REHABILITATION OF PAINFUL RACHIS

A. LOW BACK PAIN

This is one of the most common symptoms in consultation. It is one of the main causes of disability and its consequent costs, with an estimated incidence of between and 50% and 70%.

LBP is the most expensive medical condition and the primary cause of disability in people younger than 45 years old in industrialised countries (Bravo et al 2001; R e v. Soc. Esp. del Dolor, Vol. 8, Supl. II)

Low back pain (LBP) is a health problem in western industrialised countries and a cause of medical expenses, absence and disability (Van Tulder 1995). It is located between the lower edge of the rib cage and the lower gluteal fold. It may or may not radiate to the lower limb. If this irradiation follows the root of the sciatic nerve and distally surpasses the knee, it is called sciatica.

When examining a patient with back pain, the doctor should be clinical and carefully evaluate not only biological facts but also psychological and social factors.

The doctor should also determine the patient’s adaptation to the disease and teach self-care methods for the relevant factors in order to avoid disability and chronicity.

Classification

  • Acute, less than 6 weeks
  • Sub-acute, between 6 weeks and 3 months
  • Chronic, more than 3 months

Episodes generally fluctuate over time and recurrences are common.

Treatment

The objectives of low back pain treatment are to reduce symptoms (the most important being, but not limited to, pain) and disability.

A. Treatment of acute low back pain:

The objectives of treatment of acute low back pain are to control the symptoms and prevent chronic disability.

Rehabilitation treatment

Information to patients

    1. Analgesic medication
    2. Physiotherapy
    3. Controlled and progressive physical activity
    4. Regulations for joint protection
    5. Other complementary analgesic methods: it is difficult to show that the treatments improve natural history.

B. Treatment of sub-acute low back pain:

Improving pain and preventing chronic disability are the objectives of treatment of sub-acute low back pain.

Rehabilitation treatment:

    1. Physical therapies
    2. Progressive physical exercise plan
    3. Gradual physical activity programme (walking, swimming initially; later more specific exercises)

C. Treatment of chronic low back pain:

Improving pain and preventing permanent disability are the objectives of treatment of chronic low back pain.

Rehabilitation treatment:

    1. Patient information and health education
    2. Pharmacological treatment: if necessary
    3. Analgesic physiotherapy through ultrasound, microwave, TENS, magnetotherapy
    4. Physical exercise: trials and meta-analysis support the effectiveness of exercise on chronic LBP and prevents recurrences. The correct teaching and supervision is therefore important when carried out in specialised rehabilitation centres.
    5. Lumbar orthosis have not been proven effective in the primary prevention of pain. They allow an active approach to treatment, used in periods with pain and during risky activities (work, household tasks…) so as to keep carrying out everyday tasks.
    6. Manual and massage therapies: a recent review suggests its usefulness in relieving transient pain.

B. CERVICAL PAIN

High mobility of the cervical spine predisposes to degenerative changes and pain.

The presence of degenerative changes increases with age, being present in 10% of 25 year olds, 25% of 40 year olds, and more than 95% in 65 year olds (Gore, Spine 1987; Lipetz J, in De Lisa 2010)

Although the presence of degenerative cervical changes is frequent (95% in men and 70% in women > 60 years old) in people with cervical pain, not all people with cervical arthrosis present symptoms.

According to the clinical situation of each client, rehabilitation treatment will consist of:

  • Functional rest. Medical treatment.
  • Cervical collar: minimum time (in certain cases of clinical exacerbation and under medical supervision)
  • Exercises. McKenzie. Postural correction.
  • Ergonomics
  • Prescription of exercise
  • Physiotherapy

 

A multidisciplinary treatment of rachis pain is recommended, within the framework of professionals including rehabilitating doctors, traumatologists, neurosurgeons, physiotherapists, psychologists etc., in order to achieve pain relief, maximum recovery and quality of life of patients.

Additional Bibliography

  1. Gore Spine 1987
  2. De Lisa 2010

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