LBP can be defined as acute, sub-acute and chronic. Acute pain is defined as a localized pain or discomfort between the thoracic region and the sacrococcygeal region. The onset is usually unexpected, often after exertion and is aggravated with movement and lasts less than 4 weeks. When pain persists beyond the acute period, lower back pain is called sub-acute, lasting between 4 and 12 weeks. After this period, it is called chronic lower back pain.

In the vast majority of cases it is necessary to resort to conservative treatment such as Physiotherapy and Osteopathy. The main objective of these treatments is to relieve pain, reduce functional limitations, absenteeism, and also to develop injury prevention strategies.

Physiotherapy is defined as a therapy that uses therapeutic exercise, specific equipment (ultrasound or transcutaneous electrical nerve stimulation) and manual therapy (massage, support equipment and mobilization with movement). The exercises for LBP work on mobility, stability and motor control. They can be performed individually or in a group, under the guidance of a therapist, or performed at home. The results have shown that exercises performed under the supervision of a therapist are effective in reducing pain and improving functional performance. The Pilates methods, Hypopressive Abdominal Gymnastics (performed in a group) and Global Posture Reeducation (individual approach) are good treatment options as well as for re-education. These therapies enable the patient to better understand the cause of the problem and above all to learn how to change their approach towards LBP.

In a significant number of cases, the real cause of LBP is far from where the pain is felt and often the treatment for pain of the lower back (lumbar region) does not produce the expected result, and the symptoms of LBP persist. In these situations, Osteopathy will seek to find out the origin of the lesion and a functional diagnosis is performed. Various methods and manual techniques are used on various parts of the body enabling the Osteopath to look for a direct or reflex physiological response to help correct, alleviate and recover musculoskeletal, visceral and nervous system injuries.

An osteopathic treatment is different from all the rest. An Osteopath performs an evaluation of the patient as a whole, identifying the cause of the problem and then applying specific techniques appropriate to each type of body structure, not only focusing attention on the “Back Pain”, which is often only a consequence of the adjustments and compensations that the body has suffered.

An approach to low back pain cannot be treated only by the application of therapeutic protocols but rather a combination of different therapeutic visions in a unique way to identify what is causing the pain.
André Lota is Physiotherapist and Osteopath, Specialist in musculoskeletal injuries (Hospital Particular de Alvor).

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