The lower back is a very important part of the body. Its very clever in that it can move in all directions, it can generate big forces and bear huge loads, as it has a specialised set of muscles that control it. Similar to our general health, the health of the structure of the lower back is maintained through regular movement, keeping the back, trunk and legs strong, exercising regularly, maintaining a healthy body weight, caring for our mental health, sleeping well regularly, and not smoking or drinking too much alcohol. So, when these things go wrong, the structures of the back can become sensitised and unhealthy and we experience back pain.
What Is Back Pain?
Back pain is a term that relates to a pain problem that occurs anywhere between the rib-cage and the buttocks. It may also be associated with pain referring down the buttocks, legs and to the groin region. Common labels used to describe back pain are – disc degeneration, disc bulges, disc prolapses, facet joint arthropathy or osteoarthritis, annular tears and sacroiliac joint pain.
How common is it?
It is very common. Back pain rarely presents below the age of 10, however it is common during adolescence and becomes even more prevalent through life. It often occurs with other pain problems such as hip pain, pelvic pain, neck pain and headaches. Problems such as incontinence are also common with it.
Up to 80% of the population will experience this type of pain in their life, and for most people (70%) who get back pain they will recover to a large degree, although recurrences are common. For a smaller group of people (up to 30%) it may become distressing, persistent (lasting beyond 6-12 weeks) and disrupt many aspects of a person’s life. This can include limitations in the ability to do activities of daily living, exercise, work and participate in social activities. This can be very scary and lead to anxiety and depressed mood in many people. This is why back pain is the leading cause of disability. It is important to know, that it is very rare (1-2%) for back pain to be caused by a serious health problem such as cancer, fracture, infection or inflammatory disorder.
There are a lot of MYTHS about back pain including:
✖ Back pain is always a sign of tissue damage and needs urgent medical attention
✖ Scans are always needed to diagnose back pain
✖ Activities that provoke pain should always be avoided and rest is needed
✖ Loading your back and participating in activities like running, lifting and twisting are dangerous and can injure the back
✖ Experiencing this pain means your core is weak
✖ Back pain is caused by poor posture
✖ Back pain means something is out of place and needs to be put back in
✖ There is nothing you can do for it as you get older
✖ Surgery, injections and strong drugs are important to treat back pain
The FACTS about back pain often surprise people. These include:
✔ Back pain is the leading cause of disability – it can ruin lives but it doesn’t need to!
✔ It is rarely linked to serious tissue damage or life threatening disease
✔ Scans often can’t identify a cause of back pain
✔ So called ‘abnormal findings’ on scans like disc bulges, disc degeneration and arthritis are common and normal in most people without pain especially as they get older
✔ Backs don’t go out of place … ever!
✔ There is no perfect posture … a variety of postures is good for the back … even slouching is OK.
✔ Backs become healthier with movement and physical activity
✔ Gradually loading the back is safe and makes the spine stronger
✔ There are lots of things that can help back pain even when you are elderly … so don’t give up, get a good plan and stick to it.
✔ 30% of people that have back surgery are no better; benefits from injections are often short lived and strong drugs such as opioids are not effective for persistent back pain and have many negative side effects.
What Are The Risk Factors?
This type of pain is usually linked to things like: being stressed and tense, run down, carrying too much weight around the belly, sleeping poorly, low mood, inactivity, smoking, poor conditioning, overdoing it and doing things we are not fit for.
This can make your spine’s structures very sensitive. The good thing is that many of these things can be modified.
What Does Serious Back Pain Look Like? (1-2% of population)
- If you have had a traumatic injury like a fall off a ladder, seek medical advice to ensure you don’t have a fracture.
- If you are over 50, have had a previous history of cancer, aren’t feeling well, and have developed back pain for no apparent reason and it isn’t settling, then get checked by your doctor.
- If you have back and leg pain, a loss of sensation and power in the legs and have trouble passing urine get checked by your doctor.
What Happens For Most People When Back Pain Suddenly Occurs (acute back pain)?
Acute back pain can be really scary and painful. This can occur with awkward or unaccustomed movements of the back. Usually it is associated with muscle spasm where the back gets locked up making it very difficult to move. This usually settles within a few days. Although it’s scary, it’s important to try and stay mobile and active as possible.
What Happens For Most People When Back Pain Becomes Persistent?
When back pain persists beyond 6-12 weeks it is important to identify the factors that are keeping the spine sensitive in order to address them.
These factors can include: having a negative mindset about the back (“my back is damaged and can’t be trusted”), high levels of stress, worries or anxiety, low mood, fear of pain and or movement, avoidance of movement and activity, resting too much, carrying excessive weight (especially around the belly). These factors can cause changes to the nervous system making the spine’s structures very sensitive. Over tensing the ‘core’ muscles and over protecting or stiffening the spine can also be unhelpful, leading to more pain – a bit like clenching the fist all the time.
What Usually Causes Pain Flares?
Pain flare-ups are common and can be very scary. Ironically, they are usually predicted by things like being run down, unwell, inactive, stressed, doing unaccustomed activity and not sleeping well … not by damaged tissue.
Assessment of Back Pain:
It’s very important to understand that back pain usually improves with the right treatment even if you have had it for many years. Physiotherapists at Body Logic Physiotherapy play a very important role in the treatment of back pain.
The first and most important thing for us is to take time to hear your story and pain experience in your own words. We want to know how your pain feels to you and how it impacts on all aspects of your life so we can help you get back doing what you like. We will also screen you to ensure your back pain isn’t caused by serious health problems.
Following this we will conduct a comprehensive examination. This will usually involve looking at where you hurt, how your posture and spine move, your ability to relax your back and core muscles, as well as screening for your strength and fitness. We may also check things like your sensation and reflexes and do tests to check if your nerves are sensitive.
Based on all this information we will then explain to you in simple language the factors that are contributing to your pain, and discuss the best treatments options available to you.
Treatment of Back Pain
If your pain is acute (sudden onset), the key is to help you to get comfortable and moving as this helps with recovery. We will also identify the factors that caused the back pain and make a plan to prevent it in the future.
If your pain is persistent (longer than 6-12 weeks), we will work out a plan with you to help you take control of your pain and get back to living based on your goals.
Treatment may involve some hands-on techniques to relax you and get you moving, coaching you in body relaxation, training you to restore relaxed spinal movement, help you get strong and confident, resumption of physical activity and where relevant sleep rehabilitation.
A long-term plan is the key to prevent back pain from recurring and stop it interfering in your life. We also work with your doctor and or psychologist if additional care is needed.
At Body Logic Physiotherapy we are not interested in ongoing band-aid treatments. We know that the best way to manage back pain is to help you understand why you have pain, and get you back in control, moving, active and living again.
For some people this may take 2-3 sessions, however for long term problems this may take up to 7-10 sessions over a 3-4 month period. We also offer supervised exercise rehabilitation classes and one-to-one sessions to support this process if needed.
At Body Logic Physiotherapy we aim to coach people to get back in charge of their back.