Understanding Lower Back Pain with Chris Smith

April 20, 2020 at 2:13 PM

Compiled by our new Masters trained Physiotherapist Chris Smith. To book an appointment with Chris, or read his Meet the Team profile CLICK HERE.

The Covid-19 pandemic has meant changes in lifestyles and a requirement of working from home. Although physical activity has been encouraged by the Prime Minister and Ministry of Health during this time, there is a risk of increasingly sedentary behaviours. While physical inactivity is one of the major contributors to lower back pain, it is the also the easiest practice to modify.

Low back pain is both incredibly common and recurrent, but is rarely serious. In fact, with a lifetime prevalence of between 60-70% it is currently the leading cause of disability worldwide and is the most common musculoskeletal reason people visit their G.P’s (1). Low back pain will usually resolve in 6-8 weeks, however up to 25% of people may develop persistent symptoms (2). There may be many reasons for this which will be discussed below. So, what is is, why does it occur, and how can we manage it?

What is it?

Low back pain describes pain experienced between the top of the hip bones and buttocks. Although there are a small number of cases which are attributed to serious pathology, these are generally screened appropriately by healthcare professionals. The majority of people (>95%) fit into the non-specific low back pain group (3). This is because joints, discs, ligaments, and muscles in the back can all produce similar types of pain in the same locations, which makes it difficult to identify the exact source of the pain (3). Furthermore, regardless of the structures producing the pain, evidence suggests that management should focus on a holistic approach for those with low back pain. This means simply whilst considering physical contributions to a person’s pain, such as muscle tightness and weakness, clinicians should also consider how pain effects a patient psychologically and the impact it is having on their lifestyle, including work and hobbies (4). To summarise, there is more to consider than just the “back” – professionals should treat the person, not just the spine.

Why does it occur?

Low back pain is complex and multifactorial. Whilst a patient may recall a specific incident which led to the pain, it also may have occurred insidiously due to a change in lifestyle, work, hobbies, or general health. These "triggers" have been shown to be non-physical in addition to physical, and research has helped to demonstrate multiple risk factors which may contribute to the back pain experience (4,5).

Psychological factors that have been shown to contribute to low back pain include, but are not limited to, thinking you will not get better, depression, stress, and fear of movement (2,4). Health and lifestyle related factors include fatigue, sleep issues, reduced physical activity, being overweight, and smoking. Sedentary occupations, in addition to those which involve repetitive heavy lifting, may also be more likely to develop low back pain (4). From a social perspective, sources of stress such as money problems, poor relationships or support at work or home, low job satisfaction, and life events such as a death or illness can also contribute to low back pain (4).

Therefore, you can start to understand that low back pain should be considered from a broader perspective. Take a look at the diagram below and see all the risk factors that have been shown in research to contribute.

How can we manage it?

With our knowledge of these various triggers, a sensible approach would be to manage these accordingly in each client. This may well involve a different approach for each patient, some requiring advice relating to their sedentary lifestyle and some requiring psychological input for their depression or stress.

Currently the best available evidence supports an active approach involving exercise and rehabilitation. This has the best short and long-term effects on pain, disability, and function in those with low back pain. Exercise can almost reduce the risk of recurrence by 50% and is recommended in the U.K, U.S and European guidelines (6,7).

However, what is less clear is which type of exercise. Evidence shows that no one form of exercise is superior to another with general cardiovascular exercise such as walking, running, swimming, and cycling having similar effects to Pilates and Yoga (8). Physiotherapy has also been shown to be as effective as Yoga and Pilates (9). Simply put, the best exercise is exercise that you can stick to and enjoy doing. Exercise has health benefits far beyond strengthening and stretching of muscles and joints. It can reduce pain sensitivity, and it releases endorphins which can also help to reduce pain (10). Exercise also reduces fear and increases our confidence to move again and to get back to normal function.

In addition to this there are the benefits of exercise on conditions such as depression, type 2 diabetes, cancer, heart disease, obesity, and stroke (11). A quote from the World health organisation when referring to exercise “ If it was a pill, exercise would be a trillion-dollar money-maker prescribed to everyone”.

So, if you're struggling with low back pain remember, stay positive as there is generally plenty you can do about it. Feel encouraged to contact Auckland Physiotherapy and book to see me, Chris, or any of our other qualified physiotherapists to see if we can identify triggers which might be contributing, and to provide with you some individualised management. Remember... Movement is medicine!

References

Durstine, J. L., Gordon, B., Wang, Z., & Luo, X. (2013). Chronic disease and the link to physical activity. Journal of sport and health science, 2(1), 3-11.

Duthey, B. (2013). Background paper 6.24 low back pain. Priority medicines for Europe and the world. Global Burden of Disease (2010),(March), 1-29.

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.

Harber, V. J., & Sutton, J. R. (1984). Endorphins and exercise. Sports Medicine, 1(2), 154-171.

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.

Mostagi, F. Q. R. C., Dias, J. M., Pereira, L. M., Obara, K., Mazuquin, B. F., Silva, M. F., ... & Lima, T. B. (2015). Pilates versus general exercise effectiveness on pain and functionality in non-specific chronic low back pain subjects. Journal of bodywork and movement therapies, 19(4), 636-645.

National Institute for Care and Clinical Excellence (2016) Low back pain and sciatica in over 16s: assessment and management. (NG59). Manchester: NICE. Retrieved on 25/2/19 from https://www.nice.org.uk/guidance/ng59/resources/low-back-pain-and-sciatica-in-over-16s-assessment-and-management-pdf-1837521693637

O'Keefe, M. & O' Sullivan, K. (2018) All you ever wanted to know about back pain. What to do - and what not to do - to deal with low back pain. RTE. Retrieved on 25/2/19 from https://www.rte.ie/eile/brainstorm/2018/0130/937071-all-you-ever-wanted-to-know-about-back-pain/

O'Sullivan, P., Caneiro, J. P., O'keeffe, M., & O'sullivan, K. (2016). Unraveling the complexity of low back pain. Journal of Orthopaedic & Sports Physical Therapy, 46(11), 932-937.

Saper, R. B., Lemaster, C., Delitto, A., Sherman, K. J., Herman, P. M., Sadikova, E., ... & Roseen, E. J. (2017). Yoga, physical therapy, or education for chronic low back pain: a randomized noninferiority trial. Annals of internal medicine, 167(2), 85-94.

Shiri, R., & Falah-Hassani, K. (2017). Does leisure time physical activity protect against low back pain? Systematic review and meta-analysis of 36 prospective cohort studies. Br J Sports Med, 51(19), 1410-1418.