Low back pain is the most common musculoskeletal disorder throughout the world causing significant loss in work productivity and disability. It is also one of the most heavily researched areas in healthcare, yet there are still so many common myths associated with having low back pain.
Whilst most low back pain can be painful and limiting initially, 90% of people make a quick and full recovery within 6 weeks. Patient reported pain scores have been proven to be very poor in predicting the severity of the condition. The vast majority of low back pain episodes are strains and sprains in nature rather than anything more serious.
Due to recent advances in pain science research we now better understand the complexity of pain and that each person’s brain interprets pain differently and there are various factors that can influence the brain’s processing of the pain. These commonly include; previous painful experiences, mood, stress, fitness levels, personal coping strategies with stressful situations etc. Pain is the body’s protective response to sensing it is in danger. In acute low back sprains, the injured tissue needs to be protected from further injury so you sense pain. However, when people have experienced low back pain for prolonged periods of time, the tissue is healed but certain movements can still feel painful
Staying in bed has been proven to lead to slower recovery and persisting pain in low back pain. This was previously prescribed by doctors and physiotherapist alike and modifying your activities in the first few days of being in pain can still help to relieve some of your symptoms. However, the research has moved on and now we actively discourage bed rest as we know that people who have a quicker return to normal activities have shorter episodes of low back pain. Modified and structured exercise as guided by your physiotherapist is the desired way to return to normal function.
Quite the contrary. Again we know that a return to normal function and the resumption of normal activities speeds up the healing process. Regular exercise during and after the episode of low back pain has been proven to be a great way of overcoming the current episode of low back pain as well as minimizing the risk of experiencing future episodes. This is true for both cardiovascular and strengthening exercises and the best exercise for each person depends on which they are most likely to stick to over a prolonged period of time.
Just as people experience knee or shoulder pain over the course of their lifetime, it is extremely common for most people to experience a couple of episodes of low back pain, therefore people shouldn’t be fearful of it. Physiotherapists are highly skilled in identifying factors that can lead to persistent pain, such as fear of movement when in pain, extreme levels of pain and high anxiety re: their pain and identifying these early signs can significantly improve the prognosis.
MRI’s and X-rays are not indicated for the majority of acute low back pain episodes. Your physiotherapist will assess your spine and advise if an MRI is required. Generally, you will not require a scan immediately unless you have a loss of muscle strength in the leg, or you have unexpectedly lost control of your bladder/bowel.
A simple clinical examination by your physiotherapist is enough to identify the people who warrant MRI’s/X-rays for their low back pain. The difficulty with scans is that they are not as accurate as people think. Research has shown that people who have never experienced low back pain in their life have MRI results showing disc bulges, joint degeneration etc, therefore we know that these findings aren’t always relevant.
There are some specific occasions where surgery is indicated and your Physiotherapist would be able to tell this from their clinical examination. This is only the case for a very small percentage of people who have low back pain. As outlined previously the surgical option is commonly not required, as MRIs which show anatomical variances that surgeons may be interested in are not always relevant. Surgical treatment is only considered when conservative measures such as Physiotherapy have failed and a minimum of 6 weeks recovery has taken place. Outcomes from surgery can be worse and carry more risk than physiotherapy management.
As stated previously, we know that if you understand the reason for your low back pain, you will experience less anxiety with an episode of low back pain. Your skilled physiotherapists will be able to guide you through a thorough explanation of your pain at your initial consultation. They will explain the reasons for your low back pain and also the timeframe for seeing the improvements, as well as setting your goals for rehabilitation back to your usual activities.
As touched on earlier, this is by far the most effective form of treatment for low back pain. It will lead to a quicker resolution of your symptoms, minimizes the risk of further episodes, improves your mood and physical functional, and helps to alleviate stress. All of which will decrease your risk of future episodes/periods of low back pain.
Physiotherapists are experts in treating all forms of low back pain and have all the skills necessary for assessing your spine and guiding you back to your previous activities when appropriate. In the initial stages of your recovery it is very important to get your physiotherapist to advise and educate you re: what has happened and why. It also offers you an opportunity to ask your physiotherapist as many questions as you want. Initial treatment strategies will centre around decreasing the pain and may involve soft tissue work, acupuncture, taping and back mobilizations. You will also certainly be asked to perform certain exercises to encourage the early movement that is associated with the best outcomes. These will help to speed up the pain relief and make your movement more comfortable sooner.
Please seek professional help from one of our experienced Physiotherapists at Joint Dynamics to help you manage your low back pain.