In celebration of World Physical Therapy Day on 8 September, MoSanté is honoured to feature an insightful conversation with Mrs. Richa Sundaresan, a renowned physiotherapist.
This year’s focus is on low back pain (LBP) and the pivotal role physiotherapy plays in its management and prevention. With her extensive experience and expertise, Mrs. Sundaresan sheds light on the causes, treatments, and preventive measures for LBP, offering valuable advice to those affected by this common condition.
- What are the most common causes of low back pain (LBP) that you encounter in your practice?
Low back pain is a widespread condition that affects people across various age groups and lifestyles. In my practice, some of the most common causes include:
- Poor posture, especially among those with sedentary jobs and spending prolonged hours sitting at their desks, leading to muscle imbalances and spinal strain.
- Mechanical back pain resulting from muscle strains or ligament sprains due to improper lifting, sudden movements or overexertion during physical activities.
- Degenerative changes such as osteoarthritis and degenerative disc disease which become more common with age. Ankylosing spondylitis also causes lower backpain, inflammation and stiffness in your spine.
- Herniated discs, spinal stenosis, and spondylolisthesis are also common causes that we encounter, often presenting with more persistent and severe symptoms.
Lifestyle factors such as obesity, lack of regular physical activity and smoking can worsen or contribute to the development of LBP. Psychological factors, including stress and depression, have also been linked to chronic low back pain.
- How can physiotherapy help in the management and prevention of LBP?
Physiotherapy is essential in both managing and preventing LBP by addressing its root cause and contributing factors. Physiotherapists use various techniques such as manual therapy to improve joint mobility, reduce pain and correct the posture.
Modalities such as heat therapy, ultrasound, electrical stimulation, and Decompression Therapy System (DTS) are also employed to reduce pain, inflammation and manage disc-related issues, thus facilitating a quicker return to normal activities.
Therapeutic exercises are prescribed to strengthen the core and back muscles, enhance flexibility, and promote proper alignment, thereby alleviating pain and improving function.
For prevention, physiotherapists design individualised exercise programmes that focus on strengthening and conditioning the muscles supporting the spine, improving flexibility, and enhancing overall physical fitness.
Ergonomic assessments and advice help individuals adjust their workstations and daily activities to reduce strain on the back and lower the risk of future episodes of LBP.
- Can you share some effective physiotherapy exercises or techniques for alleviating LBP?
There are several exercises which have proven to be effective in alleviating LBP:
- The Pelvic Tilt is a fundamental exercise which strengthens abdominal muscles and supports the lower back.
To perform this, lie on your back with knees bent and feet flat on the floor. Gently flatten your back against the floor by tightening your abdominal muscles and hold for a few seconds before releasing.
- The Cat-Camel Stretch enhances flexibility and reduces tension in the spine.
Begin on your hands and knees, arch your back upwards like a cat while tucking your chin, then slowly lower your back and lift your head towards the ceiling to create a U-shape.
- The Pelvic Bridge exercise is excellent for strengthening the glutes and lower back muscles.
Lie on your back with knees bent and feet flat on the ground, then lift your hips off the floor until your knees, hips and shoulders form a straight line, hold briefly and then lower back down slowly.
Core stabilisation exercises are also crucial, for strengthening the muscles that support the spine.
Note: It’s important to perform these exercises correctly and tailor them to your specific condition and needs. So, consulting a physiotherapist is recommended for safety and effectiveness.
- What role does posture play in the development and prevention of LBP?
Posture plays a significant role in both the development and prevention of low back pain. Poor posture such as slouching while sitting or standing places excessive strain on the muscles, ligaments, and discs of the lower back. Over time, this sustained stress can lead to muscle imbalances, decreased spinal stability and eventually pain and discomfort.
For instance, sitting with a rounded back and forward head position can increase pressure on the lumbar discs, leading to degeneration and potential injury. Similarly, standing with an excessive arch in the lower back, also known as Hyperlordosis, can also cause muscle fatigue and pain.
As a form of prevention, maintaining good posture ensures that the spine is properly aligned, distributing mechanical stress evenly across the body’s supporting structures. This reduces the chance of overloading specific areas and prevents the development of strain-related injuries. Good posture also promotes breathing efficiency and better overall body function.
Educating individuals on proper sitting, standing, and lifting techniques is a critical aspect of physiotherapy. Being mindful of body positioning during daily activities is a practical strategy to maintain good posture and prevent LBP.
- How important is early intervention in the treatment of LBP, and what signs should prompt someone to seek physiotherapy?
Early intervention is extremely important in treating LBP. Prompt treatment can prevent the progression from acute to chronic pain, reduce its duration and severity of the pain and minimise its impact on daily activities and quality of life. It can also identify and correct underlying issues, preventing recurrence and long-term complications.
