Lower Back Pain When You Bend Forward? Here’s how you should manage.
Lumbar pain during flexion movement is one of the commonest symptoms that we all face in our routine practice. There are a number of clinical reasoning processes, which need to be considered.
Much of the literature focuses on the changes in intra-discal pressure associated with spinal flexion. Which indicate that spinal flexion pain is associated with increased disc strain. In order to strengthen the hypothesis of disc related flexion pain the clinician needs to establish other components of discogenic characteristics to support the hypothesis.
Here are some few things to remember when patient come with lower back pain.
- Observe everything, from entering into our examination room, starting with the client rising from a chair.
- History – link injury mechanisms, pain mechanisms with specific activities and past exercise regimens. Is there any “red flags” appear or not .
- Perform provocative tests – what loads, postures and motions exacerbate, what are relieving factors and what are aggravating factors? This needs to be address.
- Perform functional screens and tests – Are there perturbed postural, motion and motor patterns?
- If the clinical picture is complex and beyond your comfort zone, develop a referral relationship with a competent corrective exercise specialist.
It is not a matter of client performing an exercise – it is a matter of the client performing the exercise with perfection.
- Look for a dysfunctional movement pattern
- Not able to hip hinge properly.
- Allow the lower lumbar spine to flex forward.
- Look for the patient get up from their seat
- Do they difficulty to maintain neutral spine or bend forward into flexion as they arise?
- Do they have pain while getting up from chair?
- In the treatment room, watch them take off their shoes.
- Ask patient to pick object from floor and observe behavior pattern of movement.
- Look for fear or uncertainty at the prospect of bending forward.
Physical examination :
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