Back Pain in old age

             Lower Back Pain in Old Age

While older adults can experience pain related to any of the conditions that also affect younger adults, individuals over age 60 are more likely to suffer from pain related to degeneration of the joints in the spine. Two of the most common causes of lower back pain in older adults include mainly osteoarthritis and stenosis of spine.

Symptoms: Lower back pain and stiffness that is the most pronounced in the morning and in the evening

Includes any combination of the below symptoms:

Pain that interrupts sleep

Pain that is most pronounced first thing in the morning and again toward the end of the day

Localized tenderness when the affected area of the spine is pressed

Aching, steady or intermittent pain in the lower back that is aggravated by extended activity

Stiffness or loss of flexibility in the back (for example, unable to bend comfortably at the waist)

 

 

Possible cause: Facet joint osteoarthritis

Facet joint osteoarthritis, also called degenerative arthritis or osteoarthritis of the spine, is a degenerative condition that develops gradually over time. The pain is caused by the breakdown of the cartilage between the facet joints in the spine. At first the symptoms may only be intermittent, but can later develop into steadier pain in the lower back, and may eventually cause sciatica in addition to lower back pain.

 

Symptom: Leg pain that occurs primarily when walking and standing upright

Includes any combination of the following:

Unable to walk far without developing leg pain

Lower back pain relief is achieved quickly after sitting down

Symptoms fluctuate between severe and mild/none

Symptoms develop gradually over time

Weakness, numbness, and tingling that radiates from the low back into the buttocks and legs

 

 

 

 

Likely causes: Lumbar spinal stenosis or degenerative spondylolisthesis

Both spinal stenosis and degenerative spondylolisthesis can place pressure on the nerves at the point where they exit the spine. Standing upright, such as in normal walking, increases pressure on the nerve and results in leg pain.

 

Symptoms: Sudden onset of back pain, limited flexibility, height loss

Includes any of the following:

• Sudden onset of back pain
• Standing or walking will usually make the pain worse
• Lying on one's back makes the pain less intense
• Height loss
• Limited spinal flexibility
• Deformity and disability

 

 

Possible cause: Spinal compression fracture

As a general rule, the possibility of compression fracture should be considered after any sudden onset of back pain in adults over age 50, especially in post-menopausal women with osteoporosis and in men or women after long-term corticosteroid use. In a person with osteoporosis, even a small amount of force put on the spine, as from a sneeze, may cause a compression fracture.

Less Common Causes of Lower Back Pain

While less common than the above listed conditions, a number of other conditions can cause low back pain as well, including but not limited to:

• Piriformis syndrome
• Infection
• Spinal tumour
• Fibromyalgia
• Ankylosing Spondylitis
• Coccydynia

Aqua therapy doing a vital role in Physio?

                                                 Aqua therapy

Aqua therapy is any activity performed in water to assist in rehabilitation and recovery from hard training or serious injury.

In modern world of physiotherapy, Aqua Therapy is playing a vital role to rehabilitate all kind of patients, especially for paediatric to neurological, orthopedic patients. Aqua Therapy shows lot and lot of advantages is there, while doing these therapy, there is less energy is used to do those activities it means there is less energy expenditure, because water is doing assist by its property of buoyancy.

Physical properties of water:

In common with other forms of matter, water has certain physical properties which include mass, weight, density, relative density, buoyancy, Hydro static pressure, surface tension, refraction and reflection. Of the physical laws of water that the physiotherapist should understand and apply when giving Aqua Therapy, those of buoyancy and hydro static pressure are the most important. The lateral pressure exerted and the effect of buoyancy together will give the feeling of weightlessness.

1. Buoyancy:

Buoyancy is the force experienced as an upthrust which acts in the opposite direction to the force of gravity. A body in water is therefore subjected to two opposing forces. When the weight of the floating body equals the weight of the liquid displaced, and the centers of buoyancy and gravity are in the same vertical line, the body is kept in stable equilibrium. If the centers are not in the same vertical line the two forces acting on the body will cause it to roll over until it reaches a position of stable equilibrium.

