Low Back Pain Rehabilitation

About 20% of people affected by acute low back pain develop chronic low back pain with persistent symptoms at one year.

In some cases, treatment successfully relieves chronic low back pain, but in other cases pain persists despite medical and surgical treatment.

Symptoms of low back pain

Low back pain can present in a variety of ways depending on the cause:

• Dull achy pain, localised to the low back is usually of muscular origin. The pain may increase with repeated activity or after prolonged standing or sitting.
• Stinging, burning pain that radiates from the low back to the backs of the thighs, up to the back of leg and foot is usually a sign of nerve root compression.

This is commonly called as sciatica back pain.

Long standing cases may present with weakness in the muscles supplied by the sciatic nerve.

• Morning stiffness and pain relieved by activity is a sign of degenerative changes in the spine.

The arthritic changes are accompanied by muscle spasm in the low back.

Movement transitions may be slower

• Sacroiliac joint pain characteristically presents as pain while turning in bed. This is a common occurrence in pregnant women.

Walking, getting in and out of the car or bed is an ordeal.

The pain is usually pinpoint over the dimples in the lower back but may radiate to the buttocks or back of thigh occasionally.

• Pain that extends from the back to the buttocks and back of thigh may be due to facet joint dysfunction.

Forward bent posture may relieve the pain and arching back may increase pain, or just the other way around.

A chiropractor or physiotherapist may detect decreased mobility in the affected section of spine

• • Generalised pain and tenderness in the back with presence of knots is usually seen in fibromyalgia or chronic fatigue syndrome.
  • Pain that relieves on arching the spine and aggravates with forward bending may be due to a disc prolapse or spinal stenosis due to other reasons.

• Constant pain that is not relieved by rest or change in posture and is accompanied by low grade fever, low of appetite and general ill health points towards a more serious pathology.

Repeated activity like lifting is a major cause of overuse muscle injury.

• Poor posture: This is probably the most common cause of recurrent neck and low back pain in sedentary or corporate workers.

Constant slouched posture overstretches the back muscles resulting in stretch weakness and pain.

Over a period of time this leads to anatomical changes, faulty muscle action, chronic fatigue and persistent neck or lower back pain.

• Spondylosis or degenerative joint disease: Wear and tear of the disc and the adjacent vertebrae reduces mobility in the spine especially in the middle age.

Reduced disc height and formation of osteophytes (bony outgrowths) may lead to neural impingement causing radiating pain the back of the leg.

• Herniated or ruptured discs: A degenerated disc may bulge outwards when one bends forward.

It may press against the surrounding ligaments and nerves resulting in lower back pain.

• Sciatica: The thickest and the largest nerve in the body may be compressed on its way out from the vertebral foramen.

Bony spurs in a degenerated spine or a prolapsed disc usually cause sciatic nerve compression.

“I had 20, one to one rehabilitation personal training sessions in London with Jazz Alessi.  During this time, my posture improved tremendously, all of my chronic back pain and back problems disappeared.”

– M. Taylor – Lawyer 

Would you like to regain your back health, and learn for yourself how to get rid of sciatica pain?

Contact Jazz now for a commitment free consultation today clicking on this link HERE.

• Spondylolisthesis:  This is seen at the lumbosacral junction when the fifth lumbar vertebrae shifts more forward than usual on the sacrum (base of spine).

There is a noticeable step in the lumbar spine on palpation. In rare cases the vertebrae may shift backwards and is known as retrolisthesis

• Sacroiliac dysfunction: The joint between the sacrum and the ilium (pelvic bones) is supported by ligaments.

A sudden twist at this joint can injure these ligaments.

Faulty biomechanics like anterior or posterior tilt of the ilium with respect to the sacrum or upslip of the ilium on the sacrum may also sprain the ligaments.

• Whiplash: Low back pain after a road traffic accident is a result of trauma to the muscles and ligaments.

The violent jolt causes the muscles to seize up.

Sustained contracted state causes production of pain causing chemicals which causes more spasm.

A vicious cycle of pain-spasm-pain sets in.

Violent muscle contraction may also occur in contact sports.

• Spinal stenosis: Stenosis is narrowing of the spinal canal due to various reasons.

A prolapsed disc or a tumour may reduce the size of the spinal canal and compress the nerve roots.

• Bony irregularities: Increased sideways curvature of the spine (scoliosis) or increased thoracic kyphosis may cause increased strain in the lower back and result in lower back pain.