Individuals should consider seeking physiotherapy if they experience persistent or recurrent pain that lasts more than a few days, especially if it interferes with daily activities such as walking, sitting, or sleeping. Other warning signs include pain that radiates to the legs, numbness, tingling, stiffness or reduced range of motion in the back.
If the pain results from a specific incident like a fall or lifting injury, or if over-the-counter pain relief and rest are ineffective in alleviating the symptoms, consulting a physiotherapist is advisable. Furthermore, seeking professional help is important if the pain is accompanied by other symptoms such as unexplained weight loss, fever, or bowel and bladder dysfunction, as these may indicate more serious underlying conditions.
Early assessment and tailored treatment plans can lead to more effective recovery and a quicker return to normal activities.
- Are there any lifestyle changes or habits that can help prevent LBP?
Regular physical activity is vital in LBP’s prevention; engaging in exercises that strengthen the core, back, and leg muscles helps support the spine and maintain proper alignment. Activities such as swimming, walking, and yoga can improve flexibility and overall back health.
Maintaining a healthy body weight is also important, as excess fat, particularly around the abdomen, can increase strain on the lower back. Adopting a balanced diet rich in calcium and vitamin D supports bone health, while sufficient hydration helps maintain disc integrity.
Practicing good posture during daily activities, including sitting, standing, and lifting, reduces unnecessary stress on the back. Using ergonomic furniture and properly adjusting workstations can aid in maintaining proper alignment during work hours.
Avoiding smoking is beneficial as it is linked to reduced blood flow to the spine and increased risk of degenerative spinal conditions. Additionally, managing stress levels through relaxation techniques and adequate rest can prevent muscle tension and associated back pain.
Lastly, adopting proper sleep habits, such as using a supportive mattress and sleeping positions that maintain spinal alignment, also contribute to preventing low back pain. Overall, embracing a proactive approach to health and wellness through these lifestyle habits can significantly reduce the risk of developing low back pain.
- How can physiotherapy be integrated into a patient’s overall healthcare plan for managing chronic low back pain?
Physiotherapy works by collaborating closely with other healthcare professionals to provide a multidisciplinary approach. Physiotherapists work alongside physicians, orthopaedic specialists, pain management experts, and mental health professionals to address the various aspects of chronic pain.
Physiotherapy involves a detailed assessment to create a personalised treatment plan, including therapeutic exercises, manual therapy and education on pain management strategies. The focus is on improving function, strength, flexibility and teaching self-management techniques.
When medication is necessary, physiotherapists coordinate with prescribing doctors to ensure that exercise and therapy sessions complement pharmacological treatments effectively. For patients requiring psychological support, especially those dealing with the emotional impacts of chronic pain, physiotherapists can work closely with and refer them to counsellors or psychologists.
Additionally, physiotherapists provide guidance on ergonomic adjustment, lifestyle changes, and ongoing maintenance programs to prevent any worsening of the situation. Regular evaluations and adjustments to the treatment plan ensure that the care provided is responsive to the patient’s progress and changing needs, promoting optimal outcomes and quality of life.
- What advice would you give to someone who is experiencing LBP for the first time?
For someone experiencing LBP for the first time, my advice would be to remain calm and avoid unnecessary panic, as most episodes of acute low back pain are not serious and often resolve with appropriate care.
Initially, it is important to stay as active as possible while doing your daily actives within the comfort limits (making sure not to overdo it). It is best to avoid heavy lifting or twisting of your back for the first 6 weeks after pain begins. Prolonged bed rest can slow down recovery if some level of physical activity is not maintained.
Applying cold therapy (during the initial 48-72 hours of pain) or heat therapy (for pain lasting longer than 72 hours) can help manage pain and reduce muscle spasms in the early stages.
Over-the-counter pain relievers may also provide temporary relief, but it is essential to use them as directed. Sleeping in a curled-up (foetal) position with a pillow between your legs may also serve to elevate some of the pain.
If the pain persists beyond a few days, is severe, or is accompanied by other concerning symptoms like numbness, weakness or loss of bladder control, seek professional medical advice promptly. Consulting a physiotherapist can help identify the root cause and recommend a personalised treatment plan for recovery and prevention.
Most importantly, listen to your body and avoid pushing through intense pain. Early intervention and proper management are key to effective recovery and maintaining back health.
Richa Sundaresan
Senior Physiotherapy Consultant
BPT
DYT
MIAP
Physiotherapist Profile
Richa Sundaresan is a leading physiotherapist and a registered independent practitioner with over 20 years of extensive experience. Her expertise includes musculoskeletal pain and injuries, post-operative rehab, as well as orthopaedic and neurological recovery.
Since 2005, she has been practising in Mauritius and she is the Founder of R-Physio, a well-equipped Physical Rehabilitation Centre, located in Vacoas.
She also played a pivotal role in setting up the Physiotherapy Department at the ex-Apollo Bramwell Hospital and is a visiting consultant at C-Care Wellkin.
