Lumbar pain (or low back pain) is a leading cause of work absenteeism and a reason for widespread medical consultation. The term low back pain means pain in the lumbar region, ie between the end of the rib cage and the pelvis. This region comprises five vertebrae superimposed one on the other with, between them, an intervertebral disc and two articular facets. The intervertebral discs are a sort of absorbent cushion that distributes the forces received, while the articular facets are small joints that are on each side of the vertebrae.

The superposition of the vertebrae is arranged so as to form a curvature towards the abdomen: the lumbar lordosis. Several ligaments and muscle groups then join these structures together to form a solid and mobile whole.

The causes of low back pain are multiple and this type of pain can reach all types of individuals, from the great sportsman to the more sedentary person. Here are some causes of this evil of the century.

LUMBAR PAIN CAUSED BY ARTHROSIS

Osteoarthritis is defined as joint cartilage wear (a solid and resistant structure covering the ends of bones) and the bone on which it is deposited. Joint wear can be a precipitating factor in lower back pain because the movement can not be performed properly due to joint stiffness and inflammation. This phenomenon can cause pain.

THE LUMBAR PAIN CAUSED BY A HERNIA DISC

The hernia is an impairment of the intervertebral disc that can be described in stage according to the gravity of the protrusion (thrust of the nucleus). Indeed, the disc consists of concentric rings forming a kind of tight woven donut surrounding a gelatinous core. Initially, a weakening of the concentric rings will allow, through a gap, the progressive advance of the gelatinous nucleus inside these rings. 

This initial stage is often asymptomatic and discovered by chance (randomly during routine examination). The following stages are documented according to the progression of the gelatinous nucleus inside the rings. The pain created comes from the different structures affected: the disc itself, the surrounding soft tissues (capsule, ligaments, …) and the nerve roots (emergence of the nerves coming from the spinal cord).

LUMBAR PAIN CAUSED BY STENOSIS

This term means shrinkage. There are two types: central and foraminal. Central stenosis involves a narrowing of the spinal canal, the canal containing the spinal cord. Foraminal stenosis is the narrowing of the orifices created by the superposition of the vertebrae (the foramina) and letting out the nerve roots coming from the spinal cord. The foramina are identical on the right and left of the vertebral bodies. These strictures cause pain according to their severity and the structures affected.

THE TREATMENT OF LUMBAR PAIN

For all the situations described above, there are physiotherapy treatment guidelines aimed at reducing pain, restoring joint range, muscle strength and flexibility. Indeed, teaching the optimal postures to adopt, stabilizing muscle-building work and analgesic measures can help control and/or stop the symptoms associated with low back pain.

In addition, the treatment approach used by the physiotherapist in Dwarka will not be the same, depending on whether the lumbar pain is acute (recent), subacute (<3 months) or chronic (> 3 to 6 months).

Do not hesitate to contact your physiotherapist in Janakpuri to better understand your low back pain and for help.

Dizziness and lightheadedness, how to differentiate them?
Vertigo corresponds to the illusion of a movement of the body and/or the part which must include a rotatory component. Specifically, it refers to feeling like “it’s spinning” or the environment is around you. For its part, the dizziness is defined as a sensation of intoxication: as under the effect of alcohol. It can also refer to the pitch effect as on a boat, or to have “head in the clouds”.

The causes of dizziness and lightheadedness can be varied and it is important to consult a health professional to identify them. To this end, the physiotherapist trained in vestibular rehabilitation is able to identify the cause of vertigo and offer the appropriate treatments. Research indicates that in about 30-40% of cases, benign paroxysmal positional vertigo (BPPV) occurs. We also find Meniere’s disease or various pathologies following an infection of the inner ear such as labyrinthitis or neuritis.

What is the origin of the VPPB?
Each of our ears has three channels (semicircular canals) in which liquid circulates. Without a known explanation, it happens that particles called crystals are detached from the wall and are found in particular in the channels. This disturbance brings vertigo when the person moves his head in space, goes to bed or changes position for example.

How to treat BPPV?
The physiotherapist first identifies in which semicircular canal the crystals are. It then performs repositioning maneuvers to migrate the crystals to a reservoir called utricle where they will be destroyed. These techniques are very effective, regardless of the time since the onset of symptoms.

In the case of diseases affecting the inner ear (eg labyrinthitis and neuritis), the functions of the vestibular system are altered. This imbalance, often in one of the two ears only, causes vertigo. As a result, the physiotherapist will play a vital role in teaching the brain how to compensate for this deficit and allow the client to recover his functional abilities. This is possible thanks to a phenomenon called “brain plasticity” according to which the nervous circuits are able to reshape according to learning and experiences.

The physiotherapy in Dwarka rehabilitation is very effective as an intervention and optimizes daily functioning, in addition to having a positive effect on the prevention of falls.