Pretty much everyone at some stage in their life will suffer from an episode of lower back pain. The aim of this blog is to shed a bit more light on the most recent strategies to assist in the management of lower back pain. In addition, it is to help dispel some of the myths around lower back pain that lead to poor management and to longer term issues. If you are struggling with lower back pain please see a Chartered Physiotherapist and get on the road to recovery!
The statistics for lower back pain are pretty interesting;
• 2014/15 National Health Survey 19% of Irish people reported suffering lower back pain in that 12month period
• Back pain more common in Ireland than diabetes, heart disease, high blood pressure
• Back pain accounts for 25% of doctor visits
• Irelands leading cause of disability
A recent series of articles in the Lancet Journal – the oldest, most prestigious and best known medical journal. When an article is published in this journal as a healthcare professional you really need to take it on board. These articles combined with the great publications by the internationally renowned back pain specialist physiotherapists based here in Ireland namely Dr. Mary O’Keefe and Dr. Kieran O’Sullivan adds so much to the evidence that how we have treated lower back pain in the past needs to be updated and inspired this article so big Thanks to them for all their hard work.
Outlined below are some tips and advice on how we should be managing lower back pain to reduce the likelihood of long term disability.
1. Most episodes of lower back pain are not serious and clear up reasonably quickly
When an episode of back pain occurs it can be sudden, severe and frightening. Almost everyone will experience an episode of lower back pain during their lifetime similar to the common cold. It will run its course and settle quickly. Statistically 99% of back is not serious. Pinpointing possible triggers to recurrent lower back pain can be helpful i.e. sudden change in activities, stress, fatigue, lack of sleep. If you can address the triggers this may reduce the likelihood of re-occurrence of lower back pain and ensure lower back pain is not a long term disability. However, if your unsure of what your potential triggers are and the back pain is not settling visiting a Chartered Physiotherapist for an assessment and bespoke management plan may be required.
2. Avoid bed rest
The research shows that people who use bed rest or prolonged rest as a form of treatment for lower back pain do worse in the longer term. Similar to any other acute injury it is important to avoid pain provoking activities in the initial stages however this strategy can be detrimental over a longer period. The research indicates that moving is better over the longer term.
3. Don’t rush for an X-ray, CT scan or MRI scan
Fortunately, these tests are only required if there is suspicion of serious disease i.e. cancer, fracture, infection, spinal cord injury which accounts for 1% of lower back pain presentations. Lower back pain that is accompanied with unexplained weight loss, history of cancer, changes in bladder and bowel patterns, loss of power in the legs, numbness between the legs or fever may indicate a more serious diagnosis.
In general for people with lower back pain having one of these tests will likely show some abnormality which may or may not be the source of the pain. Some recent research found that the prevalence of lower back disc abnormality in people with NO back pain was 30% at 20 years, 40% at 30 years, 50% at 40 years, 60% at 50 years. This means that changes seen on MRI of lower back is part of the normal aging process and NOT always associated with pain therefore MRI results should be interpreted in the context of your clinical condition.
4. Surgery is rarely required as a treatment option for lower back pain
Surgery maybe required on the rare occasion where there is pressure on the nerve supplying the legs which present in pain, weakness, pins and needles and numbness in the legs that has failed to resolve with conservative treatment.
Over the medium to long term a comparison of surgery and conservative management like exercise relieved that surgery is no better. If you are unsure what exercises could help you why not contact a Chartered Physiotherapist and get started.
5. Your back is a strong robust structure
During an episode of severe lower back pain, it is common for people to think that they have “put their back out” or their disc has “slipped”. There is no evidence to support this theory and it’s more likely they are experiencing severe protective muscle spasm that accompanies the lower back pain. The discs, bones, joints in the back do not go “out of place or “slip”. The discs are firmly attached between the back bones and cannot move however they can get inflamed or swollen. The technique of “putting your back in place” or “cracking” or manipulating the back will give reduce pain and provide short term benefit as it causes a relaxation of the muscles in the lower back and the nervous system.
