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Lower Back Pain - Why isn't There a Magic Pill Yet?


Back pain can be very debilitating and disruptive to your life, preventing you from doing the things you love or performing your best at work. Lower back pain is a common occurrence and affects up to 80% of adults at some point in their lives. This may be due to an acute incident, repetitive strain, or exposure to prolonged and unfamiliar postures.


Back pain is one of those things that many patients that I see will tolerate over a period before coming to see me in clinic. They’ve been dealing with pain and ignoring it until it’s gotten to a point where it affects their work, sleep or hobbies.


We’ve found that early detection and consideration of the contributing factors help in the long-term management of back pain.


“Is it to do with my Chair?”

"I was told it's to do with my weak core."


Many of those with back pain also have a history of recurring flare ups and although research would suggest that this may be due to a variety of physiological/psychological and physical factors, ineffective initial management/diagnosis may be another contributing reason. In many cases, treatment for low back pain is focussed solely on the initial pain relief without a consideration for a full rehabilitation program to reduce the impact of further recurrences.


That’s why the first step towards treatment is to get a thorough understand of your back pain history and lifestyle to understand which components may be impacting on your recurrences of back pain. The risk factors for back pain are multifactorial and may include:


- Stresses – work, home, financial, physiological, psychological, social etc

- Work type

- Activity levels

- Medical considerations

- Genetics

- Age

- Etc..


Often, these injuries are due to what’s called ACCUMULATIVE STRAIN (see graph below). That means the way we’re repetitively moving our body, in conjunction with the above risk factors can start to compound over time and may cause various tissues to become sensitive.


Graph - 'hair that broke the camels back' scenario. Tissue undergoes various stress' that are often considered 'subclinical' until the 'point of overload' which brings on the onset of symptoms.

This may not be what you’ve experienced in the past, as its usually ONE (sometimes insignificant) action that will trigger the pain – eg. Picking up your child, putting on your shoes or even leaning forward to brush your teeth (see graph above - point of overload). Therefore, understanding the bigger picture of your activity/movement history is necessary to understanding the WHY behind your lower back pain.


Calm Sh*t down, Build it back up


While initial management of back pain is focussed on pain management, after acute pain subsides, the aim is shifted to creating a plan which supports your body's recovery and resilience in the long term. This includes exercise-rehabilitation programs and lifestyle modifications (posture, workplace ergonomics, exercise parameters, activity levels, sleep etc). This ongoing management over time is aimed towards building resilience within the spinal system and addressing other contributing factors which have been found in the research to be risk factors for persisting LBP occurrences.


While initially, certain painful activities may need to be done less frequently, ACC’s Lower Back Pain guidelines advises MOVEMENT as the number one thing you can do for your recovery. While this may seem counterintuitive for someone who is in pain, early movement has been widely researched to correlate with better recovery rates and pain levels.


Practical Recommendations:

  • Despite its complexity, your spine is a STRONG structure, so don’t fear movement. Aerobic exercise helps to stimulate better blood flow and manage inflammation and chronic pain. Walking on flat surfaces while swinging your arms can help to reduce the effects acute muscle spasm.

  • Have an assessment with a Physiotherapist – In New Zealand, you don’t need a referral to see one. A detailed assessment can help to identify directions of movement that can lead to rapid short-term changes in acute pain levels and help you get back to your hobbies and life.

  • Following your physio session, you will usually be given 1-3 specific exercises which will be easy to integrate into your daily routine. These exercises are usually unique for the type of injury.

  • For the long-term management, muscle strength is very important. Especially exercises targeting the quadriceps, glute and trunk muscles are all going to be important in reinforcing a STRONG and RESILIANT lower back.

  • AVOID staying sedentary for more than 30-40mins at a time during your back pain episode. As mentioned before, avoiding aggravating positions and doing frequent movement (such as light stretches or brisk walking) is prefered.

  • Many workplaces provide ergonomic assessments which are generally helpful. However, if your injury is exacerbated by your working environment, a more personalised assessment may be necessary. Ask a colleague to take a photo of you sitting in your workstation and bring it with you to your physio appointment.

  • Physiotherapists can provide referrals for scans and other specialists as appropriate. If you need advice around pain medication, you’ll need to chat to your Pharmacist/GP.


Why isn’t there a Magic Pill already?


As discussed above, back pain is multifactorial BUT for certain types of back pain there may be a more RAPID solution for you. This is NOT a short cut by any means, but an effective, early management strategy that has been shown to alleviate symptoms in the short to mid term. The McKenzie Method is one of the most well researched assessment and treatment method worldwide and was created and developed by the NZ Physiotherapist, Robin McKenzie. He believed in a way of treatment that allowed patients to take control of their pain by doing regular, SPECEFIC movements that RAPIDLY reversed the symptoms of lower back injuries.


Having been extensively mentored in this method and having used it over the past years, I have seen truly amazing results with this method of assessment and treatment. Rapidly reversible back pain may be possible with the appropriate assessment, for certain subgroups of lower back pain. For effective use of this approach, an appropriate assessment is generally considered best practice.


I will do another blog post about the McKenzie method in the future, but feel free to reach out to see if you would like to know more. This type of an assessment can be very effectively done via Telehealth virtual consultations as well as in-person.


Summary

Lower back pain generally settles between 10-12 weeks and in some cases, this may be prolonged due to other factors. Advanced injuries may take up to 18 months and usually further investigations and combined interventions may be beneficial to recover fully. An effective assessment, diagnosis and rehabilitation plan can help you live better during these episodes and prevent recurrences.


Disclaimer:

An individualised assessment is considered best practice when dealing with lower back pain and a medical history is often necessary to consider. The lower back has many structures and not all back pain is the same. It is important to consider the below symptoms when considering to seek care. If you experience any of combination of these symptoms or are progressively worsening, contact your GP or visit your local A&E with urgency.



References


Accident Compensation Corporation Acute LBP Guidelines - https://www.acc.co.nz/assets/provider/lower-back-pain-guide-acc1038.pdf


Melloh, M., Elfering, A., Stanton, T. R., Barz, T., Aghayev, E., Röder, C., & Theis, J. C. (2014). Low back pain risk factors associated with persistence, recurrence and delayed presentation. Journal of back and musculoskeletal rehabilitation, 27(3), 281-289.


Namnaqani, F. I., Mashabi, A. S., Yaseen, K. M., & Alshehri, M. A. (2019). The effectiveness of McKenzie method compared to manual therapy for treating chronic low back pain: a systematic review. Journal of musculoskeletal & neuronal interactions, 19(4), 492.


Parreira, P., Maher, C. G., Steffens, D., Hancock, M. J., & Ferreira, M. L. (2018). Risk factors for low back pain and sciatica: an umbrella review. The Spine Journal, 18(9), 1715-1721.




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