Low Back Pain:
The lower back (Medical term: low back) is an integral part of the entire human movement chain. It functions as part of a complex network of the skeletal, muscular and nervous systems. When the low back is injured it can affect one or all of these systems. As a result of its complex and undistinguished aetiology, the treatment for low back pain remains controversial.
Treatment options for low back pain include the following:
- Muscle relaxants.
- Nonsteroidal anti-inflammatory drugs.
- Epidural steroid injections.
- Back schools.
- Electromyographic biofeedback.
- Behaviour therapy.
- Transcutaneous electrical nerve stimulation.
- Exercise therapy.
Eighty to 90% of acute low back pain episodes dissipate within 8 – 12 weeks regardless of any intervention, but 5 – 10% regress into chronic low back pain.
Therapeutic exercises for chronic low back pain have been shown in numerous randomised controlled trials to be beneficial in reducing pain by up to 60% and improving functional ability by up to 47%. Furthermore, a Cochrane review on low back pain found evidence to support exercise therapy as an effective intervention in the treatment of chronic low back pain.
When prescribing exercises for an individual with low back pain the following goals need to be considered:
- Improve performance in endurance activities.
- Improve muscular strength around the spine.
- Eliminate any impairments in spinal flexibility.
- Reduce the intensity of the pain being experienced by the individual.
- Reduce back pain-related disability.
Dr Mike Evans on Low Back Pain:
Dr Mike Evans posts user friendly videos on complex medical issues. He makes science and medicine simple. You can check out his videos on YouTube (LINK) or on his website (LINK). His whiteboard health videos are well worth the time.
Below is a summary of his whiteboard video on low back pain. The video link follows at the end of the post.
Summary of the video:
- Low back pain is one of the top 2 reasons why people see their GP.
- Low back pain accounts for 40% of all missed worked days in the USA.
- Low back pain often resolves on its own without intervention. We can take care of ourselves.
- Severity of the pain does not reflect the seriousness of the underlying problem.
- 30% recurrence in 6 months. 40% recurrence in 12 months.
- We should view back pain as a chronic vulnerability, rather than discrete events.
- It is important to have a “back resilience plan” and a support team to help.
Back pain pattern 1: Back dominant.
- Pain is back dominant. Mostly in the low back.
- Pain can radiate down to the glutes, hips, and legs, but is predominantly in the back.
- There is relief with movement.
- There are particular movements help alleviate the discomfort, and movements that aggravate it.
- Often back “spasms”.
- Some dominant pain is “good pain”. It is not associated with damage to the spinal cord or nerves. Often does not require surgery.
Back pain pattern 2: Leg dominant.
- Often related to a disc problem (disc putting pressure on the nerves).
- Pain travels down the legs (“sciatica” / Sciatic pain).
- Pain down the leg – below the buttock to the foot.
- The leg pain is dominant.
- It is a constant pain that gets better with rest / lying down.
- Sciatica often gets better on its own, But may need: Special advice, medication, imaging.
- Leg pain is “predictable”. Certain activities / movements cause pain, other take it away.
- Pain anywhere in the leg.
- Gradually worsening.
- Heaviness that causes the individual to stop moving. Known as Neurogenic Claudication. It is related to stenosis / narrowing of the spinal canal. When severe it is hard for the nerves to keep up with activity.
Red flags: (may need more investigation)
- Sudden change in bladder and bowel control (numbness around groin / rectal area).
- Infection / TB.
- Risk for fracture (Fall, motor vehicle accident, osteoporosis).
- Cancer (Previous history of cancer, constant pain lasting weeks, not able to alleviate).
- Diseases (Ankylosing Spondylitis).
Yellow flags: (attitude and outlook are important)
- Belief that back pain is harmful or a disability.
- Fear and avoidance of activity / movement.
- Low mood isolation.
- Belief that passive rather than active treatments will help.
Should I get an MRI / Xray?
- A study by Prof Richard Deyo (LINK) showed that only 1/2500 back Xrays show a clinically significant finding.
- What is the harm in getting a screening Xray? Radiation, cost, time.
- One study with 98 asymptomatic subjects showed that 2/3rds had disc problems.
- Pain does not equal pathology.
So what works?:
- Movement – “motion is lotion”.
- Exercise (LINK).
- Avoid bed rest (people who dont move fare worse off).
- Over the counter medication for pain.
- Spinal manipulation from a Chiropractor / Osteopath*.
- Active therapies combined with exercise.
(* 8-10 sessions max. If no improvement then more treatments unlikely to help.)
“Complex problems rarely find their solution in one place”:
- Need a multi-factoral approach.
- Need a multi-disciplinary team.
- Less is more.
- Acknowledge the pain. Don’t focus on it.
- Small changes can make a big difference. 80/20 rule.
- Resilience plan needed.
- Mindset is critical.
- Develop daily habits.
- Have a knowledge of self.
Dr Mike Evans video on Low Back Pain:
Biokinetics and back pain:
- A Biokineticist can help you with your back resilience plan.
- A Biokineticist can educate you on your condition and prescribe corrective exercises.
- A Biokineticist can also give you advice on ergonomics and work station modification for back pain.
- A Biokineticist can be part of your network to help guide and support you.