Simplifying low back pain


Back pain can really interrupt your life.

Acute episodes of back pain can make even the simple everyday activities hard to do. Getting up out of a chair, rolling over in bed, putting your shoes and socks on in the morning – they’re all simple everyday activities that can become seemingly monumental when you’re struggling with low back pain.

Back pain can seem mysterious.

Why did it even start? Commonly low back pain develops for no apparent reason – you didn’t lift a heavy object or twist suddenly – you might have just got out of bed one morning and your back hurts.

There’s lots that can be said about back pain – what causes it and what to do to treat it. There’s a continual steam of new research being produced into the what, why and how of back pain. And opinions on the best management approaches are as numerous as the amount of health care provider Instagram accounts that exist!

The net result of all of that often equals confusion.

Demystifying back pain

What I’m about to say are some general truths about the majority of back pain presentations. It needs to be said that getting a thorough assessment by a qualified physiotherapist is important to confirm the best advice for you (not all back pain is the same).

Having said that there are some common trends and misconceptions that we see come in regularly to the clinic and this is aimed at simplifying things for the majority of cases.

Some back pain truths and implications…

1.The vast majority of back pain is not serious

I don’t mean it’s therefore not painful or impacting on you. But nasty structural causes of low back pain (things like fractures, infections, cord compression etc) make up less than 1-2% of all low back pain.

Most back pain it its core is a movement based issue. Scans are great at helping diagnose structural issues but don’t tell us anything about how we move.

The implication:

Calm your thinking. Back pain is like the common cold. Be optimistic and expect it to get better – because it will.

It’s highly unlikely that you need to get any scans (x-ray, CT, MRI etc). The pain is not due to a structural problem in your back. Movement problems need movement solutions.

2.  Some movements and postures can hurt more than others

Most back pain is influenced by movement. It’s quite common that acute (early stages) back pain can be worsened by certain movements. You might even be able to pick up on a pattern. For example a common pattern is pain exacerbated by sitting, bending, driving – worse in the morning.

Back pain that follows a pattern is a strong indicator that movement is likely going to help you get better. The movements that make you feel worse right now are not inherently bad or dangerous for your back. Its usually just too much too soon.

A way to think about this is like having a cut on you finger across your knuckle. If you bend your finger a whole lot that cut is not going to heal properly and the pain will likely hang around longer. But it’s also incorrect to say that bending your finger is bad or dangerous – it’s just too much too soon.

The implication:

A period of rest from a movement or position that’s shown to consistently aggravate pain, can be a good thing in the early stages to help settle the acute pain.

3. Some movements and postures can make you feel better

This is essentially the opposite of the point above. “Movement is medicine” – “motion is lotion”. Back pain most commonly  is a movement system problem. So movement can make you feel worse and movement can also make you feel better.

The example above of the person feeling worse bending, sitting, driving will often report feeling better when walking, standing or on the move.

The implication:

Leverage the movements that make you feel good to speed up your recovery. Do more of them. Short bouts done frequently is often a good approach.

Strength training

4. Your back is resilient and adaptable 

This is probably one of the most common issues we see with people presenting with persistent back pain. The strategy that helped in the early stages of pain (avoid the things that hurt) actually work to worsen the pain experience as time goes on.

To understand this concept better lets come back to that cut finger analogy again.

If you cut your finger then wrapping it up in a band-aid until it heals is a good first step. But if you then never take the band-aid off and never bend your finger again, you’ll be left with a finger that’s stiff and sensitive.  Now when you go to move it it’ll be painful. In fact the longer you leave it, even smaller movements will aggravate it. And if things progress further, you can be left with a finger that’s sore all the time despite moving it or not (we call this a persistent pain state).

Your back is similar to this. Avoidance of movement causes stiffness and sensitivity – which results in your threshold for pain-free movement to reduce. This means you can trigger your pain with less and less activity and your pain becomes more constant and persistent.

The implication:

Slowly and progressively restore normal movements – reclaim your everyday motion then work deeper into the extremes of your available range.

5. Your back is strong & movement is safe

This is true if you follow through on point 4. Progressively increasing your motion and reclaiming everyday movements and postures will bring you back to normal. If you then keep working to restore full motion in your spine you can be confident that your back is strong and robust.

It’s like you’ve slowly bent that cut finger after its healed. The tight healed tissue has stretched out and remodelled, your finger is now back to normal!

Thinking of movement as safe helps you live well and reduces the likelihood of recurrent episodes of pain. Avoidance and fear around movement are correlated with recurrent episodes of back pain.

In short slowly get back to normal life and live it to the full!

The implication:

Spines are meant to be bent, stretched and moved – the more you do this the more resilient your back will become! So move often and move right through your full range of motion!



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