6. The perfect sitting posture does not exist
Contrary to popular belief the perfect sitting posture does not exist and there is no scientific evidence that sitting causes low back pain. However, when you are experiencing an episode of lower back pain sitting for a prolonged period can be uncomfortable and sitting in a supported position maybe helpful. Your back likes to move therefore changing position/posture regularly is of great benefit.
7. Poor sleep influences back pain
When suffering from lower back pain it can be difficult to get a full night’s sleep and vice versa not getting enough sleep can be a contributory factor to ongoing lower back pain. In the same way – not getting enough sleep can make us stressed, irritable, give us a headache, it can also cause or prolong episodes of lower back pain. In addition, not sleeping well can slow down the recovery process from musculoskeletal injury. Therefore, improving sleep routines and habits can be very helpful in managing many painful conditions.
8. Lifting and bending are not enemies of the back
The back is actually designed to bend and lift. If you are lifting heavy items in an awkward position this can increase the likelihood of you experiencing lower back pain and maybe the cause of an episode of lower back pain. But this does not mean that you should avoid these in the long term. If lifting objects is a big part of your daily routine it is worth building up a tolerance therefore you ger stronger and more confident. Returning to lifting after an episode of lower back pain should be approached with the same philosophy as returning the activities after any injury. You need to train to get used to the activity, build strength/endurance in the muscles and build up tolerance to the activity.
9. Get moving – exercise is good and safe
There is no scientific evidence to show that one exercise is better than another when it comes to lower back pain. What we do know is that if the person enjoys the exercise they are likely to participate over the longer term whether that be running, walking, swimming, biking. If you are unsure of how to start back into exercising after an episode of lower back pain a visit to a Chartered Physiotherapist can be a good idea to get you off to the correct start.
Unfortunately, exercise is not a cure however it is the only current approach that might prevent the reoccurrence of lower back pain. It is worth noting that getting back to exercising after a period of inactivity can lead to its own aches/pains or episodes of feeling uncomfortable. It is good to pace yourself returning to exercise or taking up a new exercise to ensure this doesn’t happen. In addition, it is good to remember that this is not damage to your body just your body becoming accustomed to exercise again. Take confidence in this and continue with the exercise.
10. Low back pain is an individual and unique experience
Sometimes lower back pain can be attributed to structures like the disc/joint/muscles however there are other triggers in life that can make it feel worse and these are different for everyone. There can be emotional triggers (fear, stress, depression), health related triggers (being tired or run down), lifestyle related triggers (poor sleep, obesity, lack of activity, smoking), social related triggers (stress, financial issues, poor support at work). All lower back pain is REAL no matter what the trigger. Therefore, it can be a good idea to look at your overall health and wellbeing to see if there are any positive changes that could be made.
11. Don’t expect pain killers to be the answer
In most cases – strong pain doesn’t need strong pain relief. Normally over the counter pain medication can give sufficient relief to allow person to get active and moving. Using over the counter medication reduces the likelihood of associated side effects from stronger prescribed medication. It is also worth remembering that pain relieving medicines are just that and not actual pain killers. They will reduce pain levels to allow you to get moving active again therefore should be used in combination with other strategies to manage lower back pain. It is best to speak to your pharmacist or GP regarding what pain relief medication is safe and appropriate.
12. Remain active
This may seem difficult when in the middle of an episode of severe lower back pain. The key is to find balance between not resting completely and letting the back pain settle. Modifying activities so that you are not doing pain provoking activities for a few days (i.e. lifting) and then gradually building these activities back up. You do not need to be completely pain-free to start moving again. In a nutshell – you should try to remain as active as possible and get back to full activities as soon as able. If you are unsure or not confident about getting back to full activities after an episode of lower back pain making an appointment with a Chartered Physiotherapist sooner rather than later can be beneficial to get you on the correct pathway.
If you are struggling with lower back pain why not click here to make an appointment or ring (059)9116939.