April 6 2018
Low back pain is one of the most common and irritating conditions to deal with. Recent research suggests 1 in 4 Australian’s are currently dealing with it right now. Low back pain is something that nearly all adults will have at least one bout of in their lifetimes.
All sounds a bit dour doesn’t it? The good news is, low back pain is rarely serious or long lasting and there are a number of ways to manage it successfully. Part of the trouble is knowing what to do, what to take, who to see and how to get better quickly. Well, sit back, relax and read our insights into dealing with low back pain.
What is Low Back Pain and What Causes It?
Great question! Low back pain is often split into two different categories. If you have pain in your lower back that can be attributed to serious conditions such as fracture, cancer or inflammatory arthritis then your back pain has a specific diagnosis. Low back pain that cannot be attributed to a specific known condition is termed “non-specific low back pain” which is the one we are all talking about.
Whilst some episodes of low back pain feel severe, and often frightening, most people recover within a short time period of six to eight weeks and require little to no serious intervention. A great piece of research in Australia suggests that less than 1% of low back pain episodes are from serious causes and fracture accounted for most of those.
The important message is that low back pain is common and can be recurrent like a headache or the common cold. But much like a cold, the symptoms will subside and leave you without any major disability. One of the most important things is figuring out the triggers for your low back pain to help guide what you should and shouldn’t do. Early assessment is quite important in determining what to do in the case of an episode of low back pain. At Mitcham Rehab and Marion Sports Physio, we assess your low back pain and help you start to manage it from early in the piece. This will ease your mind on whether your back pain is serious and give you advice on how to manage it going forward.
I’ve Hurt My Back!! What Next?
As we just mentioned, episodes of low back pain are common, short term and a specific source of the pain often cannot be identified. One of the first principles of management is to not panic and look for quick fixes or costly and ineffective treatments. Often the quick fixes offered don’t work and invasive treatments such as injections and surgery are not needed. The best evidence we have suggests that keeping as active as possible without flaring your pain up is one of the most effective forms of treatment. This is where we can help! Knowing where to start and what to do to make you better rather than worse is challenging. This is where early assessment and advice from us can really help.
Our approach is to offer assessment and education on your condition and advise you on how to settle your acute pain down. We will provide you with a combination of manual treatment, to help loosen stiff and sore joints and muscles, and safely take you through the right movements and exercises. This approach will help you feel comfortable about managing your low back pain and resolving it as quickly as possible.
So, Do I Need an MRI or Xray?
Imaging for non-specific low back pain is rarely needed and should not be the first thing you do when you have an episode. There isn’t actually any issue with getting the scan done, it just depends on what you are told or what treatment you receive as a result.
Strong research evidence tells us that unless you present with symptoms that indicate that you fit in the 1% of people with serious pathology, imaging is not normally required. Again, if you aren’t sure, that’s where Physio can help!
Often when people get imaging the y see words like “degeneration” “disc bulging” or “arthritic changes” and worry that there back is going to fall to pieces. These changes are like grey hair, wrinkles and income tax … they are all going to happen as we age and are normal processes that are found on imaging. The relationship between these changes on your images and what is causing your pain is often weak and the findings need to be treated with caution. If you have had imaging or are considering it, have a chat with us, or your GP to see if it is appropriate. As a side note, make sure you deal with your income tax!
A Word On Medications
A range of medications are offered to people at various times for low back pain and it is very confusing to know what to take and whether to take anything at all.
The current thinking from research evidence is that a lot of the strong medications we previously thought were effective are not as good as we want them to be and can have greater potential for harm with various side effects. You should consult your GP, specialist or pharmacist for specific advice before starting any medication, but the current thinking is that simple over the counter medicines are as effective as any. The most important thing is that medicines are not used as a stand-alone treatment. You guessed it, team it up with active treatments.
So What is the Best Treatment
It will be normal for you to have significant pain early on and you may even move differently. Sometimes you feel like you are as stiff as a board and can’t move. I know you know what we mean because nearly all of us have had back pain! This is a normal part of the low back pain experience and is no different to a football player limping after a sprained ankle. Much like that football player, there is a period of rest and then a gradual return to activities with graded exposure to exercise and rehabilitation.
Rest is ok but make it short and avoid bed rest for hours and days on end. Being as active as possible is the best treatment. Try moving every hour for a minute or two to prevent stiffness and keep you on the improve.
It is also perfectly normal at this stage to be frightened to move and feel as though your back is going to go “out” and feel like it is going to give way. Firstly, nothing in your back is out! Your spine, much like the rest of you is strong, robust and is built for movement. Some great research out of a group in Adelaide suggests that a lot of the pain and protective spasm we get in episodes of pain is due to your brain seeing certain activities or movement as a danger. The call this danger in me or DIM’s for short. It is important in times of pain to try and find movements or activities that our bodies and brains find “safe.” These are called SIM’s or, safety in me. You can write down your DIM’s and SIM’s and this can help you find your triggers and keep you pain free.
To be clear, it has nothing to do with these DIM SIM’s …
“Commercial Dim Sims” by Sharon Robards is licensed under https://creativecommons.org/licenses/by/2.0/
Overall, increasing your activity within your pain limits is the most effective treatment. As we mentioned, this can be hard to know what to do. This is where we can help with ideas and problem solving to help individualise a program for you to get over your pain. Our hands-on treatments can supplement your activity and get you moving again as soon as possible.
A Word On Posture
Sitting has been given a bad rap ! There is a lot of blame placed on sitting and poor postures like slouching for causing low back pain. To date there is actually no scientific evidence to prove this theory. It is important not have the same posture for too long so get up from sitting every hour or so and relieve those postural muscles. Being active for an hour every day can reverse the potential negative effects of sitting , so, get moving!
Now That I am Recovered, Can I Prevent Any Future Flare Ups
This is an area of hot debate and needs more research but what we do know is, you guessed it, exercise is the only current approach that can prevent recurrences of low back pain. Some studies suggest it almost halves your risk of a recurrence! With all the other benefits that exercise provides as well why wouldn’t we do it!
People may tell you otherwise, but the best type of exercise is the one that you stick to!! Chat with us about what you want to do and we can help guide you on how to build up your exercise tolerance safely. Whether it’s walking, cycling, Pilates (which we wrote a piece on that you can read here), swimming or any other form of exercise, get started!
The Final Word
That’s a lot to take in and some of this may challenge your thinking. Most importantly remember that your spine is strong, robust and built to move! If your low back is sore, the best treatment is to move. Motion is Lotion! Early assessment and advice to ease your worries and help guide you on how to get better and moving quickly is what we love to do and what will start you on the road to recovery. If you need more advice, come and see us. We would love to get you back to your best or better still, get you better!