According to the Journal of Orthopedic Sports Physical Therapy (JOSPT), “Low back pain is the leading cause of activity, limitation and work absence throughout much of the world and is associated with an enormous economic burden”. The journal also notes that likelihood of recurring episodes of low back pain to range from 24-33% over a period of 6-22 months and as high as 45% within 3 years. The journal states that prevalence of low back pain is higher amongst females and chances increases linearly with increase in age. In other words, many of us have or will experience one or more episodes of low back pain over the course of our lifetime. As previously mentioned on our blog, the good news is it can be safely and accurately diagnosed and treated by clinicians, including your physical therapist.
Following your examination, your physical therapist will likely use the treatment-based classification system, which allows clinicians to categorize patients who experience low back pain based upon clinical presentation. The subgroups include specific exercise, immobilization, mobilization, and traction. Clinicians can then use a clinical predictor rule to guide their treatment program based on each patient’s presentation which research shows can increase the efficacy of treatment from 45% to 95%. In this post, we will talk about the specific exercise subgroup.
When it comes to low back pain, patients can also be classified into directional preference groups: flexion and extension. Your physical therapist will ask specific questions during their history taking such as whether or not you prefer to sit or stand to base their decision. They will also use range of motion testing and ask whether or not that particular direction makes your symptoms move towards your toes (peripheralize), or towards your spine (centralize) to make a more accurate diagnosis. From there, they will develop an exercise program to utilize both in the clinic and at home based on which movements caused your symptoms to centralize (improve), also known as your directional preference.
According to the JOSPT, around 83% of patients who experience low back pain will fall into the extension-based group and around 10% will fall in the flexion based. Extension based exercises, more commonly known as McKenzie, focus on promoting extension of the spine to centralize your symptoms. These movements will occur in a repeated manner. Flexion based exercise, or Williams flexion exercises, focus on promoting flexion movement in the spine to centralize your symptoms.
Common extension exercises include prone on elbows and repeated extensions, or prone press ups, and bridging. Flexion exercises include double knee to chest, single knee to chest, child’s pose, pelvic tilt, and seated forward bending (using table or exercise ball). These exercises are commonly performed in conjunction with one another. Pictures and instructions will be provided at the end.
In summary, most of us have or will likely experience some form of low back pain over the course of our lifetime. The good news is, as previously mentioned in some of our earlier blogs, this pain can safely and effectively be treated by physical therapists. During your examination, your physical therapist will conduct various tests to determine your directional preference, or the direction of movement that causes your pain to centralize or improve. From there, they will create a program specific to you for use both in the clinic and at home to reduce your pain and return you to your prior level of function.
Cite JOSPT: Low Back Pain: Clinical Practice Guidelines: ICF: APTA.