Management of Lumbar spondylosis

Although the degeneration of the lumbar spine cannot be cured or reversed, the symptoms that result from the degeneration can be managed and alleviated with physiotherapy and medication.

The physiotherapist conducts a full clinical assessment to help provide the most effective method of managing the condition and ensuring the best long-term outcome.

In lumbar spondylosis, most spinal joints have decreased mobility because of the changes in the spine/backbone. This eventually causes a lot of pain and can also make movement quite painful and a challenge. The physiotherapist will help the individual to:

• Maintain mobility

• Provide pain relief and learn ways to reduce pain

• Strengthen the core muscles so that they can support the spine effectively

• Stretch muscles for relaxation

• Re-train posture (this is a general underlying cause of ‘extra’ wear-and-tear of the spine)

Physiotherapy management of the condition involves three main components; education, passive and active management. The physiotherapist uses passive management to relax the individual’s body and also to decrease acute pain or inflammation.

The management is called passive because the individual doesn’t have to actively participate in the management. Usually if the individual is experiencing acute pain, then he/she would most likely begin with passive management so that the body heals and/or adjusts to the pain.

Nonetheless, one of the goals of physiotherapy is to get into active management which includes therapeutic exercises that strengthen the individual’s body so that the spine has a better support.

Passive management

• Deep tissue and spinal mobilisation: This technique targets the muscle spasms and chronic muscle tension around the lower back which tends to build up through activities of daily life.

The individual may also have spasms or muscle tension because of poor posture adopted during the day or while sleeping. The physiotherapist uses direct pressure and friction to release the tension in the muscles.

• Hot and cold treatment: The physiotherapist usually applies either a hot or cold therapy depending on the duration of the pain - whether the pain has been persistent for more or less than four to six weeks.

• Bracing: Lumbar spondylosis affects the lower aspect of the back and may cause instability which implies that the backbone has difficulty in working properly to control the individual’s movements.

Degeneration of the backbone may cause compression on nearby nerves and a brace usually provides support for the lower back to prevent further damage to the backbone, nerves and surrounding muscles.

The support also takes some of the pressure off the backbone. Bracing is a temporary treatment option for spondylosis. It helps control the pain by limiting motion.

In addition, braces can help the muscles to relax, and that relaxation can provide a level of pain relief. Long-term bracing isn't typically advisable because it can cause the muscles to weaken and therefore as part of the active exercises, the individual is taken through strengthening exercises so that the individual’s muscles eventually provides adequate support for the spine.

Active management

In the active aspect of physical therapy, the physiotherapist will educate the individual on various exercises to improve range of motion, flexibility, strength and core stability.

The physical therapy management is individualised and it takes into consideration the person’s presentation and health history. He is educated about his posture — how to move his body so that he doesn't increase his pain or cause further harm to his body.

He will eventually learn how to avoid positions that would worsen his pain. He will also learn about correcting his posture and how to make use of good ergonomics at work.

Active exercise also forms part of the individualised programme. The physiotherapist also assists in developing an exercise routine which incorporates essentials such as range of motion exercises, strengthening and the cardiovascular exercises.

The active management aspect of physiotherapy aids the individual to learn self-care which enables him to take better care of his body through good habits and basic principles.

The physiotherapist will examine and give advice on whether or not bracing is a good option, what kind of brace to wear and how long to wear it.

It’s vital to follow the instructions of the physiotherapist on how and when to wear the brace to make the best use of it, otherwise it won’t be very effective at relieving the pain and providing the needed support.

By Dorothy Ekua Adjabu
The writer is a Senior Physiotherapist at the 37 Military Hospital. Email: panierus@live.com