Physiotherapy for Back Pain in Pokhara: Treatment and Home Exercises
Back pain is the leading cause of disability worldwide and the most common single condition presenting to A&B International Hospital’s physiotherapy centre. In Nepal, the burden is compounded by agricultural work that involves prolonged bending, carrying heavy loads in dokos (wicker baskets), and working in postures that load the lumbar spine asymmetrically. At the same time, desk workers in Pokhara’s growing service economy suffer a different but equally real back pain burden from prolonged sitting and sedentary postures. Physiotherapy is the most effective non-surgical intervention for mechanical back pain, and it is substantially superior to analgesics as a long-term solution.
How Does Physiotherapy Treat Back Pain Differently From Pain Medication?
Pain medication suppresses the symptom of pain without addressing the underlying mechanical dysfunction, muscle imbalance, or movement problem causing it. This is appropriate for acute pain management — gaining enough pain control to begin rehabilitative exercise — but it is not a solution. Long-term reliance on analgesics for back pain produces dependency, side effects, and no structural improvement.
Physiotherapy identifies and addresses the actual cause: whether it is muscle imbalance, joint stiffness, disc-related nerve irritation, postural dysfunction, or a combination. Treatment combines hands-on techniques to restore mobility, targeted exercises to correct imbalance, education about spinal biomechanics, and activity modification to reduce provocation while loading the spine progressively to restore tolerance.
Multiple high-quality randomised controlled trials demonstrate that exercise therapy and manual physiotherapy significantly reduce pain and disability in non-specific low back pain, with effects that persist longer than pharmacological management alone.
How Does the Physiotherapist Identify the Cause of Back Pain?
Assessment begins with a detailed history: the onset of pain (sudden with a specific trigger vs gradual), the nature and distribution of pain (localised low back pain vs radiation into the leg — indicating possible nerve involvement), what makes it better or worse (flexion vs extension, sitting vs standing, morning vs evening), and any red flag features.
Red flags for serious spinal pathology require urgent investigation rather than physiotherapy: back pain in a patient with known cancer; pain associated with unexplained weight loss, fever, or night sweats (suggesting infection or tumour); back pain with bladder or bowel dysfunction or saddle anaesthesia (suggesting cauda equina syndrome — a surgical emergency); and back pain following significant trauma.
In the absence of red flags, a specific clinical classification guides treatment selection. The McKenzie MDT (Mechanical Diagnosis and Therapy) system classifies low back presentations into derangement, dysfunction, and postural syndromes based on directional preference — which movements centralise (reduce) or peripheralise (worsen or spread) the patient’s symptoms.
What Is the McKenzie Method and How Is It Used?
The McKenzie method identifies a directional preference — a direction of movement that reduces pain and its distribution. For the majority of lumbar presentations, the directional preference is extension (backward bending). This is the basis for the classic McKenzie prone press-up exercise: lying face down and pressing the upper body up on the arms while the pelvis remains on the floor, producing lumbar extension.
Repeated movements in the direction of preference are used to centralise and then abolish pain, and to restore normal spinal mechanics. The McKenzie method also includes a classification for acute disc prolapse (derangement with leg pain) where specific positions are used to reduce nuclear disc material from pressing on nerve roots.
McKenzie physiotherapy requires a trained and certified therapist. The assessment is specific and the treatment prescription based on individual directional preference — not a generic protocol.
What Is Core Stabilisation and Why Is It Important?
The lumbar spine is stabilised by a cylindrical deep muscle system: the transversus abdominis (anterior), multifidus (posterior), pelvic floor (inferior), and diaphragm (superior). In patients with chronic or recurrent back pain, the multifidus — the deepest paraspinal muscle — undergoes atrophy and delayed activation that does not recover spontaneously, even when pain resolves.
Core stabilisation retrains the precise activation and timing of these deep muscles to provide spinal stability during daily activities. The exercises begin with isolated deep activation (finding and contracting transversus abdominis independently of the superficial muscles) and progress to integration of this activation into functional movements — lifting, pushing, carrying.
Superficial exercises such as standard sit-ups or back extensions exercise the global mobiliser muscles but do not specifically retrain the stabilising system. Core stabilisation is a specific, skill-based intervention, not equivalent to general abdominal exercises.
What Manual Therapy Techniques Are Used for Back Pain?
Joint mobilisation involves applying gentle oscillatory forces to facet joints that have become stiff, restoring their normal movement range. It is particularly effective for localised back pain with joint restriction.
Manipulation — a higher velocity, lower amplitude thrust technique — produces an audible click and immediate improvement in range of motion in appropriately selected patients. It is most effective for acute mechanical low back pain without nerve root involvement. It is contraindicated in patients with osteoporosis, fracture, instability, and certain other conditions.
Soft tissue massage addresses muscular tension, trigger points, and fascial restrictions that contribute to back pain. It is most useful as preparation for exercise and mobilisation rather than as a standalone treatment.
Traction — either manual or mechanical — applies a distractive force to the lumbar spine, reducing disc pressure and creating space in the neural foramen. It is used for disc-related nerve root pain and is effective in the short term when combined with exercise.
What Home Exercises Are Prescribed for Lumbar Pain?
The physiotherapist prescribes a specific home programme based on individual assessment. Common exercises include: knee-to-chest stretches for lumbar flexion mobility, lumbar rotation stretches for facet joint mobility, prone press-ups for extension preference, bird-dog (opposite arm and leg raise on all fours) for deep stabiliser activation, dead bug (supine contralateral limb movement with spinal stability) for functional stability, and bridging for gluteal and lumbar extensor strength.
Exercises must be done consistently — typically twice daily — for improvement to occur. The home programme bridges the gap between physiotherapy sessions and prevents recurrence.
What Postural and Ergonomic Advice Is Given for Desk Workers and Farmers?
For desk workers: screen at eye level, seat height allowing feet flat on floor and knees at 90 degrees, lumbar support in the chair, avoiding prolonged sitting longer than 45–60 minutes without a brief standing break.
For farmers and manual workers: maintain neutral spine during lifting (hinge at the hips, not the back), avoid carrying heavy loads asymmetrically, use mechanical aids where available, take rest breaks during sustained bending work.
Postural correction is not achieved by telling someone to “sit up straight” — it requires specific muscle strengthening and proprioceptive retraining to make correct posture sustainable.
A&B International Hospital
Pokhara-02, Bindhyaabasini Way to Sarangkot
Phone: +977 061-412512
Website: abinthospital.com
If you have back pain that has persisted for more than 6 weeks, or recurrent episodes that limit your activity, physiotherapy at A&B International Hospital will address the cause — not just the symptom. ECHS polycards accepted for eligible veterans.
