Successful use of an exercise program approach in the treatment of low back pain
A pleasant overweight 60-year-old male electrician presented to CareChain with a 7-month complaint of low back pain that began insidiously. He reported a history of low back pain over the last decade that was similar in nature but much less intense and debilitating. His previous episodes were managed with manipulation, over the counter medication and relative rest and would resolve usually within six weeks. He indicated that this most recent low back pain episode had become quite unmanageable, and that it was significantly affecting his ability to perform his work-related duties. Unlike his previous episodes, this current episode had not responded to manipulation or over the counter medication. He reluctantly continued to work at his job, despite his condition significantly affecting his ability to stand and walk for prolonged periods of time. He had tried modifying his duties, but he inevitably developed severe low back pain 20 minutes into his shift. He denied any leg symptoms, but did report some leg fatigue that was likely related to the fact that he was deconditioned from general inactivity. With regards to his social life, he had all but given up his social and recreational activities, aside from activities that could be performed seated, such as watching a movie or television. To date, he had not been referred for diagnostic imaging or for a surgical consultation. His family doctor had instead referred him to a CareChain physiotherapist for a comprehensive back assessment in effort to get expert answers for his patient, rapid access to services and an evidence-based personalized plan of management.
Assessment
At his CareChain physiotherapist appointment the patient underwent a comprehensive back assessment. During his assessment, the CareChain physiotherapist noted that the patient’s symptoms were reproduced with standing and walking and relieved entirely with sitting and flexing forward. He had no difficulty with toe walking, heel walking or tandem gait. His straight leg raise was negative bilaterally and there was no evidence of lower extremity myotomal weakness or dysesthesia. Additionally, there was no evidence of leg pain. Accordingly, he was diagnosed with facetogenic low back pain (also known as back dominant pain aggravated by extension) and was provided with a personalized plan of management which included an exercise program emphasizing cycling and aquafit as well as flexion based and core stability exercises. In addition, the CareChain physiotherapist took the time to educate the patient on the specific aspects of his condition including prognosis, activity limitations, and postural advice. At the end of the consultation, the CareChain physiotherapist faxed a consult note to the referring family physician which included an outline of the patient’s personalized plan of management as well as recommendations for ongoing treatment. The patient was advised to touch base with his family physician to discuss non-opioid prescription pain relieving medications and to review his plan of management at his earliest convenience. Additionally, he was advised to find a reputable physiotherapist who would be confident in executing his CareChain plan of management and to follow-up with his CareChain physiotherapist on an as needed basis.
Treatment
Over the course the next twelve weeks the patient attended several physiotherapy sessions. He elected to attend treatment close to his place of work. He was initially seen three times per week and was instructed to perform his CareChain home exercise program on his off-days from the clinic.
Results
- 75% improvement in his facetogenic low back pain
- Improved tolerance for standing and walking
- Improvement to tension and stiffness in his lower back after prolonged standing tolerance in work duties
Each week, his condition was reevaluated by his treating physiotherapist and his exercises progressed as per his CareChain plan of management. Crucial to his recovery was removing any aggravating factors while building his tolerance for standing and walking. As he improved, his physiotherapy sessions were reduced until he was managing his condition at home with his prescribed CareChain home program. His tolerance for his job-related duties steadily increased and he slowly started reintroducing his social and recreational activities. At his follow-up appointment with his CareChain physiotherapist he reported a 75% improvement in his facetogenic low back pain (back dominant pain aggravated by extension) and that his main complaint now was primarily related to tension and stiffness in his lower back after prolonged standing. Nonetheless, the patient indicated that this too was improving with the prescribed exercises and activity recommendations. Physical examination at the time of his follow-up was unremarkable. The patient was further educated about his condition and the importance of staying active, avoiding aggravating factors until asymptomatic and the continued importance of managing his condition through cardiovascular fitness, flexion-based exercises, and core stability exercises.
Conclusion
As is the case with many back dominant pain patients, this patient’s symptoms resolved through conservative management. Key to this was a comprehensive back assessment, rapid access to a network of surgeon-trained physiotherapists and an evidenced-based personalized plan of management. Had his symptoms persisted or worsened the CareChain physiotherapist would have connected with his family physician to discuss a multidisciplinary approach to managing his symptoms that would have included changes to his medication, motivational interviewing, cognitive behavioural therapy as well as ongoing physiotherapy. As his symptoms were back dominant and there were no neurological deficits, rapid access to a spine surgeon or advanced imaging would not have been warranted. Nonetheless, his symptoms are now almost resolved, and he was able to return to most of his activities without having to wait months or years for an appointment with a spine surgeon.
Effective back pain assessment and treatment with physiotherapy
Not all patients need surgery to relieve back pain. That’s why CareChain enables physiotherapists to effectively assess and treat back pain. Do you suffer from back pain? Make an appointment with one of our CareChain physiotherapists for an in-depth evaluation of your back pain. Whether you need physiotherapy or a spine specialist, CareChain will make sure you get the care you need as quickly as possible. If you have any questions, or would like book an appointment, reach out to us at CareChain at 1-844-675-2947. Our dedicated staff will be happy to lend a hand, and get you started on your road to recovery today!