8 Steps to Tackle Back Pain
Low back pain (LBP) is the most common cause of musculoskeletal pain and disability in the world. 80% of people will experience it at some stage in their life. The good news is that most people will fully recover from an episode of back pain. What is abnormal is not recovering!
Most acute LBP is a result of simple strains and sprains and the prognosis for recovery is very good. Within the first 2 weeks, the majority of people will report significant improvement and by 3 months around 85% will have fully recovered. Only a small minority develop long-standing problems.
Furthermore, only 10-15% of acute back pain is attributed to serious identifiable pathology – that means that 85% of acute back pain can only be described as “non-specific low back pain” and cannot be attributed to a specific structure in the back e.g. a disc.
The challenge is to ensure that you recover fully and reduce your chances of having long standing pain and disability.
Download a copy of our 8 Step Guide to Tackling Back Pain or read on.
1. Find out if your back pain is serious or not.
The majority of back pain is nothing serious; but how do you know? Seek out a good physiotherapist or other health professional knowledgeable in back pain, to appropriately assess your condition. They can then either reassure you that nothing major is wrong or instigate an appropriate management plan if you have something more serious.
2. Scans usually aren’t necessary.
The majority of low back pain does not require any sort of imaging (e.g. x-ray, MRI). There are only rare circumstances where any sort of imaging is required and your physiotherapist or health professional will be able to identify when to refer for this.
A large number of findings on imaging can be considered normal signs of ageing (or living) and are present even in people without LBP. Consequently, imaging must always be correlated with your clinical presentation.
A study in 2001 looked at findings on MRI in people without back pain. It showed that despite having no pain, 92% had disc degeneration, 56% had disc height loss and 64% had disc bulges among a number of other things. As such, it is apparent that not all “problems” identified on scans cause pain or need to be treated. Findings like these can often be described as “wrinkles on the inside”!
3. Keep moving!
The research is now conclusive; those with LBP who remain active and return to work sooner have better long and short term outcomes. So, as long as the pain is not hugely debilitating or you are specifically advised not to, you are encouraged to avoid bed/prolonged rest and keep moving. Motion is lotion!
4. Exercise, exercise, exercise!
Despite consistent advice to the contrary, the fact of the matter is that no particular form of exercise has demonstrated superiority over others. What is helpful is any form of exercise!
If you enjoy the exercise you are doing, you are more likely to continue doing it and thus reducing your chance of future recurrence. So find something you like doing and get moving! Research shows us that just doing exercise can reduce your chance of developing back pain by approximately 25-40%.
5. Don’t aim for the “perfect posture”.
The perfect sitting/standing posture may not exist! Everyone is different and prefers sitting/standing differently and that is perfectly fine. What is important is finding comfortable positions for you – this may be different when you are in pain compared to when you have no pain. This may mean that initially certain positions may be painful (but not necessarily dangerous) and it makes sense to avoid them whilst they are painful. Normalising painful positions/postures is important for full recovery. That is, just because a certain posture was painful at some point in time, does not mean that you should try to avoid it forever!
6. Look after yourself.
Back pain can be caused by a combination of many factors; including physical, social, emotional, psychological and many other factors. What this means is that in most cases of LBP is that it isn’t just one of these things causing your pain, but rather a combination.
Back pain is multi-dimensional and a great analogy is the cold sore. Most people have had a cold sore before – it tends to come back when we aren’t taking care of ourselves for a variety of reasons. Perhaps we aren’t sleeping well, eating well or are stressed/run down – these can all contribute to a cold sore appearing. Back pain acts much the same – stress, fear, sleep and loading patterns can all affect back pain (among other things). Thus a multi-dimensional problem requires multi-dimensional solutions!
Now that you know that all sorts of things can contribute to developing back pain, you should think about aspects of your life which may be contributing to your pain state. Once identified, you will be in a better position to take action or seek appropriate help to lessen the impact of these issues on your pain state.
7. There could be a better alternative to taking pain medication.
Although certain medications have been deemed helpful for reducing pain (e.g. paracetamol and certain anti-inflammatories), research is now finding that they are often no more effective than placebo. Any medication also carries its own set of risks and has side-effects.
Exercise has demonstrated equal efficacy to a number of medications and has much lower risk! Consequently, exercise is a desirable alternative to taking pain medication. Additionally, it is not desirable to encourage passive dependency on medications where active, self-efficacious strategies appear to have greater long term benefits.
However, if you are experiencing significant discomfort it is advised that you consult your general practitioner or pharmacist for medication advice.
Other means to assist with managing any pain you are experiencing include the use of a simple hot pack or a TENS unit that many people with back pain report to be quite helpful.
8. Don’t become a movement avoider.
In the initial few days of acute low back pain, many people will find certain movements very painful. In these stages it may be wise to avoid such movements until they become less painful. Failure to do so can constantly aggravate your back condition and further wind up your pain levels. In saying that – the back was designed to bend, extend, flex and twist, thus it is essential that once pain allows, that you start to regain control over these movements and not avoid them permanently. If you permanently try to avoid certain positions, you can often increase your risk of further episodes of pain or impair your movement.
If you are experiencing back pain and need to know whether it is serious or not, or would like some specific advice or treatment for your condition, call 8850 7770 to make an appointment with one of our physiotherapists.