Exaggerated anterior pelvic tilt or increased lumbar curve is another reason for persistent back pain.

• Osteoporosis: Osteoporosis is a metabolic bone disease. Its name comes from Latin for “porous” bones.

The inside of a healthy bone has small spaces, like a honeycomb.

Osteoporosis increases the size of these spaces, causing the bone to lose strength and density.

In addition, the outside of the bone grows weaker and thinner.

This can lead to fractures of the vertebrae. It is most often seen in elderly women after menopause (linked to lower estrogen levels) or in populations receiving less sunlight.

• Fibromyalgia: This is a chronic pain syndrome involving widespread muscle pain and fatigue.

The individual presents with constant pain with knots in the back muscles.

• Ankylosing spondylitis (Question mark spine): This is a hereditary condition (HLA B27) that affects the low back especially the sacroiliac joint.

The patient develops severe progressive pain and stiffness in the entire spine with reduced rib cage mobility as the disease progresses.

• Vertebral fractures: These may be as a result of traumatic injury.

A vertebra weakened by infection or reduced calcium levels may also collapse resulting in compression fracture.

• Pelvic floor dysfunction: Lower back pain in women after pregnancy has been linked to weak pelvic floor muscles.

The Core muscles and PFM work synergistically to influence posture by regulating intra-abdominal pressure and thoracolumbar fascial tension.

Weakness in the pelvic floor muscles affects core stability resulting in chronic pain. ⁽⁹⁾

More serious pathologies of lower back pain include tumour, tuberculosis of the spine, Abdominal aortic aneurysm, infection or autoimmune diseases.

Referred pain in the low back may be seen in kidney stones.

Sudden weakness in both legs with loss of bladder and bowel control and sensory loss in the anal region is a classic cauda equina symptom requiring immediate surgical attention.

Diagnosis of low back pain

Most GPs (general practitioners, primary care physicians) will be able to diagnose back pain after carrying out a physical examination, and interviewing the patient.

If the pain persists for too long, further tests may be recommended.

The radiological investigations like X-Ray and MRI help to detect any bony abnormalities like fracture or a prolapsed disc.

Enhanced CT or Myelograms that use injectable dyes are helpful in demarcating any space occupying lesions or ruptured arteries along the spinal cord.

Electro-diagnostic procedures may be recommended in chronic cases of nerve compression to understand the prognosis.

Other tests like Ultrasound are being used now a days to pick up ligament or tendon injuries.

Physiotherapists, Osteopaths, Chiropractors and Sports Injury Rehabilitation Specialists rely more on detailed patient history, physical examination and special tests to evaluate back pain.

How a muscle or a joint feels’ below the fingers gives the most accurate diagnosis to an expert clinician. It helps to identify:

• tenderness,
• muscle spasm,
• joint stiffness and
• trigger bands.

Active/passive ROM and repeated movements help to diagnose muscle related pain.

Special tests such as Slumps test, FABER test, Gaenslen’s test, Straight leg raising and Crossed SLR tests etc, help to diagnose back pain due to reduced neural movement or muscle/joint pathology and disc involvement respectively.

Manipulation of the lumbar spine gives crucial clues regarding facet joint dysfunction.

Evaluation of MRI, posture, muscle strength and tightness reveals pain that may be due to muscle dysfunction or trauma.

More often, it is these muscular imbalances that are the root cause of pain.

The findings on investigation may be purely coincidental or asymptomatic. ⁽⁵⁾

“I used to have back pain but, thanks to Jazz Alessi’s customised strengthening, stretching, breathing, back exercises, postural movements and the individualised programme he designed for me I don’t have any spine or back pain anymore. I’m now able to have a very intense workout and I took my fitness to the next level.”

– W. T.  – London Metropolitan Police 

Contact Jazz now for a commitment free consultation today, by clicking on this link HERE.

Opioid analgesics prescribed for chronic pain or fibromyalgia are highly addictive and should be prescribed with caution.

Drugs like paracetamol, ibuprofen are most commonly prescribed for acute lower back pain in the UK.

Surgery Treatment

This option should only be considered if all other therapies fail.

Surgeries do not guarantee pain relief instead may result in loss of flexibility.

Certain surgeries help to repair compression fractures by using glue cement.

Corrective surgeries are aimed at correcting structural scoliosis or limb length deformity that cause lower back pain.