2. Hydro static pressure:

The molecules of a fluid thrust upon each part of the surface area of an immersed body. Pascal's law states that fluid pressure is exerted equally on all surface areas of an immersed body at rest at a given depth. Pressure increased with the density of the fluid and with its dept. This means that swelling will be reduced more easily if exercises are given well below the surface of the water where the increased pressure may be used.

Physiological effects of Aqua therapy:

The physiological effects of water therapy combine those brought by the hot water of the pool with those of the exercises. The extent of the effects varies with the temperature of the water, the length of the treatment and the type and severity of the exercise. Usually they have to maintain temperature as well as the chlorine level. They have to ensure the purity of water as well.

The physiological effects of exercise in water are similar to those of exercise like outside of water . The blood supply to the working muscles is increased, heat is evolved with each chemical change occurring during the contraction, and the muscles temperature rises. There is an increased metabolism in the muscles resulting in a greater demand for oxygen and increased production of carbon dioxide. These changes augment the similar changes brought about by the heat of the water, and both contribute towards the final effect. The range of joint movement is either maintained or increased, and muscle power increases.

During the immersion the physiological effects are similar to those brought about by any other form of heat but less localized. A rise in body temperature is inevitable because the body gains heat from the water and from all the contracting muscles performing the exercises. As the skin becomes heated the superficial blood vessels dilate and the peripheral blood supply is increased. The blood flowing through these vessels is heated and by convection, the temperature of the underlying structures rises.

The relatively mild heat of the water reduces the sensitivity of sensory nerve endings and the muscle tone will diminish when the muscles are warmed by the blood passing through them.

Therapeutic effects:

• Relieve pain and muscle spasm- Exercises includes strengthening and stretching exercises, helps to achieve in a remarkable way
• To gain relaxation
• To maintain or increase the range of joint movement- To increase the range of movements, Physios are mainly using mobilization techniques
• To re-educate paralyzed muscles- it helps to educate the muscle even muscle power is zero
• To strengthen weak muscles and to develop their power and endurance.
• To encourage walking and other functional and recreational activities.
• To improve circulation ( tropic condition of the skin )
• To give the patient encouragement and confidence in carrying out his exercises, thereby improving his morale.

Physiotherapy For Chronic Problems

              Physiotherapy for Chronic Conditions:

As a Physiotherapist, I realized that physiotherapy can treat acute and long-term problems, and people were looking at months and months of expensive treatment for their pain related chronic problems as well as others. There is one slogan about physiotherapy is “Today pain Tomorrow gain” Peoples are hesitating to tell their problems others due to their financial situations or others, It might be lead to severe or chronic conditions. Once they feel like ‘ I can not tolerate anymore’ , then only they will try to find the solution for that. For example if you are having chronic back pain means, you can not recovery at once, it will take time. They have to consult their Physician or Physiotherapists and have to react accordingly. Those people try to learn all home based activities from their physiotherapists for their problems, it will help them to recover from the illnesses or from their recurrences.

Here are some of the ways physiotherapists treat a variety of conditions and diseases.

1. Physiotherapy can help bad knees:

 

Lot and lot of recent studies show that the physiotherapy treatment  combined with medication was just as effective as arthroscopic surgery in treating osteoarthritis knees. ‘Many arthritic joints are helped by work on flexibility and strength. Physiotherapists can often remove the source of the knee pain by identifying a cause such as

 

muscle tightness around the knee, and treating it with exercises or stretching. ‘We will do a biomechanical assessment looking at everything from muscle tightness to weakness to how joints move if they move too much or too little,’  ‘Based on that, we’ll prescribe an appropriate course of action that may include exercise to calm the inflamed joint or muscle or address the factors contributing to the problem.’ If the problem derives from an imbalanced gait, physiotherapists can prescribe orthotics (for example. shoe inserts that correct alignment problems) as well as some of gait training exercises. You know ‘Physiotherapists are very good at looking at the whole picture, while surgeons might just look at the joint,’ Sometimes pain may be caused by Joint Derangement, For that Physiotherapists are using Some special techniques like Mulligan or other manipulation techniques to reduce the Joint Derang

