Working from Home and the Potential Strain on our Bodies.

Treating low back pain with electrotherapy

Among the many impacts of the coronavirus pandemic, one of the least publicised is that of low back pain. Far more of us are currently working from home, often without the necessary ergonomic support of chairs and desks designed to prevent back problems, and as a result, physiotherapists are seeing a growing number of patients presenting with low back pain.

Among the many impacts of the coronavirus pandemic, one of the least publicised is that of low back pain. Far more of us are currently working from home, often without the necessary ergonomic support of chairs and desks designed to prevent back problems, and as a result, physiotherapists are seeing a growing number of patients presenting with low back pain.

One way of treating low back pain is with electrotherapy. The practice takes advantage of the high excitability of nerve fibres, stimulating them with electrical pulses to achieve a number of therapeutic effects. As well as pain relief, this includes stimulation to help strengthen muscles, meaning it can be used to address both the symptoms and causes of low back pain.

Treating the SYMPTOMS of low back pain with electrotherapy

Most acute low back pain is a result of injury to the muscles, ligaments, joints, or discs. The body’s reaction to injury is to instigate an inflammatory healing response, which can cause severe pain.

TENS (Transcutaneous Electrical Nerve Stimulation) uses electrical pulses to provide pain relief by blocking pain signals from reaching the brain. High frequency (HF) TENS, or sensory stimulation, uses pulses of 80-100 Hz and works via the gate control mechanism, inhibiting the transmission of pain signals to the brain while producing a pleasant tingling sensation. As a result, HF TENS is effective for providing patients with relief from the symptoms of lumbar pain.1

However, rather than just treat the cause of the pain, it’s important to also address the cause of the injury. Thankfully, electrostimulation also has an answer for this.

Treating the CAUSES of low back pain with electrotherapy

Sitting slumped over a desk while you work puts increased strain on the muscles and ligaments in your back, which can then lead to injury and low back pain. To address the cause of posture-related low back pain, we need to restore balance between the trunk flexors and extensors and strengthen our paraspinal and abdominal muscles to improve spinal stability and help us sit up straight. This is where NMES can help. 2,3

NMES (Neuro Muscular Electrical Stimulation) uses electrical pulses to produce muscle contractions, mirroring the impulse sent from the brain. NMES can be used as a standalone treatment, but is most effective when used in combination with voluntary exercise such as proprioceptive or functional rehabilitation.

By safely controlling the contractions, the muscles can be made to exert themselves much more than the patient would be capable of voluntarily, and without placing additional stress on joints. Additionally, NMES can help the patient to recruit the deep lumbar stabilizers.3,4 This allows patients to effectively and safely strengthen their trunk muscles during exercise, thereby helping to address the causes of low back pain.2,3

However, if symptoms remain, functional rehabilitation for low back pain can still be carried out by combining NMES and TENS in a single treatment. One device with this function is Chattanooga’s Intelect Mobile 2.

Intelect Mobile 2 – the next generation in electrotherapy

Intelect Mobile 2 is an innovative device designed to provide clinicians with everything they need for effective electrotherapy treatment, and comes in three different configurations, STIM, ULTRASOUND, and COMBO.

All three options include an intuitive touchscreen user interface, a library of suggested protocols, and Bluetooth connectivity for easy software updates. And as the name suggests, the device is truly mobile, enabling it to be easily carried or mounted on a wheeled cart.

Intelect Mobile 2 STIM and COMBO provide 2-channel electrotherapy with over 20 different waveforms, offering therapists multiple treatment options. For instance, when treating a patient with low back pain, Channel 1 can be used to deliver TENS treatment for pain relief, while Channel 2 provides muscle stimulation to support functional rehabilitation exercises. Or therapeutic ultrasound can be used as an adjunct pain-relieving modality. 5

Altogether, Intelect Mobile 2 is an excellent option for therapists interested in using electrostimulation for treating not only low back pain, but also a range of other neuromuscular conditions.

References

1 Jauregui JJ, Cherian JJ, Gwam CU, Chughtai M, Mistry JB, Elmallah RK, Harwin SF, Bhave A, Mont MA. A Meta-Analysis of Transcutaneous Electrical Nerve Stimulation for Chronic Low Back Pain. Surg Technol Int. 2016 Apr;28:296-302.

2 Durmus D, Akyol Y, Alayli G, Tander B, Zahiroglu Y, Canturk F. Effects of electrical stimulation program on trunk muscle strength, functional capacity, quality of life, and depression in the patients with low back pain: a randomized controlled trial. Rheumatol Int. 2009 Jun;29(8):947-54.

3 Baek SO, Cho HK, Kim SY, Jones R, Cho YW, Ahn SH. Changes in deep lumbar stabilizing muscle thickness by transcutaneous neuromuscular electrical stimulation in patients with low back pain. J Back Musculoskelet Rehabil. 2017;30(1):121-127.

4 Coghlan S, Crowe L, McCarthypersson U, Minogue C, Caulfield B. Neuromuscular electrical stimulation training results in enhanced activation of spinal stabilizing muscles during spinal loading and improvements in pain ratings. Annu Int Conf IEEE Eng Med Biol Soc. 2011;2011:7622-5.

5 Goren A, Yildiz N, Topuz O, Findikoglu G, Ardic F. Efficacy of exercise and ultrasound in patients with lumbar spinal stenosis: a prospective randomized controlled trial. Clin Rehabil. 2010 Jul;24(7):623-31.