In case of disc prolapse or nerve root compression, the surgeon may recommend removing part or whole of the disc and widening the foramen through which the nerve exits the vertebral column.

In cases of multiple compression fractures or multiple disc prolapse, the surgeon may consider fusing adjacent vertebrae to provide greater stability.

NON-MEDICAL TREATMENT

Recent studies are recommending the use of safer and non-invasive ways to rehabilitate acute and chronic lower back pain.

• Cognitive behavioural therapy has seemed to help people deal better with chronic back pain.

As the bio-psychosocial model of pain shows how one’s state of mind affects pain perception, CBT sessions that motivate people to adopt a more active lifestyle have proven beneficial. ⁽¹⁰⁾

These sessions encourage people to give up bed rest, and overcome the fear of movement.

The sessions also help patients to cut down on the use of medications.

• Adjuvant therapies:

Many clinicians have also used acupuncture and dry needling for the management of acute and chronic low back pain.

Though this technique has not found a place in the NICE guidelines it has helped to provide symptomatic relief in persistent back pain cases when used with other treatment techniques.

The effects are short term. ⁽¹¹⁾

Customised Pilates exercises is gaining popularity among patients and Physiotherapists due to its wonderful effects on the core muscles. ⁽¹²⁾

It has been seen that weak core muscles are a major reason for recurring or persistent low back pain.

Jazz Alessi, a 2^nd generation Pilates Personal Trainer in Central London and an elite personal trainer for back pain finds authentic Pilates extremely beneficial for his clients.

He combines customised back pain exercises with perfectly modified Pilates technique to provide painless movement in just 6 – 12 sessions.

Customised back pain exercises, and one to one Pilates works well in all cases of back pain including disc prolapse and spondylolisthesis.

Yoga strengthens the low back extensors and lumbar-pelvic – hip muscles.

It’s a great way to get rid of the nagging back pain the natural way but, also increases the risks for a herniated disc and sciatica thus, in the case of back pain or injury Yoga exercises will not be enough whilst, it must be fully customised.

As an elite personal trainer for back pain and exercise specialist, Jazz Alessi blends selected or modified Yoga with customised low back stabilisation exercises to maximise the benefits of both.

His clients in central London, simply enjoy the triple benefits of Yoga, Pilates and modified exercises designed by Jazz in the comfort of their home.

All it takes is a Pilates, or Yoga mat!

Cortisone injections are recommended by some clinicians to manage chronic or persistent lower back pain.

However, the effects are short term and not directed towards resolving the root cause.

“Jazz made all the difference I needed and I’m so happy now that my back pain is completely gone. My posture and  my core are so much stronger now. Alessi Jazz was born to train and he is 100% focused at all times.”

– Emma Choli – International marathon runner 

Exercise therapy and Customised Back Rehabilitation:

Physical therapy has gained a lot of support from clinicians in the past few years for rehabilitation of lower back pain.

Exercises are the back bone in all types of back pain injuries and back pain rehabilitation.

Among other things, a customised personal training programme for back pain rehabilitation could include:

• Soft tissue techniques like myofascial release, muscle energy techniques to relieve pain, tenderness and muscle spasm.
• Mobilisation and Manipulation techniques help to increase intervertebral or SI joint mobility and unlock locked facets. ⁽¹⁴⁾
• Stretching of tight low back extensors, quadratus lumborum, latissimus dorsi, hamstrings and calf muscles helps resolve lower back pain due to correct muscle length imbalances.
• Strength training exercises for erector spinae, quadratus lumborum and hip abductors helps improve muscle performance ^(15,16)
• Core strengthening of the multifidus and transversus abdominis and pelvic floor muscles ^{(17, 9,20)} are crucial for the lumbar stability during movement.
• Lumbar stabilisation and proprioception exercises to improve balance strategies and reflex activation ^(17,18,19) to prevent recurrent back pain
• Correction of faulty biomechanics like increased or decreased spinal curvatures, pelvic tilts, limb length discrepancies, hip-knee-ankle joint mobility etc.
• Posture correction and educating about work place ergonomics, lifting techniques, appropriate mattress, quitting tobacco and foot wear advise to prevent recurrence
• Weight management if obesity is the cause of low back pain

“I wanted to improve my fitness level, gain more energy and lose weight while, correcting my posture and getting rid of my severe back pain. Once we start training Alessi was always available and answered all the questions and back rehabilitation queries I had. I achieved everything I wanted and I went beyond my goals. My posture is so much stronger and I don`t feel any back pain anymore.”

