Low back Pain
Low back Pain (LBP) is the primary cause of disability in the world and the second leading cause of disease burden in Australia (1, 2). The Australian Institute of Health and Wellness have reported that approximately 70-90% of Australians will get back pain in their lifetime (2). Back pain is a leading reason Australians are out of the workforce and cost to the Australian economy is 4.8 billion dollars a year (2). Therefore, LBP is a common problem, an expensive problem, and importantly to people with LBP, a disruptive problem that can prevent engagement in meaningful activities such as work.
So what is LBP?
One specific identifiable cause of back pain is often not possible. Most low back pain is therefore referred to as non-specific. There are a number of structures of the back that can cause pain, however serious injury or disease is very uncommon.
In one study only 0.9% of people in an Australian population had a specific identifiable cause of LBP (3).
Findings of scans and investigations do not correlate with a person’s pain and function. A lot of people beyond the age of 30 will have positive findings on a scan such as an x-ray or MRI but will often not experience pain or dysfunction. Routine imaging is not recommended for low back pain (1).
The vast majority of back pain will be improved at 3 months; however recurrence of back pain is common. Whilst recurrence of LBP is common it is important to remember for most people, it will likely be of mild to moderate severity and short lasting (1).
For less than 28% of people LBP symptoms are severe and persistent, however for these individuals the consequences can be high, including social disability such as loss of income and reduced quality of life (1).
Why the transition from acute to persistent (chronic) back pain?
Persistent LBP may be the result of a number of complex processes that vary greatly between people. These may include psychological factors (anxiety, depression), social factors (stress, financial), and physical factors (deconditioning) (1). Poorer physical health is associated with recurrent back pain: such as due to smoking, obesity, and low levels of physical activity. Impaired sleep will also predispose an individual to back pain. Negative beliefs such as fear of movement are also associated with developing chronic LBP (1).
Managing back pain – what to do?
Despite a plethora of research articles and guidelines there is still a divide between current health care practices and those supported by evidence (1). Whilst there is no cook-book-recipe approach, what is clear is that remaining active with a focus on continuing work and social activities is important (4). Whilst common treatments still include advice for rest and the use of strong pain killers, these are often of little benefit (4).
Appropriate education is important for both acute and chronic LBP. This may include advice to remain active, returning to activities (work and social), treatment options, and information relating to low back pain causes and mechanisms. Coaching for appropriate lifestyle change may also be important, such as strategies around sleep or stress management. Importantly, surgery and injections for the vast majority of people with back pain are not indicated. In contrast, particularly for persistent low back pain, engaging in active exercise management is recommended (4).
What exercise is best?
A recent systematic review found that various forms of exercise are effective for treating chronic LBP (5). A Lancet medical review also recommends active exercise management for acute back pain when indicated and as a first line treatment for persistent back pain (4). The Lancet review does not make a recommendation for any specific form of exercise, indicating rather that an individualistic approach is likely the best. Depending on a client’s needs a program may target strength, flexibility, and endurance. However, for some learning to relax certain muscles and/or becoming more confident with certain movements may be just as important.
So why choose a Physiotherapist for LBP?
Physiotherapist have the necessary knowledge to manage all aspects of LBP and enable you to make an informed decision about your healthcare. Accordingly, there are some great ways physiotherapists can optimise your recovery with acute or chronic low back pain:
Effective assessment: working with you to determine what factors relating to LBP are most relevant to you
Education – we believe strongly in giving you the necessary knowledge to make informed decisions about your health.
Collaborate with you as person – the best exercises and programs are the ones you do and enjoy!
Challenging fearful movements – helping you get stronger in those movements you feel apprehensive about.
Structured programming - progressive loading tailored to your abilities and needs
Goals – the best program is individualised and realistic, your goals personalized to you. Getting you back to or keeping you doing the things you love!
Long term focus – the plan will always include self-management strategies with a long term and holistic approach. We are not necessarily selling a quick fix. But we are empowering you to take an active approach in your recovery.
If you have low back pain and are interested in management for this the best thing for you to do is sit down with one of our physiotherapists for a free initial assessment. A physiotherapist can collaborate with you to create a plan best suited for you. If you aren’t happy with this plan, no problem, there is no obligation for you to continue. If you have any more questions regarding low back pain please feel free to pop in to the clinic for a chat with one of our physiotherapist at no cost to yourself.
1. 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, 391(10137), 2356-2367
2. Australia Institute of Health and Wellness. 2019. Back Problems. Available at: https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/back-problems/contents/what-are-back-problems
3. Henschke, N., Maher, C. G., Refshauge, K. M., Herbert, R. D., Cumming, R. G., Bleasel, J., ... & McAuley, J. H. (2009). Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 60(10), 3072-3080 2009; 60: 3072–80.
4. 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, 391(10137), 2368-2383
5. 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 Published Online First: 30 October 2019. doi: 10.1136/bjsports-2019-100886