Lower back pain. The dreaded words that are unfortunately all too common in the UK population. In the United Kingdom alone, 100 million work days are lost each year due to lower back pain (Croft P et al, 1993). Up to 70% of the population will encounter non-specific lower back pain at some point in their lives (Hoy et al., 2014)
People are often afraid of moving when they hurt their back because they are worried they'll do more damage. Pain does not necessarily mean damage, and this is never more true than in lower back pain. If you gradually challenge the lower back to move with gentle rotation and flexion exercises, the muscles which have likely gone into spasm will gradually release with time. It is now proven with many good studies, that those of us with lower back pain who return to work as soon as we are able, do much better, much more quickly than those who stick to rest. (Wynne-Jones, G et al. 2014) #RestisRust #MotionisLotion
Don't pursue a scan
Scans can be a useful tool to identify the cause of pain. In lower back pain however, this is rarely the case. There is a very poor link between the results of scans like X-rays and MRI and the pain a person is encountering. We often see people with a horrid looking scan, with no pain at all, and often get people with severe pain and a completely clear scan. This means that if we rely on a scan to tell us what the issue is, rather than the symptoms a patient is encountering, we may be lead down a path which is not related to the pain at all. At the end of the day, who cares if a scan tells us we have a degenerative spine when the majority of the population would be told the same thing. There is almost always something else separating those who have scan showing a degenerative spine with no pain, and those who have the same scan results and significant pain.
Pursuing a scan and revealing certain pathologies can often lead to fear of pain and worsening symptoms, when the pathology may well not be the thing causing the lower back pain in the first place!
Do NOT avoid exercise
Exercise is one of the most consistently supported treatments for lower back pain throughout all the most respected authorities. It is THE most effective way to treat your lower back pain in both the acute and chronic stages (O’Sullivan and Lin, 2014).
The other misconception in that one type of exercise tends to be worse than others, the most important thing is that you are exercising in the first place. Gradually build up your resistance, time and difficulty of exercise as your ability and tolerance improves and you should reap the rewards in the long term.
Studies have shown that high load resistance training is also beneficial. Just make sure you keep technique in check. You can't go wrong with getting strong! (Pieber et al, 2014)
Do NOT be afraid of your pain
Lower back pain can be scary, it can be disabling and it can make you want to stay in bed. You mustn't however, let it take control of you. Again, pain does not necessarily mean damage, and often in the back the amount of pain we feel compared to the size of the problem are very disproportionate. Furthermore, because the lower back is at the centre of all of our anatomical movements, it's no wonder that we feel so much pain.
Pain is a funny old thing, but we are discovering more and more that pain is a reflection of how much damage we feel we are doing to ourselves, and how much danger we perceive that presents us with.
As mentioned above, if you can start to overcome your fear of pain, and get yourself moving, you'll set yourself on an upward trajectory towards recovery. Physiotherapy is all about getting the wheels in motion.
Core, core, core...
Ah, the C word. I can't tell you the amount of patients I've seen who have had longstanding lower back pain, and with some basic and gentle core strengthening exercises are pain free within weeks. There are a whole system of muscles which will benefit the lower back, but targeting the trans-abdominal muscles with a variety of different exercise will generally work the correct systems, and get you back to feeling fighting fit. The common misconception is that doing lots of sit-up type exercises may provide you with core stability but often this is not the case. Speak to your trainer or physiotherapist about the best ways to train your transabdominals. The most important thing is that you get the level of difficulty right, try too much too soon and you may cause a flare up of your symptoms, try too little and you'll be unlikely to challenge your muscles enough to make a dent in your symptoms.
1 Wynne-Jones, G. et al., 2014. Absence from work and return to work in people with back pain: a systematic review and meta-analysis. Occupational and environmental medicine, 71(6), pp.448–56.
2 O’Sullivan and Lin (2014) Acute low back pain Beyond drug therapies; Pain Management Today, Volume 1, Number 1.
3 Pieber et al (2014) Long-term effects of an outpatient rehabilitation program in patients with chronic recurrent low back pain; Eur Spine J 23:779–785.
4 Croft P et al. The prevalence and characteristics of chronic widespread pain in the general population. Journal of Rheumatology, 1993, 20:710-3.
5 Hoy, D., March, L., Brooks, P., Blyth, F., Woolf, A., Bain, C., Williams, G., Smith, E., Vos, T., Barendregt, J., Murray, C., Burstein, R. and Buchbinder, R. (2014). The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Annals of the Rheumatic Diseases, 73(6), pp.968-974.