Treatment of back pain: Interview with Tokpessa Innocent Lakna, Physiotherapist and Director of CNAO-Lomé

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Extract from the article: Les kinésithérapeutes sont très souvent sollicités pour traiter le mal de dos, extrêmement fréquent aujourd'hui. Ce professionnel de santé intervient sur prescription médicale uniquement. En fonction de la localisation du mal de dos et des éventuelle

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« The physiotherapist is the practitioner specialised in the rehabilitation of musculoskeletal disorders. He can help cure a simple or serious back pain... »

Physiotherapists are very often called upon to treat back pain, which is extremely common nowadays. This health professional intervenes on medical prescription only. Depending on the location of the back pain and any abnormalities found during the assessment, they will use manual techniques such as massage or manipulation to relieve the pain. In this interview, Innocent Tokpessa Lakna, Specialist in Physiotherapy, Director of the National Centre for Orthopaedic Fitting (CNAO-Lomé) talks about rehabilitation for the treatment of back pain.

Health-Education: What is the role of the physiotherapist?

Innocent Tokpessa Lakna: The role of the physiotherapist is in some way to apply measures that allow the patient to improve his functional autonomy. But there is not only the physiotherapist in this function, there is also the physician-rehabilitator. These are two different but complementary roles.

The physiotherapist assists the rehabilitation physician. Both have one objective: to improve the patient's autonomy in his activities of daily living without the help of a third person.

When does the physiotherapist intervene?

The physiotherapist receives the patient after he/she has met the rehabilitation doctor. The latter, after having received the patient in consultation, carries out an examination following which a protocol of care is established.  This protocol contains the main lines on which the physiotherapist must work with the patient. And it is at this point that the physiotherapist accesses the patient.

Can a patient go directly to the physiotherapist without going through the rehabilitation doctor?

No. A patient cannot directly see a physiotherapist because the physiotherapist works on a medical prescription, however in certain circumstances physiotherapists can directly see the patient provided they necessarily do their assessment. There is what is called the physiotherapy assessment which allows the mapping of the patient's disorders and disabilities and to establish a set of techniques to improve autonomy. Following this assessment, they can refer the patient to the doctor or not in case there is no doctor in the area.

Who should go to the physiotherapist?

All those who are limited in activities of daily living, and those who have a disability. These are: those who have difficulty walking, grasping objects, difficulties in dressing or in using the toilet, in an area where there is no doctor-rehabilitator.

What is the role of physiotherapy in the treatment of back pain?

The physiotherapist intervenes at several levels. The physiotherapist is the practitioner who specialises in muscle rehabilitation. He can help treat simple or severe back pain, by practising personalised relaxation exercises, stretching and massage. Firstly, to calm the pain, a set of techniques is used to reduce the patient's pain. Secondly, to improve the mobility of the spine, as pain is accompanied by a limitation of the mobility of the spine.  Finally, the physiotherapist formulates lifestyle rules to avoid the recurrence of pain, i.e. how to proceed in order to reduce the risk of pain occurring in the patient.

What does rehabilitation consist of?

First of all, there is a first step: calming the pain. To calm the pain, we have a certain number of materials, devices that provide electricity or heat to combat the pain but also to reduce the contractures. Once the pain has subsided, the flexibility of the back must be improved by means of a massage to loosen the muscles and a muscle stretch, before asking the patient to perform back movements. Then the back and stomach muscles are strengthened in the case of back pain, and the neck extensors and flexors in the case of neck pain. Finally, we end with what is known as exercise training on an exercise bike or treadmill, with the patient doing exercises of increasing duration.

These are the four stages of physiotherapy for patients with spinal pain if there are no contraindications.

Do you have to go to a massage parlour to relieve back pain?

I call "city massage" the massage that is done in the rooms. City massage is for aesthetics and comfort. In case of back pain, the patient has to go to the hospital, see a rehabilitation doctor after a check-up, and then be sent to a physiotherapist for sessions. What people don't know is that there are several types of massage: those to stimulate the muscles, relax the muscles, improve blood circulation and finally those to improve lymphatic circulation. In the city, I think people don't know the difference. Of course, you can feel relief after city massage sessions, if you are lucky enough to get sessions adapted to the back pain mechanism you are experiencing. But it is preferable to go to the hospital, to see a rehabilitation doctor who will carry out an examination and, depending on what he has found, will establish a suitable protocol.

Interview by Abel OZIH