Online Physiotherapy: Lower Back Pain Treatment, a Physiotherapy Case Study
by Physiotherapist Dr. Carol Johnson (PT) (BPT, MPT – Orthopaedics & Sports Rehab, COMT, MATT, BLS)
Online Physiotherapy for Lower Back Pain: ABSTRACT
Mr Sridhar had chronic slipped disc and faced sudden onset of acute lower back pain during the Covid-19 lockdown. He took Online physiotherapy and reports, “Initially I was a bit apprehensive about taking physiotherapy online. However, the doctor was very reassuring and very patient in terms of guiding me through the various exercises. It was an online video session throughout with the physio demonstrating the exercises and monitoring my movements. This was backed by physiotherapy videos of exercises neatly organised into an exercise program. Very easy to follow! I have been going through the routines for nearly 3 weeks now and I have started feeling much better with the pain reduced substantially.”
Online Physiotherapy for Lower Back Pain: PREFACE
Mr. Sridhar S., a male patient in his forties, came to ReLiva Physiotherapy for treatment of severe lower back pain which occurred a week ago, while lifting a heavy object. Mr. Sridhar said that he suffered from a ‘catch or pull’ like sensation after which the pain got worse. He then tried few home remedies for back pain like applying balm and taking bed rest to reduce the pain, but it had very little effect. Meanwhile, the symptom progressively increased in nature till a point, where he had to visit an Orthopaedic Doctor who asked him to take an MRI and prescribed muscle relaxants, pain medication and calcium supplements. With these, his back pain reduced from an 8/10 to 6/10. The patient was advised physiotherapy thereafter.
Due to the Covid-19 lock-down, we advised Mr. Sridhar to stay at home and undergo physiotherapy sessions online as it would be the most convenient and safest option available.
Online Physiotherapy Appointment & Scheduling:
The patient was given an appointment for 05:30 pm for the assessment & consultation and a session length of 30 to 45 minutes was already informed by the appointment team. ReLiva’s source of communication for the consultation was the video call feature on Whatsapp via the cell phone.
Online Physiotherapy Consultation:
Lower Back Pain History:
Mr. Sridhar was online at 05:45 pm. A general history of the existing condition was taken and it was found that the patient had chronic back pain owing to slipped disc at multiple places. There was no history of trauma to the lower back when the current episode of pain came on. It was sudden in onset and it kept getting worse over a span of one week. The back pain was constant, dull aching and sometimes sharp in nature. It got worse in the mornings and aggravated on bending forward, sitting for less than 5 minutes and turning in bed. He rated his pain as a 6 out of 10 in intensity. Since his job requires him to sit for hours at a stretch in front of a computer, his goal was to reverse the pain in order to be able to do that at least, for now.
Online Physiotherapy Assessment:
After the history was taken, self-palpation for tenderness or pain was done covering the entire lumbar spine, pelvis and hips. The palpation techniques were demonstrated by us first, then done by the patient. The lumbar spinous processes and paraspinal muscles were tender on touch, but he felt intense pain when palpating his left PSIS.
Movement analysis was done next. The patient had to find someone to hold the camera for him, for us to be able to see the movements clearly. Flexion (Bending forward) was painful during movement and restricted at the end range, Extension (Bending backward) was painful at the end range, Lateral Flexion (Side Bends) were painless and unrestricted and Left rotation was painful and restricted. Composite spine movements were all unrestricted and painless except for diagonal flexion to the left.
During the assessment of this particular movement, we experienced network issues and could not see clearly as to what happened, but the patient experienced immense pain increasing the rating to a 9/10 in intensity. He could not move after that. Internet connectivity could be a risk in such a situation.
Online Physiotherapy Treatment for Lower Back Pain
We suspected a muscle pull or a ligament to be sprained at that time, but couldn’t be entirely sure about it due to lack of visibility and thus advised him to lie down on his abdomen with a hot pack to the painful area for 10 minutes. We asked the relative to apply Relispray (A vapocoolant pain spray, that was readily available with him) after heating, followed by 10 minutes of cooling with a cold pack. We disconnected the call and let the patient connect with us once he was done with the contrast therapy.