– Alless – Fashion designer 

​Would you like to regain your back health, and learn for yourself how to get rid of sciatica or lower back pain?

Contact Jazz now for a commitment free consultation today, by clicking on this link HERE.

Need of the hour today

• Globally accepted management plan: With more than 540 million people suffering from lower back pain and associated disability, ⁽⁴⁾ a standardised set of back pain treatment guidelines is urgently needed.
• Cutting down on diagnostics and costly surgeries: In 90% of the cases, lower back pain is mechanical and self-limiting in nature.

There is usually a disruption in the way the components of the back (the spine, muscle, intervertebral discs, and nerves) move.

The condition resolves completely through self-care and active lifestyle. ⁽²⁾

Recommending expensive investigations and persuading patients for hi-tech surgeries amounts to medical malpractice. ⁽⁴⁾

A radiological diagnosis may not always be symptomatic.

Having worked with over a 600 cases of low back pain over the past 20 years, expert personal trainer in Central London Jazz Alessi believes that an MRI finding of disc prolapse need not always be the reason for pain. ⁽⁶⁾

The reason may lie somewhere else. ⁽⁵⁾

• Conquer fear – Lower back pain can be puzzling and disproportionate in nature.

According to the latest research published in the journal of rehabilitation medicine, lower back pain is distressing mainly because of its unpredictability and possibility of recurrence. ^(3,4)

“At 40, I was enjoying life working as a nursery nurse. One day I experienced the most unimaginable pain of my life. All I had done was lift up a crying child. The pain was agonizing, I couldn’t move. It was like my back had all seized up… Nothing I did relieved my pain… A regular activity can also become painful all of a sudden….” – Tracey

This fear makes people avoid movement.

Avoidance of movement results in more muscle stiffness and more pain.

Jazz Alessi, the most sought after elite personal trainer in Central London, trains and coaches you to eliminating this fear.

Jazz helps his clients make sense of their pain.

Explaining the ‘why’ and ‘how’ of the pain helps patients put pain in the right perspective.

Jazz has learnt through his long term experience that individuals are more compliant to rehab once they understand how it will help them.

Low back pain can have multiple causes and each of them must be examined by your sports injury medical doctor before deciding any type of treatment options. (4,5)

The widely popular bio-psychosocial model of pain and disability must be incorporated in all cases of low back pain.

• Switch to active lifestyle: Sedentary and office workers especially, need to take note of this.

It has been recommended that 150 minutes of exercise per week is extremely beneficial to build up cardiac and muscular endurance.

Regular exercise keeps muscles fit to resist the pressures of any unexpected surge in activity.

This is just one of the reason why Jazz Alessi elite personal trainer in London, advocates regular back pain exercises for all his London clients.

• Mobility is the key to early recovery: Bed rest and being off work is counterproductive.

As a rehabilitation expert, Jazz helps you improve your mobility and early return to normal activities fighting back pain efficiently.

Prolonged bed rest causes imbalances, tightness and muscle weakness.

Poor muscle strength results in faulty movement patterns and incorrect muscle action.

These eventually lead to increased pain.

Being off work results in social isolation and depression which aggravates pain.

“Working out at the gym was my stress buster. I was doing my usual Abs routine, when I got a sharp shooting pain all the way down my right leg. Sciatica ! And that I thought was the end of my gym routine. These exclusively tailored exercises and fitness routine helped me to return to the gym in just 3 months. He helped me understand my spine better. He taught me how to move effectively and efficiently and supervised me throughout. It’s been a year since and I haven’t had another episode of sciatica”.

• Regain control of your spine – According to Jazz, an elite personal trainer for back pain specialised in lower back rehab – back pain is not the end of the road.

An episode of low back pain only reminds you that you need to treat your spine better.

You need to analyse your daily activities and identify the faulty movement.

As an expert personal trainer in London Jazz has worked with top CEO’s, sports persons, lawyers, medical doctors and TV personalities with varied and demanding job profiles.

Advising them on their movement deficits and rectifying muscular imbalances and addressing postural dysfunction to heal their back has gained him immense popularity.

He believes in bespoke programmes and hands on approach.

Using customised exercises, yoga and Pilates, Jazz achieves low back pain relief in just 6 – 12 sessions.

His techniques find a strong support in the 2017 NICE guidelines for back pain management.

