Therapy of the chronic lumbar spine syndrome

1. heat application

The therapy of the chronic lumbar spine syndrome with various heat media (thermotherapy) serves to relax the muscles and promote blood circulation, thereby improving the metabolism. Heat causes a pleasant increase in blood circulation in the treated soft tissue with a limited penetration depth of approx. 3 cm.

An increased metabolic activity leads to the removal of “waste products” and tense tissue is loosened, which results in pain relief. There is no strong deep action on the disc itself, the penetration depth is too small for this. Heat applications for the therapy of chronic lumbar spine syndrome are available in various forms.

A very successful example is the hot roll. A towel rolled according to a special pattern is used for this. Hot water is poured into this roll.

Afterwards the painful body regions are dabbed with this towel. An application with moist heat is perceived as more pleasant by most patients and also has a calming effect on the general well-being. Nothing stands in the way of a daily application of heat therapy, unless skin irritation or circulation problems (especially a drop in blood pressure) occur, which is rarely the case.

The optimal duration of a single application is between 20 and 40 minutes. Natural mud packs or fango packs are also advisable for chronic lumbar spinal syndrome. Fango packs are now almost only administered in special spa facilities, as the time required is quite considerable.

Fango is used several times, so for hygienic reasons a very high heating is necessary. Natural mud packs, on the other hand, are disposable products which are placed on the skin and brought to the desired temperature with special heat pads. Neither method can be used for self-treatment of lumbar spinal syndrome, as the amount of equipment required is very high.

An old home remedy recipe is also very well suited for use at home in the case of lumbar spine syndrome, namely heat therapy with the help of jacket potatoes. After cooking, these are chopped up and placed in a cotton cloth, which is then placed on the painful areas. The starch contained in the potatoes should help the body to remove “waste products” from the muscles and activate the body’s own healing processes.

Unlike, for example, an acute herniated disc, massage therapy is absolutely appropriate for degenerative spinal diseases. In addition to the classical massage, underwater massage is particularly suitable, although it is no longer offered in many physiotherapeutic practices, as the costs and material expenditure are too great and are not paid for by health insurance companies within the necessary limits. However, some massage practices and clinics with their own department for physical therapy still have the necessary equipment for underwater massage.

In the case of underwater massage for lumbar spine syndrome (UWM), the patient lies in a large tub, the pressure of the massage is administered by the treating therapist with the help of a water hose. The back muscles are systematically massaged with circular movements. The hedgehog ball massage is suitable as a self-therapy, in which a nubbed ball is rolled over the aching musculature.

Ideally, a second person should do this, of course, as many parts of the back are very difficult or impossible to reach. The intensity of this treatment is, like every massage therapy, very individual and depends primarily on your own well-being. Direct current increases the reaction and function of motor nerves.

In iontophoresis, galvanic direct current is used to introduce medication through the skin. Depending on the medication applied, the effect is pain-relieving, anti-inflammatory and/or circulation-promoting. Diadynamic stimulation currents with direct current and impulse current components have a blood circulation-promoting and pain-relieving effect.

Low-frequency ultra stimulation current has a strong pain-relieving effect and increases blood circulation. Pain relief usually occurs already during the treatment of the lumbar spine syndrome. Interferential current therapy is particularly recommended.

Here, two medium-frequency currents are conducted through the skin into the body. In the depth of the muscles and in the area of the intervertebral disc, low-frequency currents are generated, which lead to a good pain-relieving effect. The effect of transcutaneous electrical nerve stimulation (TENS) is based on the therapeutic principle that low-frequency impulse and direct currents on the one hand block pain-sensitive cells and on the other hand have a pain-relieving effect via nerve cells of the spinal cord.

Overall, the TENS effect varies considerably from patient to patient. However, one advantage of the TENS unit is that it is available on prescription for self-treatment at home. The application takes place several times a day for one to several hours.

Since most spinal diseases are of degenerative nature and a causal therapy (healing) is usually not possible, the prophylactic measures to avoid a deterioration in findings or to avoid recurring symptoms, a special importance. For this reason, patients with a lumbar spine syndrome should be advised to behave in a way that is suitable for their back. It is known from studies that when lifting a load from the back, very high forces act on the intervertebral discs of the lumbar spine.

This can lead to an acute lumbar spine syndrome (“lumbago“) in a weak or damaged back. Learning and internalizing the rules of back school and the consistent implementation in everyday life is essential. We are also aware that everyday working life may require physical strain which seems unavoidable.

But even small changes in behaviour can have a great back-protecting effect. For example, the conscious use of the abdominal press (abdominal muscles) during heavy lifting reduces the strain on the spine by a considerable amount. Many back problems, including the lumbar spine syndrome, can be alleviated with just a few simple changes in the private and professional environment.

For example, the workplace and movement behaviour should be checked for “back-friendliness”. An ergonomically shaped, height-adjustable desk chair should be a matter of course for a back pain patient with predominantly sedentary activity. Height-adjustable desks are also being used more and more frequently.

Changing working heights and the possibility to work standing up can make working at the desk more back-friendly. In general, a frequent change of position is something with which you can relieve your back well. The frequently taught straight sitting is not as good as many people think when you take up this position for a long time.

Pressure measurements have shown that the straight forced posture puts quite a large load on the intervertebral discs of the lumbar spine. Specific exercises can also be very well integrated into the daily work routine, which can be performed well at the workplace without the need for equipment or space. With a well thought-out mixture of strengthening and relaxation exercises, a significant improvement of the complaints can be achieved in a short time, e.g. 10 minutes of the lunch break.

An aid that is highly recommended for use at home is the large gymnastics ball, also known as a sitting ball. These balls are available in several sizes. As a rule, adults should choose a ball with a diameter of about 65 cm.

Sitting on this ball alone provides a good training effect, as the ball promotes dynamic sitting. On this ball, the muscles are constantly activated to compensate for even the smallest changes in posture, as sitting still and rigidly on this machine is not possible. This means that just sitting on the ball trains the entire trunk muscles. Furthermore, the gymnastics ball offers a variety of relaxation and training possibilities, which we will discuss in more detail elsewhere.