Successful physio for a pinched nerve in the lower back involves 3 aspects:
Appropriate lower back, pelvic and hip strengthening
It is important to note that the goal of physiotherapy treatment for lower back pain is not to “push a disc back in” as that is physically impossible, or to improve how the lower back looks on an X-ray or MRI. The goals are always to eliminate symptoms over time and to restore normal movement and activities, including work, sport and exercise. Naturally, it is a long-term goal to reduce the likelihood of the symptoms recurring.
1. Symptom reduction
Physio treatment for lower back pain is great for improving pain and movement quickly. The appropriate treatment techniques depend on the individual, their movement and nature of their pinched nerve issue, so a thorough assessment is important.
Treatment may involve a combination:
Lumbar joint mobilisations
Education and retraining of the lower back and pelvic muscles
Soft tissue massage
Combined with appropriate gentle exercises, the early expectation is that we achieve “centralisation” of symptoms, where the pain moves back up the leg towards the lower back where the pinched nerve originates. Reduced pain, improved movement and improved sitting and walking endurance are also expected.
In some cases, over-the-counter medications may be useful to help settle the pain in the early stages of the injury, and occasionally a G.P. consultation may be necessary for a short course of prescription pain medication. Strategies such as using heat packs or regular warm showers are possible ways to reduce pain in the short-term without taking medication.
2. Activity modification
Regardless of how bad the symptoms may be, everyone has a life that they ultimately need to maintain. Whilst complete avoidance of certain activities may occasionally be recommended, usually the goal is to be able to continue normal activities with specific modifications, and still achieve improvements in pain and movement. An example of an activity modification may be for a desk-based worker to get off their work chair once every 20 minutes to protect their back from the excessive stress of prolonged sitting, rather than having time off work totally. The level of activity modification will depend on the nature of the activity and severity of the symptoms.
3. Appropriate lower back, pelvic and hip muscle strengthening
When it comes to physical injuries and Physiotherapy, exercise is the best medicine. Physio for the lower back will be essential for feeling better, moving better and helping to reduce the chances of future recurrence. It is important to note that the appropriate exercises for an individual need to be determined with a physical assessment. Not all exercises are appropriate for everyone and some may even worsen symptoms. Without a physiotherapy assessment, doing the same exercises that a friend was given by their physiotherapist, would be the same as taking the same medication that a friend was given by a doctor without first seeing their own doctor.
The lower back (where the nerve is pinched) and pelvic bones are joined together directly and a healthy lower back starts with good muscle control of how these bones and joints move together.
Gentle stretches and early strengthening exercises at home are a great way to help maintain the improvements achieved with treatment during physiotherapy sessions. As the pain improves, exercises can progress to harder ones to help continue strengthening. Eventually the lower back will be strong enough to handle normal work activities, sport and exercise again without any of the original symptoms. This means that the original pinched nerve is no longer a problem. It may take 6-12 weeks to get to this stage.
Exercises should be maintained long-term to help reduce chances of recurrence, and physiotherapist-supervised exercises are a great way to maintain exercise in the long-term using free weights such as dumbbells and barbells and specialized machines such as clinical pilates reformers and trapeze tables.
What causes a pinched nerve?
Pinched nerves are a very common cause of low back pain. True pinched nerves are usually due to disc issues. The discs sit between the bones of the spine to assist with shock absorption and cushioning between the bones. They can be considered similar to a strawberry jam donut, with jam being in the middle covered by bread. Over time due to repetitive inappropriate load beyond which a disc is strong enough to tolerate, the “bread” of the disc can sustain micro traumas, and allow the jam to slowly seep through towards the outer layers of the disc. Eventually the jam may push the boundaries of the outer layers and bulge out. If the jam continues to seep out and the outer layers are disrupted, the jam may extrude out of the disc. The follow picture shows the progression of a degenerative disc issue:
As the nerves from the spinal cord exit the spine very close to the discs, the contents of the disc can impinge or contact the nerves and place pressure on them, which is when we can consider a nerve pinched. This can be further exacerbated by degenerative processes in the joints and bones, causing them to enlarge and create further potential pinching on the nerves as they exit the spine.
What are the symptoms of a pinched nerve?
The hallmark sign of a pinched nerve in the lower back compared with other causes of low back pain is pain and/or pins and needles or numbness down at least one of the legs. This is also known as “sciatica” or “sciatic pain” and is referred from the lower back. When it comes to physical injuries, pins and needles or numbness is indicative of a nerve related issue. The leg symptoms may go down as far down as the toes.
Symptoms typically include, but aren’t limited to:
Pain down at least 1 leg, from the glute region to potentially as far down as the toes
Pins and needles or numbness down at least 1 leg
Lower back pain
Symptoms worse in the morning
Symptoms improve with movement (until the movement is excessive)
Symptoms worse with extended sitting and/or extended walking
How can we help you?
At Melbourne Sports Physiotherapy our goal is to get you moving pain free as soon as possible.
But, we also want you to actually move better and live a healthier, more active and fulfilling life!
If your sports, fitness training or work has been wearing your body down, book in with one of our expert massage therapists so we can help you reduce your pain or stiffness.
If you are showing some signs of this condition or simply want help prevent this from happening in the future then book in with one of our highly experienced Remedial Massage Therapists today!