• Work towards prevention: About 80% of adults experience low back pain at some point in their lifetimes.

It is the most common cause of job-related disability and a top reason for missed work days.

It accounts for 11% of the disability in UK alone. ⁽⁴⁾

This suggests that we must focus more on prevention.

Adoption of correct posture, practising correct exercises, movements, lifting techniques and improving workstation ergonomics goes a long way in preventing recurrent back pain.

Among other successful back recovery strategies and checks we use, we are also measuring your back rehabilitation programme targeting specific metrics (see the picture below) of your spine function:

• Improving your back function
• Decreasing and eliminating back, pelvis, hip and associated pains by restoring joints, ligaments and muscle balance
• Peripheralisation of your pain and symptoms

“What Jazz does is prepare a customised personal training programme, for you as an individual. The customised exercises Jazz designed for me helped me to completely get rid of my back pain, tension in my shoulders, and hip pain and increased my body coordination, flexibility and overall improved the range of movement throughout my body. I’m also about two stone lighter now than I was when we first met.”

– Beverley Sage – ex singer – Artist 

Would you like to regain your back health, and learn for yourself how to get rid of sciatica and lower back pain?

Contact Jazz now for a commitment free consultation today, by clicking on this link HERE. 

Back pain rehab by Jazz Alezzi

As an elite personal trainer and rehabilitation expert, I am passionate about recovery after injury, and designing the most suitable customised exercises for you as a client.

I never use a ‘one hat fits all approach’.

I design very comprehensive and effective rehab programs for each of my clients.

In my 20 years of experience as a back-pain rehab specialist in Central London, I have come across a large variety of back pain cases.

In my opinion, as an exercise physiology specialist and rehab expert, majority of LBP cases stem from dysfunction of the trunk muscles including the hip and the pelvis and this is exactly what most personal trainers specialising in back problems don’t get it.

Delayed activation of these muscles during movement, result in unwanted pressure on the disc and ligaments.

Overtime, this presents as pain during movement.

The individual selectively stops performing the painful movements causing further deconditioning.

As a personal trainer in Canary Wharf, I work closely with my clients working in an office based job to reduce and eliminate back pains.

I help them overcome fear and explain the ill effects of limited mobility.

After conducting a thorough back injury assessment, I note the weak, tight and overstretched muscle groups.

I also look at shoulder, hip movement and foot.

Since the trunk forms a link between the shoulder and hip in the kinetic chain, an incorrect scapular or pelvic movement may percolate through the chain resulting in lower back pain.

I also perform work place assessments for my London based clients.

Identification of my client’s functional limitation helps me to set realistic goals

As a certified injury rehabilitation specialist, I customise for you using the most effective strengthening exercises for the low back muscles with stretching of the tight muscles achieve full range of motion throughout the kinetic chain.

I personalise all exercise, movements and lifestyle.

This helps me to provide an effective and efficient support, to going beyond my clients’ goal.

I also use modified Pilates and Yoga to improve mobility and core strength around the lower back.

As a long term certified nutritionist, I also advise my clients on weight loss diets if overweight and obesity is an aggravating factor of their lower back pain.

I believe in personalised nutrition for optimum spinal health.

I take time and formulate your perfectly customised personal training programme.

This incorporates the most effective, modified exercises from Pilates, Yoga, body conditioning, Martial arts, gymnastic ensuring your programme is entertaining providing you with the best holistic approach for a very effective and long term back pain relief.

Your customised low back rehabilitation programme professionally supports you moving again safely in all three plans of motion maximising your chances to maintain optimum back health in a long term.

Some of the approaches and causes I mentioned above are taught through my low back rehab curriculum rehab courses for personal trainers specialising in back problems.

Are you living in greater London, or east London, and are looking for the best  Rehabilitation Elite Personal Trainer in Canary Wharf?

All you will need is a Pilates mat at home or office or even a nearby park and I will bring with me all the equipment required.

I Will Train You At Your Convenient Time and Place – At Your Greater London Location!

“Thank goodness, I found Jazz. I used to have lots of postural problems and serious back pain, and of course I was very worried about this. His back rehab training was perfectly customised to my goals and needs, and since training with him I have not had any regular back pain at all. Jazz training helped me to regain my back balance, and to get rid of my back pain.”

– Nerea Carrion – Entrepreneur

For the best back pain rehabilitation London based package, Get Now Your Free Low Back Pain Injury Rehabilitation Consultation through this link, HERE.