Once that was done, the patient was able to move about, but the pain still persisted. Therefore, pain relieving and safe spinal movements were taught to the patient. He was then advised to repeat the same procedure at night before sleeping and was given an appointment for the next day.
Online Physiotherapy Treatment: Session 2 (Day 2)
The day of the second session, the patient reported significant reduction in pain, rating it as a 5/10. Thus, exercises were progressed. Spinal stretches were added along with a few stability exercises. Mr Srinivas was advised to continue these, once a day without our supervision, as well. We took extra efforts to communicate that ‘Exercise is Medicine’ and that it should be taken in the prescribed dosage and frequency religiously.
Online Physiotherapy Treatment: Session 3 (Day 6)
The 3rd session was scheduled after 4 days. The patient noted that the pain was no more constant in nature and had good relief. Strengthening exercises of the posterior chain was then started. The exercise prescription was accordingly progressed and patient was advised to continue the ‘exercise medicine’ at home.
Online Physiotherapy Treatment: Session 4 (Day 10)
The 4th session was scheduled again after 4 days. He noted that the pain had reduced to a 1/10 and was only present on sitting for more than 30 minutes. Exercises were further progressed and involved core strength and endurance training. He would continue doing those exercises by himself, as prescribed.
Online Physiotherapy Treatment: Session 5 (Day 17)
The 5th session was scheduled after a week. The patient did not feel any pain at all until he sat for 2-3 hours. In Spite of sitting for that long, the pain was rated as 1/10. Back Pain Exercises were then progressed to maintain the effects of the same. The patient was happy to have achieved his goal.
Online Physiotherapy Treatment: Maintenance
Follow ups are scheduled every 3 weeks from now, to assess the progress of the condition and modify activities if necessary. The main goal now, is to prevent the recurrence of mechanical low back pain.
Online Physiotherapy for Lower Back Pain: CONCLUSION
On the whole, online is a new way of treating and delivering physiotherapy care and it seems to work well. A large number of cases could be treated in the same manner – self care, exercise prescription and movement training could be taught to patients online. Moreover, it is found to be very convenient for the patients as they can continue their physiotherapy treatment in the safety of their home using the equipment/ items that are available to them.
Patient Review about Lower Back Treatment
This is what the patient, Mr Sridhar has to say about his experience of tele physiotherapy –
“In March, I had a mini-relapse of a chronic lower back problem. The ortho diagnosed it as a slip disc problem in multiple places and asked me to get started on physiotherapy right away. And then came the lockdown for COVID-19.
I was worried about how my treatment would proceed as no one was allowed to go out. when I came across Reliva e-Physio. Initially I was a bit apprehensive about taking physiotherapy online.
However, the doctor was very reassuring and very patient in terms of guiding me through the various exercises. It was an online video session throughout with the physio demonstrating the exercises and monitoring my movements. This was backed by videos of exercises neatly organised into an exercise program. Very easy to follow in the absence of a physio! I have been going through the routines for nearly 3 weeks now and I have started feeling much better with the pain reduced substantially.
Reliva e-Physio is a very impressive solution not requiring me to travel to any clinic. I would highly recommend Reliva to anyone looking for physiotherapy in these times of lockdown and even beyond.”
Should you need treatment for a physical pain or expert care for Facial palsy, Pregnancy exercises etc, register for an online physiotherapy session here or simply call us at +91 99209 91584 and we will connect you with a physiotherapist best suited for your condition.
Related Reading for Online Physiotherapy:
Shoulder Pain Treatment with Online Physiotherapy
Online Physiotherapy for Fracture Treatment: a Case Study
Hemiplegia Treatment: Online Physiotherapy
Avoid Surgery with Back Pain Physiotherapy
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