mulligan bent SLR works since the patient realizes they can move their leg into a flexed position pain free?