Besides the common cold, lower back pain is the most common complaint people visit a doctor for. There is an 80% chance we will have at least one episode of back pain in our lifetime. Low back pain can be localised in the spine (centrally or to one side), but can also radiate down the leg which is commonly referred to as sciatica.
Back pain can arise from the joints, discs, and muscles, which are generally classified as soft tissue injuries. Occasionally the nerves are affected, and if there is an associated loss of reflexes, sensation and muscle strength, it is classified as radiculopathy or neural compromise. Contrary to popular belief, the back does not actually go “out” when there is pain. X-rays findings of people with back pain are often normal.
Back pain can be caused by a lifting injury or from trauma such as a motor vehicle accident. However, most of the time, there is no single cause. It is probably attributed to a combination of factors such as joint stiffness, poor stabilisation, posture, biomechanics (how we move), genetics (blame your parents!), weight gain and even depression.
Treatment of the condition often involves some form of movement intervention to treat the underlying stiffness involved. There is no one exercise which benefits all back problems. A thorough assessment needs to be undertaken. Specifically targeted manual mobilisation or manipulation of the restricted segment has been shown to result in a speedier recovery. We also try to provide some form of self-management program, rather than solely relying on treatment within our rooms. Core strengthening has also been scientifically shown to be effective, especially for chronic long-standing problems. Acupuncture utilises a different theoretical paradigm, but can be effective in some cases. We tend to use electrical modalities such as ultrasound and interferential machines sparingly, as the latest evidence suggests they are less effective than movement-based interventions.
Some self-management strategies for lower back pain:
- Avoid prolonged sitting and bending, and try to stretch backwards regularly.
- Lift with a straight back, keep the load close and bend at the knees.
- Maintain a healthy weight and diet, and perform regular aerobic-type exercises.
- Maintain an erect posture when sitting and standing.
- Avoid bed rest when in pain.
- During an episode of back pain, try and return to light day-to-day activities such as walking relatively soon, whilst avoiding the more strenuous and painful activities involving prolonged bending and heavy lifting.