Banishing back pain

The following fact might surprise you, it certainly surprised me when I first read it:

Lower back pain is the leading cause of disability and lost productivity worldwide!

In developed countries, in particular, the cost burden caused by lower back pain is extraordinary. Lower back pain which lasts longer than 12 weeks is called chronic lower back pain (CLBP) and 20% of the world population is affected! In around 90% of cases of CLBP, no definite cause for the pain is found and this is termed non-specific LBP. It is remarkable that so many people are walking around with a debilitatingly painful condition for which there is no satisfactory explanation.

The causes of CLBP are complex and beyond the scope of this brief article but suffice it to say that the presence of back pain does not necessarily mean that there is damage of any sort to your back or the surrounding structures. It is for this reason that back x-rays and fancy scans are not recommended unless there are signs of complications such as nerve damage or extreme pain. Most of the time, these scans would prove inconclusive in non-specific CLBP or even lead doctors and patients on a wild goose chase to try and nail down a cause. Moreover, CLBP has a strong mental component meaning the stress, anxiety, and financial cost involved with trying to find a cause can actually serve to worsen the pain further.

So, what to do? 

Move!

For many people, the tendency is to rest and lie in bed when back pain strikes. It is clear now that this is the worst thing to do for back pain in the vast majority of cases. Exercise training has collectively been shown to be effective in reducing back pain while passive modalities such as therapeutic ultrasound, massage, manipulation, and hot & cold therapy have all been found wanting. Passive modalities might be used in addition to a good exercise plan but the exercise should form the foundation of any back pain treatment plan. Pain is not a contraindication to moving your back; graduated exercise and movement in all directions is safe and healthy for the spine.

Many different types of exercise are beneficial for back pain, not just the ‘core’ exercises we are so often lectured about. The research would seem to indicate that Pilates, stabilisation or motor control exercises, resistance training, and aerobic exercise training are the most effective treatments, but chat to your physiotherapist about a treatment plan to suit you.

Remember to also work hard at shifting your negative mindset away from fear avoidance behaviour, negative recovery expectations, and poor pain coping as these behaviours are more strongly associated with persistent pain than actual tissue damage!

I’ll leave you with 10 helpful facts about back pain from a brilliant BJSM editorial by O’Sullivan and friends:

1. Persistent back pain can be scary, but it is rarely dangerous

2. Getting older is not a cause of back pain

3. Persistent back pain is rarely associated with serious tissue damage

4. Scans rarely show the cause of the pain

5. Some pain with exercise and movement does not mean that you are doing harm

6. Back pain is not caused by poor posture

7. Back pain is not caused by a ‘weak core’

8. Backs do not ‘wear out’ with everyday loading and bending

9. Pain flare-ups do not mean that you are damaging yourself

10. Injections, strong drugs and surgery usually aren’t a cure