What Is Biofeedback For Low Back Pain?

If you are one of the 540 million people in the world who suffers from low back pain then you might know a thing or two about trying all sorts of things to feel better. In our blogs we have written about all sorts of treatments from TENS units to platelet rich plasma injections. Low back pain, it seems, will make you so desperate for relief that you will probably try anything once! Since low back pain often doesn’t have a specific thing that you can point to and say “If I fix this I will be completely better”, treatment can be elusive and resemble a lot of guess work. But it doesn’t have to be that way.


International guidelines have clearly laid out some of the tried and trusted techniques for helping to heal low back pain. There isn’t a magic pill that can’t make your pain disappear overnight, but there are some specific things that you can do to help speed up recovery and help to prevent future low back issues. Biofeedback is one of those things.



Biofeedback refers to the process of collecting information about your body in order to make you more aware about what it is doing and how it is reacting to things.


What Is Biofeedback For Pain?


Despite the fact that you might not have heard too much about it before now, biofeedback isn’t a completely new technology. In fact, it has been around since the 1920’s! Biofeedback refers to the process of collecting information about your body in order to make you more aware about what it is doing and how it is reacting to things, so that you can have more control over some of the less voluntary actions.


The idea behind biofeedback is that when you become aware of what is going on in your body, you can use the power of your mind and this new awareness to help you gain more control over your body. This gives you more control over your health. Biofeedback therapy has been used to treat a range of conditions like headaches and migraines, chronic pain, and high blood pressure.



Biofeedback devices have come a long way since they were first invented.


The History Of Biofeedback


The first generation of biofeedback devices were fairly limited because of the type of technology that was available at the time. A basic sound or a simple analogue needle display would show the readings and it was very hard for individuals to interpret the information on their own. As time went on the technology improved and digital numerical displays were used. The came the 1980’s with the rise of the first Apple computers and everything became digitized.



Biofeedback devices have evolved but are still not very user friendly and need help interpreting the data.


Biofeedback has come a long way since then, with interactive displays, detailed recordings and statistical analysis being the norm. Unfortunately, user friendliness has not improved to the extent that it could be and this is partly why biofeedback has not been more popular. The technology has been mostly in the hands of academic research facilities or high end rehabilitation clinics where they have trained healthcare providers to implement and interpret the results of this technology. Knowing how and where to place the sensors as well as how to interpret the information has not been something that users could do for themselves. The equipment has also been extremely expensive, with some devices costing anywhere in the range of $40,000!



SEMG is often used to treat back pain and headaches.


3 Common Forms Of Biofeedback Therapy


There are three types of biofeedback therapy that are used the most. They are:


  1. Electromyography (EMG/SEMG) - measures the activity and tension levels of your muscles. This type of therapy is often used for retraining muscles after an injury, physical rehabilitation, anxiety, and headaches.

  2. Neurofeedback or electroencephalography (EEG) - measures brain wave activity and is often used to treat seizure disorders such as epilepsy, as well as disorders such as attention deficit hyperactivity disorder (ADHD).

  3. Thermal biofeedback - measures skin temperature for treating conditions such as Raynaud’s disease and headaches.



EMG biofeedback is often used to treat migraines and anxiety


Common Conditions That Biofeedback Can Help With


There are many different conditions that healthcare providers are now treating with biofeedback technology. Some of these conditions include:


  1. Chronic pain

  2. Temporomandibular Joint disorder (TMJ)

  3. Headaches

  4. Back Pain

  5. Fibromyalgia

  6. Anxiety

  7. Incontinence

  8. ADHD

  9. COPD

  10. High Blood Pressure

  11. Epilepsy

  12. Asthma

  13. Injuries

  14. Raynaud’s Disease

  15. Rheumatoid Arthritis


EMG measures the electrical activity generated by the body that causes muscle contraction.


What Is SEMG Biofeedback For Low Back Pain?


Surface electromyography (SEMG) is one of the oldest biofeedback modalities - it goes all the way back to the 1920s where it was used for clinical research. Sometimes clinicians describe SEMG as something they use to measure tension in the muscles, but it actually measures the electrical activity generated by the body that causes muscle contraction.


SEMG is a valuable tool for clinicians and patients because it means they can see and learn things about the muscles that can’t be done by just feeling, or observing, the muscle. Why is that a big deal? Because then clinicians can know more about what is wrong with the muscles, how tired they are, how strong they are, how evenly they share the work, and then they can make a highly personalized plan for a faster, more efficient recovery.



