Physiotherapists in Richmond treat many different conditions including the issues profiled below.

Low back pain treatment - short, cheap, effective?

A recent article reported in The Lancet has reported a good effect on low back pain without significant input in terms of money or time. Six sessions of cognitive behavioural therapy were offered to 400 back pain sufferers whilst a further group of 200 did not get the therapy. Both groups received the standard care from their general practitioners. The intervention aimed at helping self management by challenging beliefs about physical activity and back pain which could be seen to be unhelpful. Patients were encouraged to discuss their underlying beliefs about what was going on and to challenge negative thinking about the pain and the functional difficulties it presents.

Recognising and countering fear avoidance and managing and recovering from flare ups in the pain were also covered. After a year the intervention group had significantly higher scores on questionnaires intended to measure disability and pain. Overall the intervention was cheap and easy to apply, especially when its effectiveness is taken into account, an uncommon effect with treatments for low back pain. Short term effects are much more common after treatments but they rarely last more than a few weeks. The treatments effects in this case did last and so may reflect patients. ability to better self manage.

Lumbar Facet Joint Syndrome

The lumbar spine is a very complex structure made up of a large number of different anatomical structures, many of which can be sources of pain in different situations. One structure which is known to contribute to low back pain is the facet joint, the small synovial joint placed at each side of each disc level. The facet joints are made up of one facet from the vertebra above and one from the vertebra below, with a joint capsule lined with synovial membrane. The joint capsule is well supplied with nerve endings which could transmit pain. In normal backs the facet joints serve to control the movements permitted at the particular part of the spine in which they lie, but do not take large amounts of weight.

With degeneration of the discs the facet joints are pushed together more strongly and forced to take larger amounts of weight, leading to degenerative changes developing within them and then the transmission of pain. The facets are forced to take more weight than they are designed for. Patients with this syndrome particularly dislike extension of the spine which forces the facet joints together and elicits pain. Mobilisations and regular exercises can be helpful from a physio.