How a Maternity Support Belt can Help Reduce Pregnancy Pain.

Pregnancy pain is a common experience for many women, but it can often have a negative impact on their work lives and quality of life. Remedies for pelvic pain and low back pain during pregnancy often focus on water exercise and physiotherapy, which are not always practical solutions, but a growing number of clinical studies also support the role maternity support belts can play in reducing this pain.

There are two common types of pain during pregnancy:

Pelvic girdle pain

Pelvic girdle pain is defined as pain in the symphysis and/or between the posterior iliac crest and the gluteal fold, particularly in the vicinity of the sacroiliac joint.

There are several causes for this, but they tend to stem from hormonal and mechanical changes in the body, as internal organs move and ligaments soften to make room for the birth of the baby. During pregnancy, an increase in the hormone relaxin can cause increased laxity of the ligaments of the pelvic girdle, with the resulting increase in range of movement in the pelvic joint causing pain.1

While typically mild to moderate, pelvic girdle pain is reported as the most common reason for pregnant women taking sick leave, with studies reporting a prevalence of 4%-76.4% in women during pregnancy

Low back pain

Often beginning in the second trimester, low back pain is defined as pain between the costal margins and the inferior gluteal folds, which may be associated with pain referred down to the leg. Usually accompanied by painful limitation of movement, low back pain often interferes with quality of life and daily living.

The cause of low back pain is related to additional stress placed on the back as a result of changes in the body during pregnancy. It is normal to gain 20-40 pounds in weight during pregnancy, and as the abdominal muscles stretch, they lose their ability to maintain posture, causing the lower back to support the increased weight of the torso. Increased axial loading results in increased spine compression, which leads to pain.

Low back pain is often considered “normal” in pregnancy, with studies reporting a prevalence of 50%- 71.3% in pregnant women.6 As with pelvic girdle pain, low back pain is another leading cause for pregnant women seeking sick leave.2

How a maternity support belt can help reduce pregnancy pain

A maternity belt is a supportive garment designed to be worn during pregnancy to provide support to the lumbar spine or pelvic regions, thereby helping to relieve pain.

The intended effects include:

  • Compressing the body to increase proprioception
  • Reducing mechanical loading of the localized weight
  • Stabilising the lumbar spine and pelvis
  • Stimulating the action of the muscles around the abdomen, spine and pelvic floor

A range of recent studies3,4,5 have demonstrated the effectiveness of maternity belts in reducing both pelvic girdle pain and low back pain, as well as providing improved stability and reducing the risk of falling during pregnancy.

Convenient, safe, low cost, and easily accessible for pregnant women, it is common for specialists to recommend maternity belts, especially alongside other therapies.

MyBabyStrap®

DonJoy’s MyBabyStrap® is a lumbar maternity belt designed to help reduce pain and discomfort during and after pregnancy. It is indicated for

  • Lower back pain
  • Pelvic pain
  • Sacroiliac pain
  • Postural instabilities
  • Discomfort due to stretching and expansion of the abdomen
  • Back support after birth

MyBabyStrap includes a number of features to help provide functional, easy-to-use support for pregnant women.

Thanks to itsmodular design, the support is easy to adjust, making it adaptable to all stages of pregnancy and also after birth. This includes an adjustable back pad and four rigid posterior stays to help provide extra support and compression in the lumbar area, and bilateral straps that can be tightened to help provide additional relief. It also comes with a removable elastic strap for lower abdominal support.

MyBabyStrap’s anatomical shapefollows the natural contours of a pregnant body for a comfortable fit, with no pressure on the abdomen. Its thin, soft, and breathable fabric and ergonomic front panel also help to provide comfort whether sitting or standing, while the design includes stylish details for a more fashionable and attractive appearance.

Finally, the belt is easy to fit, with a simple hook-loop closure that allows patients to quickly and simply adjust it to reach the desired level of comfort. It comes in one size that fits waist circumferences from 80 to 150 cm.


REFERENCES

1. Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J. 2008;17(6):794-819.

2. Kristiansson P, Svärdsudd K, von Schoultz B. Back pain during pregnancy: a prospective study. Spine (Phila Pa 1976). 1996;21(6):702-709.

3. Kordi R, Abolhasani M, Rostami M, Hantoushzadeh S, Mansournia MA, Vasheghani-Farahani F. Comparison between the effect of lumbopelvic belt and home based pelvic stabilizing exercise on pregnant women with pelvic girdle pain; a randomized controlled trial. J Back Musculoskelet Rehabil. 2013;26(2):133-139.

4. Flack NA, Hay-Smith EJ, Stringer MD, Gray AR, Woodley SJ. Adherence, tolerance and effectiveness of two different pelvic support belts as a treatment for pregnancy-related symphyseal pain – a pilot randomized trial. BMC Pregnancy Childbirth. 2015;15:36.

5. Bertuit J, Van Lint CE, Rooze M, Feipel V. Pregnancy and pelvic girdle pain: Analysis of pelvic belt on pain. J Clin Nurs. 2018;27(1-2):e129-e137.

6. Kovacs FM, Garcia E, Royuela A, González L, Abraira V; Spanish Back Pain Research Network. Prevalence and factors associated with low back pain and pelvic girdle pain during pregnancy: a multicenter study conducted in the Spanish National Health Service. Spine (Phila Pa 1976). 2012;37(17):1516-1533.