Low back pain is a condition that can be experienced at any age and affects most people at least once in their life. In 90% of cases, the most common presentation is described as non-specific low back pain meaning no serious structures or sinister pathologies are involved (World Health Organization (WHO), 2023).
However, despite most cases of back pain being non-sinister, people with back pain can experience significant pain and disability. In fact, low back pain is one of the leading causes of disability worldwide.
What causes low back pain?
In most cases, it is difficult to pinpoint one specific structure as a source of a person’s back pain. Any structure that has a nerve supply, e.g., the intervertebral disc, muscles, joints, and nerves themselves, can contribute to a person’s pain experience. On top of that, if pain persists, other factors can contribute to the person’s pain experience. These factors can be mediated by what’s happening in the spinal cord and brain. Even though it is difficult to pinpoint a specific structure, physiotherapists are experts at undertaking a comprehensive examination to determine what factors are contributing to your experience of pain and work with you to develop a plan to reduce pain, improve function and address contributing factors.
What factors might contribute to low back pain?
There have been many factors suggested to contribute to low back pain, such as sedentary behaviours, smoking, high physical stress, obesity, etc, but everybody’s body is different, and it is likely that different factors play a part for each individual person. It is also known that, due to the multifaceted nature of pain, factors such as sleep, and mental health play a large role in the emotional aspect of the pain experience.
Key facts to know about back pain include:
- Getting older is not a cause of back pain.
- Back pain is rarely associated with serious pathology.
- Scans rarely show the cause of back pain.
- Pain with exercises does not mean you are causing damage.
- Backs do not wear out with everyday loading and bending.
- Pain flare-ups do not mean you are damaging your back.
- Injections, surgeries and strong drugs are rarely the cure.
- Effective treatment for low back pain
- Spine posture during sitting, standing and lifting does not predict low back pain or its persistence.
(O’Sullivan et al., 2019)
What are some options for treatment for low back pain?
Research varies on timeframes for episodes of low back pain, but studies have shown that most people who present with acute or persistent low back pain improved markedly in the first 6 weeks (Costa Et al 2012).
Physiotherapists can play a key role in the management of lower back pain. Management might include:
1.Physical assessment
To understand your unique situation, a physiotherapist will conduct a comprehensive assessment that takes into account your history, movement patterns, and any symptoms you may be experiencing. This helps to ensure that any potentially serious underlying conditions are ruled out and that your treatment plan is tailored to your specific needs (Finucane et al., 2020). With this knowledge, a tailored treatment plan can be formulated to help each person achieve their goals.
2.Exercise prescription
Exercise is a crucial aspect of physiotherapy management for people with low back pain. Exercise can involve a focused exercise program that aims to address any impairments that may hinder daily activities and functions. Staying active can help individuals re-engage in meaningful activities and reduce the negative effects of sedentary behaviour. Exercise is an essential tool to build confidence with movements and activities.
3.Manual therapy
Manual therapy can be an important part of physiotherapy treatment for individuals suffering from low back pain. Manual therapy involves the use of ‘hands-on’ techniques with a specific purpose. In most cases, manual therapy reduces pain by influencing the nervous system. Additionally, it can enhance mobility, leading to increased self-assurance and confidence with movement.
4.Education
Gaining a greater understanding of the complex systems in play during low back pain episodes is crucial for empowering people through rehab. Education can encourage an active lifestyle, exercise advice, appropriate loading strategies and lifestyle modifications such as pacing and stress management. People with knowledge can enable them to make informed decisions allowing them to actively participate in their rehabilitation.
5.Multidisciplinary team
Depending on the specific patient, a collaborative approach to managing back pain may be superior and appropriate. The holistic nature of the treatment can include a variety of disciplines such as dietetics, occupational therapy, exercise physiology, psychology, pharmacology, and medical management to address the individual’s needs and goals.
Contact one of our clinics if you are experiencing lower back pain. A physiotherapist can guide you and help manage your pain, promote healthy habits, and discuss strategies to reduce recurrence.
References
Finucane, L. M., Downie, A., Mercer, C., Greenhalgh, S. M., Boissonnault, W. G., Pool-Goudzwaard, A. L., Beneciuk, J. M., Leech, R. L., & Selfe, J. (2020). International framework for red flags for potential serious spinal pathologies. Journal of Orthopaedic & Sports Physical Therapy, 50(7), 350-372. https://doi.org/10.2519/jospt.2020.9971
NSW Agency for Clinical Innovation. (2016). Management of people with acute low back pain. Musculoskeletal Network. https://aci.health.nsw.gov.au/__data/assets/pdf_file/0007/336688/acute-low-back-pain-moc.pdf
O’Sullivan, P. B., Caneiro, J., O’Sullivan, K., Lin, I., Bunzli, S., Wernli, K., & O’Keeffe, M. (2019). Back to basics: 10 facts every person should know about back pain. British Journal of Sports Medicine, 54(12), 698-699. https://doi.org/10.1136/bjsports-2019-101611
World Health Organization (WHO). (2023, June 19). Low back pain. https://www.who.int/news-room/fact-sheets/detail/low-back-pain