Non-Specific Chronic Low Back Pain Treatment Methods

Conventional physical therapy applied to patients consists of Transcutaneous Electrical Nerve Stimulation (TENS), Ultrasound (US) and Hot Pack. TENS will be applied for 20 minutes at a frequency of 100 hertz. US will be applied for 5 minutes at an intensity of 1.2-1.5 W/cm2. Hot Pack will be applied for 20 minutes. Treatment will be applied to the lumbar region. Application will be made 3 days a week for 4 weeks.

The individual will be in a sitting or lying position without muscle tension, and progressive relaxation will be provided with verbal commands given for each body part in order. The patient is asked to place their hand on their abdomen and by applying light resistance, they are provided with the direction in which the breath will go. During diaphragmatic breathing, the person breathes deeply and slowly through the nose and out through the mouth for 5-7 seconds, holds it for 2 seconds and exhales for 6-8 seconds. During this time, the abdomen is inflated in 4 directions and care is taken to ensure that there is no auxiliary muscle activity. First, after taking a deep breath, the muscles are tensed, this tension is maintained for 5-7 seconds and then the muscles are relaxed (8-10 seconds). This application will be applied in 3 sets, with 5/6 repetitions and then returning to calm/normal breathing. The treatment will be applied 3 days a week and will last for 4 weeks.

Application of the Technique: The direction of the technique will be shaped according to the direction of movement of the patient's pain. If the patient's pain occurs during flexion, flexion will be applied, if it occurs during extension, extension SNAGS will be applied. In the flexion SNAGS application, the physiotherapist places the mobilization belt at the patient's spina iliaca anterior superior (SIAS) level while the patient is sitting or standing. The physiotherapist places his hand, thumbs or the hypothenar part of the hand parallel to the spinous processes one level above the relevant segment. Then, he asks the patient to flex until he feels pain. The physiotherapist continues the flexion by applying force towards the cranium with his hand. After waiting for a while at the end point, the starting position is returned. During this time, the physiotherapist maintains the natural shift in the facet joint. If the pain does not disappear, the application is applied unilaterally.