 

 

2. They can help to increase the Normal Lung Function:

 

breathing techniques

That whole-picture approach doesn’t stop with the musculoskeletal system (the joints and muscles we use to stand and walk). Physiotherapy also addresses conditions in the autonomic nervous system the involuntary muscles and nerves that control our organs.

Patients with asthma or sleep apnea, for example, can be treated by cardiovascular physiotherapists, who may use breathing control exercises simple one might be blowing up a balloon or focus on improving the mobility of chest and neck muscles through stretching and strengthening programs. These exercises are helping more in post surgical rehabilitation, as well as some chest expansion diminished conditions like Ankylosing spondylitis, Protruded shoulder, Muscular dystrophy conditions and bed ridden patients etc.

 

3. It can relieve pelvic floor dis­orders

Nowadays, physiotherapy techniques to address pelvic floor disorders too, which can occur when pelvic muscles tighten, shorten or fall into spasm after pregnancy, childbirth or abdominal surgery. ‘The pelvic floor muscles are involved in sexual function as well as

                          

bladder and bowel function, and they help support the spine and abdominal organs. Dysfunctions can manifest in conditions such as painful intercourse, urinary or bowel incontinence, or general abdominal or groin pain. ‘These problems sometimes don’t show up on MRIs or ultrasounds.Physiotherapists typically uses a massage technique called ‘trigger point release’ directly on the affected pelvic floor muscle to relieve the spasm and also integrates core strengthening exercises and relaxation techniques through Pilates.

 

4.It combats obesity

Another trend of physiotherapy field is ‘lifestyle modification’ physiotherapy, such as preventive health care and management of chronic pain. Due to this this, we can reduce degenerative diseases on weight bearing joints. Physiotherapists often works in conjunction with physicians to treat obese patients, in part by making it easier for

them to exercise. ‘We educate them about the physical impact that excess weight has on the musculo­skeletal system’ the physical backbone of our bodies.. In addition to addressing problems such as sore knees and tendinitis through traditional physiotherapy techniques, physiotherapists can design personalized exercise programs that won’t overtax vulnerable joints. Even something as simple as helping patients select shoes with the right support and conditioning can help to get sedentary patients moving again. Similar principles apply when working with patients whose mobility has declined due to aging or the side effects of chemotherapy.

 

5.It can relieve chronic pain

Depending on the cause, a program of physiotherapy can ease chronic pain by strengthening the muscles that surround painful joints or muscles. Some  study of women with osteoporosis whose chronic pain was linked to spinal compression fractures found that patients used significantly less pain medication and reported improved quality of life after just 10 weeks of a physiotherapy program designed to improve balance and stabilize the lumbar spine. Lots of back pain and OA chronic cases also getting remarkable relieve through physiotherapy.

6.It can cure back pain

Problems such as poor posture, muscle strain or arthritis can cause back pain. Treatment will depend on the source of the problem, I advises a three-fold approach: weight management (to reduce stress

on joints), muscle strengthening (to improve mobility and reduce recurrence) and ‘re-patterning’ of muscles. That involves changing the coordination of all the muscles in a particular area, usually through a series of dynamic exercises. ‘There are about two dozen muscles in and around the lower back that really matter. ‘Strengthening two or three doesn’t have as much of an effect as teaching all 24 how to work together.’ in these ways physiotherapy helps in back pain.

It takes time and practice to stretch or retrain muscles that have a long-established bad habit. But doing so can prevent a recurrence of the injury. When I was tempted to skip my exercises, I’d remember that the effort and money I was investing might help prevent more extensive and expensive interventions.