The spine consists of 33 bones called vertebrae stacked on top of each other. There are 7 in the neck (cervical spine), 12 in the mid back (thoracic spine) and 5 in the lower back (lumbar spine). The additional 10 vertebrae are fused in the sacrum and coccyx at the base of the spine. The vertebrae are supported by ligaments, discs, muscles and connective tissue making the spine a stable structure. It is common to get pain in any part of the spine, from the neck to the lower back. In fact, back pain is the leading cause of musculoskeletal disability and days off sick from work worldwide. It is incredibly common with up to 80% of people experiencing it during their lifetimes. Although back pain can be concerning for people the good news is research suggests that active approaches such as physiotherapy are the gold standard treatment and help to improve pain, function and quality of life.
What to expect?
Physiotherapists will take a thorough history and use screening questions to understand more about your back pain. We will then assess your movement and provide you with an individualized treatment plan based on your assessment findings. This is likely to include exercise, education and may also include hands on treatment. We may also refer you onto clinical pilates and massage therapy if appropriate.
At your initial assessment we will set goals around what you want to achieve, of course you want to be pain free, but it is important you set functional goals so you can see your improvements and ensure you get back doing what you want to do. If required, we will refer you for an x-ray, specialist appointment or to other health professionals. We can also complete your ACC paperwork, so you do not need a referral to see us.
Do I need physiotherapy?
If you are experiencing back pain we advise you to come and see our specialised team. Physiotherapy is effective for all types of back pain including disc bulges/ herniation, sciatica, spondylothesis, osteoporosis (including fractures) and osteoarthritis. It is also great for pre or post spinal surgery.
Back pain can be very debilitating and can have a huge effect on your daily life. If it persists, it can affect your mood, work and relationships. It is key you get onto your pain quickly and take control. Ongoing back pain can affect how you move and can cause the muscles around your spine to weaken, this in time can make your back pain worse and impede your recovery. It can also lead to increased risk of recurrent episodes of low back pain.
Evidence based timeframes & expectations for improvement
For acute low back pain research suggests that many patients will improve with physiotherapy including advice, education, re-assurance, gentle exercises and in some cases manual therapy and should be followed up for at least 10-14 days (see here). Furthermore, research also suggests that physiotherapy, including exercise is effective in reducing risk of low back pain by 33% (see here).
The severity of low back pain and disability it causes were also lower in groups that exercised regularly. Types of exercise recommended can vary between patients, however 2-3 times weekly was recommended in this research. Therefore, your physiotherapist may continue to see you for 4-6 weeks individually, or refer you to one of our exercise classes in line with this evidence. Pilates for example has been shown to reduce pain and disability in a variety of conditions including low back pain.
It is common however for low back pain to last longer and there may be multiple reasons for this. In which case evidence suggests being followed up by your physiotherapist and if appropriate your physio can make a referral to a specialist for an opinion. Persistent low back pain is defined as that which had lasted for over 3 months and research recommends physiotherapy as first line treatment. For example this study showed that 12 weeks of physiotherapy reduced pain and disability scores of the 100 patients at 12 weeks compared to their baseline scores. Furthermore, these improvements were maintained at the 1 year mark. Therefore, to get the most out of your rehab, it may be necessary to continue with rehabilitation for between 8-12 weeks.