SEMG can be used to up-train or down-train muscles to help them work better.


Goals For SEMG Training


Unlike traditional biofeedback methods, SEMG is great for more direct coaching of individuals. There are generally two goals for SEMG training. The first goal is to help chronic pain patients understand how tense they actually are compared to their pain free friends. The second goal is to help patients gain more control over their muscles and make sure that they are being used appropriately. SEMG can be used to help decrease (or, down-train) muscles that are being used too much, or two increase (up-train) muscles that are being used enough and that are weak or not being used at all. It can help to correct imbalances in the muscles, making sure that the right muscles are being used at the right time, and in the right way.


So why haven’t we heard more about SEMG before? If you do a search for “SEMG biofeedback for low back pain” you will find that most of the studies were conducted during the 1980s and 1990s, with not much information after that. As we have mentioned before, SEMG biofeedback has been used with proven results for relaxation training, treating low back and neck pain, as well as rehabilitating stroke patients.



SEMG is expensive, complicated to use, and almost impossible to interpret the results without extensive training that not even many physical therapists receive


SEMG Equipment


Unfortunately the technology has not evolved enough to make it accessible enough to patients. The equipment is expensive, complicated to use, and almost impossible to interpret the results without extensive training that not even many physical therapists receive. This has meant that the technology has been limited to use in academic circles or specialized hospitals and clinics. Recently there has been an upsurge in new studies being done on SEMG which may indicate that the technology is evolving and creating a renewed interest in the use of SEMG biofeedback for chronic low back pain. The studies that are being done are showing promising results for patients.



Studies have shown positive results for trials of SEMG for low back pain patients.


Clinical Results For SEMG Biofeedback For Chronic Low Back Pain


Several studies over the years have shown significant improvements in both cognitive and behavioral outcomes for chronic low back pain patients. One study by Flor et al, done in 1991, found that SEMG biofeedback of the lumbar muscles was “superior to cognitive behavioral counseling (including relaxation without biofeedback) and medical treatment (as usual).”


A second study found that training the lumbar muscles with EMG biofeedback was associated with "improvements in chronic low back pain for up to two and a half years"!


A third study found that adding SEMG biofeedback to a traditional exercise program for chronic low back patients resulted in a “significant increase in lumbar strength measures”. While the researchers wanted to do further investigation to see if the improvement was due to an actual change in the muscles, or because of a reduction of fear avoidance, both of those are actually helpful for treating low back pain patients, especially because so many sufferers are terrified of working out in case they further injure themselves.



SEMG can help with muscle imbalances that affect chronic low back pain.


Other studies have found that when you correct the muscle imbalances in chronic low back pain patients with EMG biofeedback you get “decreased pain with gains lasting up to four years post treatment”!.


With results like these it is no wonder that researchers and healthcare providers are starting to take another look at this technology and see how to best adapt it to the modern population.



Not all health insurance plans cover biofeedback treatment.


Does My Insurance Cover Biofeedback?


Sadly not as often as we think they should. Some medical and psychological insurance plans cover neurofeedback or biofeedback for certain conditions. It really depends on your insurance plan and your carrier. If you are thinking of trying biofeedback check with your insurance company. They may also cover things like the initial consultation while not covering the actual treatment. Many companies still consider the treatment to be experimental even though it has been researched for decades. Hopefully this is something that will change in the future.



Side Effects Of Biofeedback For Low Back Pain


Biofeedback is a non-invasive treatment for low back pain sufferers. The fact that there are no side effects or potential complications makes this an excellent choice for treating low back pain and is why some physician guidelines recommend it as a first line treatment for chronic low back pain. There is virtually no risk to patients.



Biofeedback has proved itself as a suitable treatment option for chronic low back pain sufferers.


Conclusions


With chronic low back pain reaching epidemic proportions and patients missing out on work as well as social engagement opportunities, the cost to both sufferers and the economy is huge. With no one-size fits all approach to managing low back pain it is important that those who suffer from this condition have as many treatment opportunities available to them as possible.


SEMG biofeedback has little to no risk to patients and has a significant amount of positive scientific research behind it to justify its use for treating chronic low back pain. In the fight against CLBP it should definitely be considered within a comprehensive treatment plans for helping individuals recover as quickly as possible, and also to help prevent future injuries from occurring. Biofeedback has proved itself as a suitable treatment option and using it in interdisciplinary multimodal pain programs should be encouraged.