Coping With Lower Back Pain
Most of us will experience lower back pain at some point in our lives. It is both incredibly common and recurrent, but rarely serious. In fact, with a lifetime prevalence of between 60-70% it is now the leading cause of disability worldwide and the number one musculoskeletal reason people visit their G.P’s (1). Whilst most low back pain will resolve in 6-8 weeks, up to 25% of people may develop persistent symptoms (2). There may be multiple reasons for this which we will discuss later. So, what is it, why does it occur and what is the best management?
What is it?
Simply put it is pain experienced in the lower back between the top of the hip bones and buttocks. Whilst there are a small number of people whose low back pain is attributed to serious causes, these will generally be screened appropriately by healthcare professionals. Most people (>95%) fit into the non-specific low back pain category (3). This is because joints, discs, ligaments and muscles in the back all have the potential to produce similar types of pain in the same locations, therefore making it difficult to establish the exact cause of the pain (3). Furthermore, regardless of the tissues producing the pain research suggests that management should focus on a holistic management approach for someone with low back pain. This means in addition to considering physical contributions to a person’s pain, such as tightness and muscle weakness, healthcare professionals should also consider how pain effects someone psychologically and the wider impact it is having on their lifestyle and social situation including work and hobbies (4). After all we are humans, and physical and mental health are inextricably linked. Therefore, there is more to consider than just the “back” – we must treat the person, not just the spine.
Why does it occur?
Low back pain is multi-factorial. Whilst there may be a specific incident which initially led to the pain, it may have also been a change in lifestyle, work, hobbies or general health which triggered it. These "triggers" have been shown to be non-physical as well as physical and research has helped to demonstrate the wide range of risk factors which may contribute to the pain (4,5).
Psychological triggers which may contribute to low back pain can be thinking you will not get better, depression, stress and fear of movement (2,4). Health and lifestyle related triggers can include being fatigued, sleeping problems, low levels of physical activity, being overweight and smoking. Sedentary occupations and those which involve repetitive heavy lifting may be more likely to develop low back pain (4). From a social perspective having money problems, poor relationships or support at work or home, low job satisfaction, stressful life events like a death or illness can all contribute to low back pain (4).
Therefore, you can see that low back pain should be considered from a broad perspective. Look at the diagram below and see all the elements that have been shown in research to contribute.
Given our knowledge of the various triggers, a sensible place to start would be to manage these. This may involve a different approach for each patient, with some requiring advice regarding their sedentary lifestyle and some requiring psychological support for depression or stress.
Currently the best available evidence suggests that an active approach involving exercise and rehabilitation have the best short and long-term effects on pain, disability and function. Exercise can almost halve the risk of recurrence and is recommended in the U.K, U.S and European guidelines to manage low back pain (6,7).
Regarding low back pain, evidence shows that there is no one form of exercise that is superior to another. For example, general cardiovascular exercise including walking, running, swimming and cycling have been shown to be as effective as Pilates (8). Also, physiotherapy has been shown as effective as Yoga (9). Simply put the best exercise is the one that the person will stick to. The key is staying active, as exercise has health benefits far beyond simply toning and stretching of muscles. It can reduce pain sensitivity in our nervous systems and releases endorphins which help to reduce pain (10). It helps reduce fear around our injuries and increases our confidence to move again and get back to normal function.
Not to mention the benefits of exercise on conditions such as depression, type 2 diabetes, cancer, heart disease, obesity and stroke (11). A quote form the World health organisation when talking about exercise “ If it was a pill, exercise would be a trillion-dollar money-maker prescribed to everyone”.
If you experience low back pain, remember to stay positive as there is generally a lot that can be done about it. Book an appointment with one of our physiotherapists to see if they can identify triggers which might be contributing to the pain. Alternatively, book with one of our Personal Trainers to get a programme of exercise suited specially for you. Remember, movement is medicine!
- Duthey, B. (2013). Background paper 6.24 low back pain. Priority medicines for Europe and the world. Global Burden of Disease (2010),(March), 1-29.
- O'Keefe, M. & O' Sullivan, K. (2018) All you ever wanted to know about back pain. What to do - and what not to do - to deal with low back pain. RTE. Retrieved on 25/2/19 from https://www.rte.ie/eile/brainstorm/2018/0130/937071-all-you-ever-wanted-to-know-about-back-pain/
- National Institute for Care and Clinical Excellence (2016) Low back pain and sciatica in over 16s: assessment and management. (NG59). Manchester: NICE. Retrieved on 25/2/19 from https://www.nice.org.uk/guidance/ng59/resources/low-back-pain-and-sciatica-in-over-16s-assessment-and-management-pdf-1837521693637
- O'sullivan, P., Caneiro, J. P., O'keeffe, M., & O'sullivan, K. (2016). Unraveling the complexity of low back pain. Journal of Orthopaedic & Sports Physical Therapy, 46(11), 932-937.
- Hartvigsen, J., Hancock, M. J., Kongsted, A., Louw, Q., Ferreira, M. L., Genevay, S., ... & Smeets, R. J. (2018). What low back pain is and why we need to pay attention. The Lancet.
- Foster, N. E., Anema, J. R., Cherkin, D., Chou, R., Cohen, S. P., Gross, D. P., ... & Turner, J. A. (2018). Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet.
- Shiri, R., & Falah-Hassani, K. (2017). Does leisure time physical activity protect against low back pain? Systematic review and meta-analysis of 36 prospective cohort studies. Br J Sports Med, 51(19), 1410-1418.
- Mostagi, F. Q. R. C., Dias, J. M., Pereira, L. M., Obara, K., Mazuquin, B. F., Silva, M. F., ... & Lima, T. B. (2015). Pilates versus general exercise effectiveness on pain and functionality in non-specific chronic low back pain subjects. Journal of bodywork and movement therapies, 19(4), 636-645.
- Saper, R. B., Lemaster, C., Delitto, A., Sherman, K. J., Herman, P. M., Sadikova, E., ... & Roseen, E. J. (2017). Yoga, physical therapy, or education for chronic low back pain: a randomized noninferiority trial. Annals of internal medicine, 167(2), 85-94.
- Harber, V. J., & Sutton, J. R. (1984). Endorphins and exercise. Sports Medicine, 1(2), 154-171.
- Durstine, J. L., Gordon, B., Wang, Z., & Luo, X. (2013). Chronic disease and the link to physical activity. Journal of sport and health science, 2(1), 3-11.