A global crisis, but also an individual pain….in the literal sense. Individual because so many different things can cause low back pain, it is what we call multifactorial (reference, reference), from bending forwards and lifting something too heavy and spraining the back (like an ankle sprain) or simply being a bit under the weather, not sleeping very well and that coming out as back pain (like a headache or a cold). It is often not one single cause but a combination of a few.
So, there has been a lot of talk about low back pain over the last week in the medical community but also in all major media outlets. The Lancet, a highly respected Journal, last week released a series of papers in an attempt to address the issue.
These are mainly directed towards Health Care Professionals, with the aim of appealing to them to stop offering ineffective and potentially harmful treatments. However, we can also take some good messages from this to help people who are suffering from low back pain.
But firstly, what do we mean by ineffective and potentially harmful treatments.
For me, this is when health care professionals are telling patients that something specifically is wrong with their back. It is pretty much impossible to be specific with structures that are causing pain in the back (reference). So if you have back pain, and you are being told that something is out of place, or something is out of alignment, please question the person telling you this….as the likelihood is, it is not.
This is also why they state that scans are unnecessary. Unfortunately scans are not all they are cracked up to be as if you scan lots of people who have no back pain at all a lot of these people will have ‘something wrong’ with their back whether that be degenerative changes, disc bulges, tears etc (see table, reference)….but they have no pain! How does that work? It works because those structures don’t cause low back pain….lots of other things combined do.
The second part of being ineffective is the treatments that are offered. This is a contentious subjective. What we do know is that acupuncture, traction, or electrotherapy (ultrasound, interferential, laser) provide nothing more than a placebo effect (reference). If the person you are seeing for your low back pain use any of these, please question them as to why.
The main contentious issue lays with manual therapy (mobilisations, manipulations, massage, soft tissue release). Now I use manual therapy with my patients, as it does work (to reduce pain). But it works with some people and not others, and there are good times to use and not use. Often this good time to use it is in the acute stage / the really painful stage where it can have an effect of reducing pain and allowing people to start to exercise and rehabilitate the back. However we have to be realistic with what manual therapy does and it can become a harmful treatment when therapists or practitioners tell patients or clients that what they are doing is changing the structure of the back or musculature, for example, putting joints back in or realigning joints, releasing muscles etc. It does none of this. And if people start to believe this, then they become reliant on therapists doing something to them to make them better, rather than doing the right things and rehab’ing, which in the long term can lead to more low back pain.
To put it simply, what mobilisations, manipulations and massage does is affect our nervous and sensory system to reduce pain and relax tissue. This makes you feel better and therefore able to move easier or have the confidence to move easier.
So what is the point of this article? Well in the next couple of paragraphs we’ll go through how to tackle acute low back pain, and in the following articles how to rehab the back, get strong and reduce the chance of getting it again. But what I wanted to do, is give people an outlook of where the medical community is in terms of low back pain, and what works and what doesn’t and hopefully encourage people to expect more, or question more when it comes to their treatment. If you have any questions please do not hesitate to get in touch.
What to do when you have acute, severe low back pain.
This is normally the earlier stages of back pain and can be very very painful.
1. The first thing to do is not to worry.
Only 1-2% of people with low back pain have anything seriously wrong with them (reference). And when over 80% of the population get low back pain, that’s a very small number. With this in mind, when we have this pain we do not need to rush to get a scan.
2. Scan’s will always show something, but are not needed.
Scans will shows something in foot and healthy 20 year olds with no pain as well, so that something is often not linked to your pain. Rather than focus on a scan, ask yourself what will it change (often we only want to scan if we are considering invasive interventions like surgery or injections), and then focus on what you can do to get yourself better.
Often low back pain is like a sprain of the back and can be considered like an ankle sprain. Picture that, going over on your ankle, lots of swelling and inflammation, lots of pain, unable to move the ankle or walk on it. But, you rest, use pain relief and ice, slowly start to move, slowly start to walk on it and after a couple of weeks it starts to get better. Low back pain can work in the same way.
- Walk little and often. 10 minutes 3-4 times a day.
- Change your position every 20 minutes
- Return to work and normal activity as soon as possible (helps to speed up recovery)
- Stay in one position for too long or embrace bedrest
4. Pain relief can help.
I say this loosely as we all metabolise pain relief differently. But the key thing is to move. Otherwise we develop a fear of moving, brace and move stiff causing muscles to tense and spasm, which is then a catch twenty two as you will get pain from the muscle and not moving properly. Use what suits you and take regularly rather than when just in pain. If you have queries regarding this, consult your general practitioner.
The best things to do in this acute stage is to keep your exercises as simple as possible but do them regularly. Work on just two movements to start, forwards and backwards and then once they are nailed you can progress on.
Once you can seated flexion comfortably with no pain and good fluid movement move on to standing.
Click the links for videos. Repeat each exercises 5-10 times, every 1 hour.
6. Take note of your life at the time.
Are you sleeping ok? Are you getting the recommended 7-9 hours? Do you feel stressed? Or anxious? Are you a bit run down? Are you exercising enough? Guidelines suggest we should do 150 minutes (2.5 hours) of cardiovascular exercise a week, and resistance / strength training twice a week. All these things have been linked with increasing the risk of low back pain. So if you are a bit stressed, a bit run down, not sleeping well, spending long periods sitting and not reaching the exercise recommendations then you will be a likely candidate to get low back pain. Write down everything you have been doing, or felt over the last four weeks and see what you find. Then come up with an action plan to help improve on any factors that may be contributing.
I hope this helps some people get over their acute low back pain. If you have any questions, please do get in touch. For those of you that may have moved on from the acute stage but are still left with a niggling back pain which goes through good and bad days, watch this space for part 2.