What you should know about back pain - by Alex Cross
Lower back pain is the most common presenting problem I see in the clinic, which is not surprising as it is the leading cause of disability worldwide1,2. However, back pain is too often managed with outdated treatments and information, further driving the pain cycle. Although back pain is common and can be scary, it is rarely dangerous or associated with serious tissue damage1. The purpose of this blog is to dispel a number of erroneous fallacies surrounding lower back pain and the idea of it being a life sentence.
Although back pain may last for a significant period of time, it is often not associated with serious damage to tissues or structures. Almost everybody will get back pain at some point in time, and most people will recover relatively quickly from an episode of back pain (usually within 6-8 weeks). As back pain is rarely due to structural damage, and most people have various episodes of back pain, it is often not necessary to MRI or x-ray the back, as this will rarely determine the cause of the pain episode3. In fact, disc and vertebrae abnormalities are seen in up to 97% of asymptomatic individuals, highlighting that pathology does not always equate to pain3. Rather, back pain is both complex and common, with no real distinguishable cause, hence why many clinicians refer to it as ‘non-specific lower back pain’. There are a number of specific structural features of the spinal column (muscles, joints, bones – figure 1) that could be contributing to the pain cycle, or commonly, pain could be driven by more psychosocial factors (work/home stress, poor sleep, inadequate health, mental trauma). As a result, there is no one quick-fix or antidote to improve symptoms immediately.
Figure1. Lumbar Spine Anatomy (https://www.spineuniverse.com/anatomy/lumbar-spine)
With this in mind, it is important to ensure individuals do not take back pain laying down. What I mean by this is that we need to find the right balance between movement and letting the painful area settle. Yes, it is important to reduce aggravating factors and modify potential loads, however, we need to continue maintaining some degree of movement and exercise to aide recovery. This helps to strengthen muscles around the area ensuring they can tolerate load once normal activity is resumed.
What type of movement?
Although all this information is good, the question of ‘what exercise is the best for lower back pain’ remains largely unanswered. In my opinion, and the outcome of much research – any form of exercise!
Exercise should be specific to goals and level of function, as well as what you enjoy doing! Various evidence supports the idea that any form of exercise, as long as it is tailored to the correct level, will lead to positive effects in the reduction of lower back pain4. Exercise therapy has been shown to be more effective than other, more passive treatments, in the reduction of back pain4. The most effective forms are generally considered to be – aerobic, motor control/stabilization, pilates and general strength, which can all be dutifully prescribed and laid out in a physio session4.
In particular, pilates can be a great adjunct to an individual’s normal weekly exercise regime, as it has shown to be particularly effective in individuals with chronic lower back pain (>12 weeks)5. The effectiveness of pilates-based rehabilitation stems from improvements of core strength, range of motion, balance and coordination, muscle symmetry and strength as well as overall flexibility5. Along with this, clinical pilates also has the ability to be low impact and guided specifically to the individual, meaning if somebody is in an acute flare up, they can get moving in a gentle, but effective manner. Here at Bayside Sports Medicine Group, we have physiotherapists that are trained in clinical pilates, so if you feel like that is something that may benefit you, book in today for an initial pilates assessment.
In support of all we have gone through in this blog, some of the worlds leading physiotherapists designed a great infographic to inform about some of the misconceptions surrounding back pain (Figure 2). Hopefully, this has clarified questions and concerns and outlined that back pain is neither uncommon, nor is it often attributed to one specific structure. However, in saying this, you should not just accept back pain as a part of your life, there are many ways we can tackle this together and ensure you continue to live a unencumbered and active life.
Figure 2. 10 Facts About Back Pain
References
1. O’Sullivan, Peter B., J. P. Caneiro, Kieran O’Sullivan, Ivan Lin, Samantha Bunzli, Kevin Wernli, and Mary O’Keeffe. “Back to basics: 10 facts every person should know about back pain.” (2019).
2. Hartvigsen, Jan, Mark J. Hancock, Alice Kongsted, Quinette Louw, Manuela L. Ferreira, Stéphane Genevay, Damian Hoy et al. “What low back pain is and why we need to pay attention.” The Lancet391, no. 10137 (2018): 2356-2367
3. Do not routinely offer imaging for uncomplicated low back pain BMJ 2021; 372 :n291 doi:10.1136/bmj.n291
4. Owen PJ, Miller CT, Mundell NL, et al Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis. British Journal of Sports Medicine 2020;54:1279-1287.
5. Effects of Pilates-Based Exercises on Pain and Disability in Individuals With Persistent Nonspecific Low Back Pain: A Systematic Review With Meta-analysis. (2011). Journal of Orthopaedic and Sports Physical Therapy, 41(2), 70–80.