The physiotherapy is carried out at: The areas of application are always as follows:
- Alleviation of pain
- Stimulation of blood circulation and metabolic processes
- Improvement of condition (strength, endurance, coordination, mobility)
- Rehabilitation
- Therapy (early and long-term treatment)
- Prevention
The therapy for back pain can have the following contents: The listed contents are both active and passive measures.
- Manual therapy
- Massages, trigger point massages, fascia rolls
- Physical therapies (heat, electricity, ultrasound)
- Strengthening, mobilization
- Tape recorders
- Drug therapy
Back pain, or the treatment of the back and spine, is a large area of physiotherapy. More and more concepts are being developed and many physiotherapists are specialized only in this area.
Physiotherapy is divided into passive and active measures. Passive, i.e. the physiotherapist treats and the patient has to “do nothing”, is mostly used in acute cases and when the pain is in the foreground at that moment. Physiotherapy is intended to relieve pain and help the patient in the moment.
The active physiotherapy usually follows the acute stage. Here the patient cooperates and becomes active under control or in cooperation with the physiotherapist. This also includes a homework program and training in everyday situations, so that the back is relieved of back pain for a long time.
Physiotherapy is often entered into with a false expectation that the structures can be healed by a single treatment or simply by “laying on of hands”. However, successful physiotherapy requires a good physiotherapist who is sensitive to the individual problems of the patient and recognizes holistic connections, and a motivated patient who is willing to cooperate and change things. There are various techniques to passively relieve the patient of his back pain or to alleviate it.
For example, manual therapy is widely used. There are many different concepts. It is mainly used to mobilize joints, i.e. to move and “manipulate” them.
During manipulation, dislocated bones are brought back to their original position through repeated small movements. It is a gentler method than setting. This method is often used for existing facet joint arthrosis.
Manual therapy also includes traction – a guided “pulling apart” of joints. This technique has a very relieving effect and can especially help to alleviate back pain by creating space for trapped and overloaded structures. This pulling apart can be achieved by using the sling table, certain traction belts or simply with the hands.
Either the entire spinal column is stretched, or individual segments, i.e. two consecutive vertebrae, or the joints between ribs and vertebrae. This passive pull can also be used to relax muscles if the origin was an incarceration. Furthermore, muscular relaxation is achieved by rotation – that is, twisting.
Rotations always have a relaxing effect on the body. A gentle method for the back looks like this: The patient lies in a supine position on a couch or a mat. The lower legs and feet are laid relaxed on a large gymnastics ball so that the knees and hips are bent by about 90 degrees.
The physiotherapist gently holds the legs so that they do not slip down and slowly swings them to the right and left with the ball. In this way, a relaxing rotation is achieved in the trunk. Special exercises against back pain can be found in the articles:
- Physiotherapy for a LWS syndrome
- Back school
- Exercises for spinal canal stenosis in the lumbar spine
Another method to relieve back pain caused by an overstrained back is the so-called fascial techniques.
Fasciae are connective tissue structures that connect everything from head to toe. They wrap around muscles and connect them to long chains. According to the latest findings, it is assumed that a lot of pain is caused by the bonding of these structures.
The fasciae lie relatively deep in the tissue, so that with a lot of (sensitive) pressure the entire chain can be treated in one line.This technique is particularly suitable for the often hardened shoulder-neck musculature and the long back extensor on the right and left of the spine. Basically, it can be performed anywhere on the body. Further methods from the heat therapy offer themselves.
The hot roll or fango packs are particularly pleasant. The latter have a relaxing effect in various ways through their natural active ingredients. With the hot role two towels rolled into one another are filled with a liter of boiling water.
Gradually, these are rolled up on the patient’s back with gentle pressure. The combination of pressure and moist warmth provides relaxation over a large area and increases blood circulation to the deep tissue. During the fango, a mud mixture is poured onto a sheet and heated in a special fango oven.
The patient finally lies down on the mud pack and is wrapped in a large sheet for about 20 minutes. Due to its soft consistency, the healing mud adapts exactly to the back, which provides a pleasant feeling and the body is able to absorb the natural ingredients. The techniques mentioned above provide both physical and psychological relaxation and can thus alleviate back pain.
The red light lamp, which can be used well as preparation for further relaxation measures, also works over heat radiation. As last example of passive measures against back pain, electrotherapy is mentioned here. Various forms of current can be applied by applying two electrodes and a moist intermediate substance in the body.
Depending on the type of current, intensity and duration of the application, there are different theories of pain reduction. Some types of current have the advantage of reaching deep into the tissue and thus also deep structures. In this way, drugs or healing ointments can also be introduced into the tissue (the skin resistance decreases under the current supply).
Especially for deep back pain in the lower back, the so-called ultra stimulation current has proven itself in practice. However, depending on the sensitivity of the patient, the current can also be perceived as unpleasant. In this case, another measure should be preferred to prevent the release of stress hormones, which in turn would lead to increased tension in the body.
The be-all and end-all of active measures in physiotherapy for back pain is movement. The patient should develop a feeling for his body, which movements are good, when the back is overloaded, when it is straight and when it is crooked. Many people make evasive movements in everyday life without noticing it.
In the long run, however, these false strains damage the body and suddenly pain is there with no apparent cause. Physiotherapy for back pain should always include an active posture training through coordination and balance exercises, in which the patient is first adjusted in various everyday postures through visual control and tactile stimuli (i.e. help through touching with the hands) and this feeling is taken over more and more and can later assume and control these postures on its own. Posture training can be supported by means of support exercises (isometric exercises).
These have a lengthening and stabilizing effect on the trunk. Suitable exercises are, for example, the four-footed stand, the wall support or support via bars in the seat. In the article “Back pain – not with a strong back” you will find extensive information on this topic.
An example exercise from physiotherapy for back pain: Take a straight and upright sitting position – ideally on a large gymnastics ball – in each hand you hold a long stick (bamboo sticks, broom handle) to the right and left of your body. Now you start to become aware of your body from below and adjust it to a stable position: The feet are hip-wide, pointing forward and possibly slightly turned outwards, the legs are parallel to each other, the knees point straight forward. Knees and hips are at right angles.
Now press the entire soles of your feet firmly down into the ground, the pelvis straightens up, the abdomen becomes tense, the shoulders sit loosely on the straight trunk, the shoulder blades pull down backwards, the head is pushed out long upwards, the chin is pulled slightly down towards the chest, feel how the neck becomes long. Now press the wooden sticks firmly into the ground and feel how your back becomes long. This tension they hold again and again for a few breaths.Another simple exercise from physiotherapy for back pain to move the spine and sometimes an acute remedy for back pain, is the change from a potbelly to a cat’s hump in a four-footed position.
From the pelvis to the head, the back is rolled up and down vertebra by vertebra. You can find more exercises in the article Exercises against back pain. Stretching exercises also have a relaxing effect and help loosen muscular imbalances in the body.
Through long bending and sitting postures the front of the body, especially the chest muscles and the hip flexors but also the neck is often tense and shortened. An exercise to get length in the entire front chain looks like this: Lie on your stomach, with your hands supported below the shoulder joints. The toes are laid down long, the legs are stretched out stably, the belly is tensed.
Now slowly press the upper body upwards over the arms as far as it is comfortable. Breathe deeply into the stomach to increase the stretch. If you like you can also put your head in the neck.
All articles in this series:
