Back pain is the most common reason to see a physiotherapist, and the second most common reason to see a GP. So it’s really common, but actually quite misunderstood – most people don’t know the major triggers of back pain, meaning you could have a lot more control over your pain if you only knew more about it… so here are some facts about it to help you!
FACT 1. Back pain is pretty normal. Almost everybody will experience low back pain at some point in their lives. Getting it doesn’t mean you will now be a chronic back pain sufferer (we tend to be a bit alarmist when it’s our back, but a back injury can heal just like any other injury can).
FACT 2. Getting an MRI scan or x-ray when you don’t need one (more on this later), statistically means that your pain will cost you more and take longer to get better….
Strong evidence shows that serious disease (such as cancer or fracture) is only present in approximately one percent of people with low back pain and a scan is only needed if it this is suspected. Your Chartered Physiotherapist or GP should be able to identify signs and symptoms which suggest serious illness and warrant more investigations.
The unfortunate thing about getting an unnecessary scan, is that it is almost guaranteed to show up disc bulges and degeneration among other things. These are actually a normal part of aging (think of them as wrinkles on the inside) BUT it’s unlikely these are the cause of your pain.
There have been a lot of really strong studies done, where they have MRI’d people with and without back pain, and they found that the MRI scans looked the same whether people were in pain or not (see table below).
This tells us that there is more to pain than meets the eye. Pain is not just based on physical factors. It has a lot of triggers, many of them not what you think! If there was one cure for back pain, whoever had it would be a multi-billionaire! The bottom line is, there isn’t. Back pain is multifactorial (ie a number of factors create and maintain it), and everyone’s life is different, so there are probably a number of different reasons for your back pain, and therefore generally no one simple fix or solution. HOWEVER through understanding YOUR back pain, its triggers, and how you can address them, you can regain control of your back pain.
FACT 3. You shouldn’t rush into surgery.
The results on the scan might lead you to be referred to a consultant for procedures such as injection or even surgery – Mary O’Keefe from the UL is a leading researcher in back pain, and states that “almost all international guidelines recommend it be avoided for a considerable period of time to allow adequate time for either natural recovery or recovery using non-surgical approaches, like exercise. Unfortunately, many people are sent for surgeries such as lumbar fusions too quickly which involve more cost, more risk and importantly do not seem to improve outcomes. As well as being unnecessary and expensive, these procedures can create a lot of worry that can distract people from helpful activities like exercise. While leaving no stone unturned can be good for other things in life, too many tests can lead to the ineffective overtreatment of low back pain.”
FACT 4. Rest is bad, activity is good!
In the acute stages, bed rest is probably all you want to do, but unfortunately science has proven it will take longer for your back pain to get better if you do this. “Relative rest” is recommended- in the first few days,you do what you can, and avoid what hurts, before gradually trying to ease back into that activity. That is a simplistic view, and sometimes you need a bit of help in figuring out exactly how to do that. But there is very strong evidence that keeping active and returning to all usual activities and hobbies is important in getting better. The back, like all body parts, is designed for movement and will adapt to different activities with practice and the right approach.
FACT 5. Exercise helps to reduce pain and prevent future episodes
Exercise is very good for low back pain and the best is the one that you enjoy, and stick with over time. For example, walking, running, cycling, swimming, yoga and pilates all have similar effects for low back pain and are equally safe so people should pick the exercise they prefer, or choose a mix of exercise.
Exercise is the only known current approach that can prevent recurrence of low back pain. It almost halves the risk of recurrence. The longer the person can do the exercise for, the better results they will get.
FACT 6: Pain does not mean damage - The common view is that low back pain is always a sign of injury or damage. While in some cases it is (for example a broken bone, or an underlying medical condition), we now know that low back pain can be triggered or made worse by depression, stress, low energy/being run-down, unhealthy lifestyle, smoking, being overweight, sleeping badly, stressful life events. This is not saying the back pain is not real! It is!! But these issues can trigger the pain, or make pain worse if you have it already. This is because our brain responds to situations of stress, and can tend to heighten things like pain. So just because the pain is bad doesn't mean the damage is bad!There is actually no relationship between pain intensity and extent of damage.
Pain can lead to us getting caught in a vicious cycle of pain (see image below)– the pain makes you depressed or anxious, which increases the pain. Or the pain has made you become inactive and gain weight, which has made your pain worse. Very often you just need to figure out how to break out of this cycle so you can actually make a start on getting back into things (we can help with this).
FACT 7: Stress and lack of sleep can trigger back pain.
Stress is a big trigger for back pain. For example, your relationship with your boss and co-workers, your job satisfaction, feeling supported at work and when returning to work are all extremely important in low back pain. Identifying there is a problem and trying to address it will not only help your situation, but may improve your pain.
Sleep is important to prevent back pain – you are much more likely to hurt your back if you are tired, and your pain is worse if you are tired, and it takes you longer to recover from pain or injury. The ideal is 8 hours per night. Here is are some tips on “sleep hygiene”
Generally speaking, a healthy lifestyle will help your back pain - being a healthy weight, giving up smoking, spending time with people who make you happy, reducing work and life stress, are all sensible and cheap ways to treat low back pain and reduce the risk of recurrence.
Other things you can do:
- Get back to work as quickly as you can if you hurt your back.
- Move more, sit less! Your best posture is the next posture! Your back is made to move, not to sit all day, so break up inactivity by moving when you can.
That’s a lot of information in one go. People often need help to know where to begin, and need help in breaking out of the pain cycle so they can actually make progress. If you feel you are caught between a rock and a hard place with your back, or just want a bit of advice, get in touch, we can help you get back on the right track.
We will assess you physically, see what we can do to improve your movement, strength and function, usually with a combination of hands on treatment (to help to break you out of the vicious cycle of pain) and a rehabilitation plan. We will also have a look at lifestyle factors and see what you could improve to help manage your back pain better. We also run back care pilates for people who want to get going but have a back complaint or medical issues holding them back.