Lower back pain is often described as “a 20th century disease”, Its prevalence has become more and more common as our lifestyles have changed with increasing time demands at work and our home lives – particularly in light of reduced physical activity and increases in time spent sitting, with the spine in a prolonged flexed posture. But what can be done about it?
Background on back pain
Lower back pain is one of the most disabling disorders in the western world, with significant impacts to our personal, economic and social wellbeing. The rate of reported lower back pain increases significantly through adolescence, with associated disability, care-seeking and activity avoidance behaviours. At any point in time, a quarter of all adults in Australia have lower back pain. For 10-40% of this group, this can become persistent, with a significant impact on quality of life.
Only 1-2% of people will present with a more serious or systemic disorder, such as systemic inflammatory diseases, fracture or other serious malignancy. Your practitioner will screen for these at your initial consult, taking into account a range of symptoms and risk factors that would increase their likelihood of presentation. In most people however, lower back pain is benign and typically arises from a non-specific back sprain or sudden increase in sensitivity, which is amplified by psychosocial and/or lifestyle stresses.
Once these more serious malignant presentations have been ruled out, a big part of the task ahead is to then help the patient better manage their symptoms and enable them to get on with their lives without discomfort.
It is also important to bear in mind that while the presence of features shown on imaging such as advanced disc degeneration, spondylolisthesis, and structural changes to vertebral bodies are risk factors for lower back pain, they don’t predict it! How else can we explain the high proportions of “abnormal” findings in pain free populations, such as disc degeneration (91%), disc bulges (56%) and disc protrusion (32%)? These have been shown to be poorly associated with both pain and disability; there must be other reasons for this ongoing pain.
A relationship between beliefs and pain?
More and more evidence suggests that factors such as sleep disturbance, sustained high stress levels, depressed mood and anxiety are strongly predictive of lower back pain. It reinforces the role that lifestyle factors and negative thoughts have in sensitising spinal and nerve structures through the overstimulation of the “flight or fight” response, or sympathetic nervous system. These negative beliefs are also predictive of greater pain and disability levels, as well as the length of time of an exacerbation and time then needed off work.
Thoughts such as “I know it will just get worse”, “hurt equals harm or more damage” or “I’m never going to get better” only serve to make the problem worse!
What then is the take home message?
There are several key points then to remember, if you do suddenly have an acute onset of back pain while getting into the car on the way to work, or have that niggling ache in sitting that has been there for weeks. These include:
- Pain with movement does not mean you are doing harm.
- Gradually increase activity levels in relation to time, not pain
- It is safe to exercise and work with back pain – but you may have to modify the way you do this at first
- Relaxation is key – particularly in teaching normal breathing patterns and managing levels of back muscle tension and mobility
- Specific exercises as prescribed by your therapist will help maintain range of movement and help manage discomfort. Over time these will be progressed into more functional positions as your back becomes less sensitive.
- It is important to avoid “guarding” movements and holding your breath as a way of reducing pain short-term.
- Aerobic exercise for 20-30minutes/day that does not excessively exacerbate pain is important to build exercise tolerance, with gradual increases each week.
As physiotherapists at Physico City Physiotherapy, our first job is to screen people to exclude significant disability. We aim to identify those patients who appear at high risk of malignancies or other significant impacts on pain, and liaise with your GP to help to direct to the appropriate management strategy as indicated.
Our next task is to then help you in the management of your back pain, particularly if it is not settling with simple advice or is affecting you in the work or home environment. We aim to understand patient concerns and address any negative pain beliefs, while educating about the benign nature of lower back pain and how our own beliefs and psychosocial state influence our perception of symptoms.
A combination of active rehabilitation, coupled with a better understanding of lower back pain helps you get back to enjoying life faster. If you would like to know more, give us a call today!
Dillingham, T. (1995). Evaluation and management of low back pain: an overview. State Art Rev, 9, 559-574.
O’Sullivan, P. (2012). It’s time for change with the management of non-specific chronic low back pain. British Journal of Sports Medicine, 46(4), 224-227.
O’Sullivan, P., & Lin, I. (2014). Acute low back pain; beyond drug therapies. Pain Management Today, 1(1), 8-13.
Walker, B. (1999). The prevalence of low back pain in Australian adults. A systematic review of the literature from 1966-1998. Asia Pac Public Health, 11, 45-51.