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Back Pain

Did you know that most people will experience back pain at some point in their lives?  Our lumbar spine (lower back) is an amazingly robust area in the spine that experiences significant physical demand throughout our entire life.  We utilise the back to help us get dressed in the morning, participate in sport, maintain the garden, through to carrying the weekly shopping.  Back pain doesn't need an accident such as a fall to rear its head.  Most people report back pain without any specific incident, instead they may have maintained a poor posture for a long period of time, only to wake the following day with a very stiff and painful back.

A common presentation of acute lower back pain we typically see looks like:

  • very stiff in the morning, with a lot of trouble getting up out of bed

  • aggravation of back pain when leaning forward to tie ones shoes

  • trouble getting out of a chair or the car

  • a band of muscle tightness running across the top of the hips and the lower back

  • typically undertaken increased physical activity the previous day, such as a big day in the garden or a heavy leg day in the gym

Whether you've injured your back from a trauma on the sports field or its become sore from an unknown reason, there is hope as most back pain resolves in 4-6 weeks.  To help speed up your recovery and to identify the need for an MRI or a referral, your physiotherapist plays an important role in managing your back pain.  

Do I Need An X-Ray or MRI?

Do you know someone who has ‘slipped a disc’ in their back? Maybe you know someone whose back has ‘gone out’ and needs to be realigned?

Despite great advances in the technology for scanning the body, we still struggle to pin down the source of your pain. Studies have shown that degeneration and disc bulging is common in backs without pain (Brinjikji et al., 2015). In fact 30% of people in their 20’s have a disc bulge without pain, and 37% will show disc degeneration. These numbers increase to 50% & 68% for people in their 40’s.

As degenerative changes commonly seen on an MRI, the Richmond Rehab are reluctant to refer for scans of the lower back unless the patients symptoms clinically indicate the need to rule out a significant pathology.

The causes of back pain are commonly multifactorial. Strength, flexibility, work habits and posture may be contributors, however we also know that your understanding of back pain and previous experience can greatly impact your recovery. In fact, 95% of lower back pain cases are categorised as ‘non-specific’ as stated by Steffens et al. (2014). These are cases where a patient does not present with symptoms that can be definitively liked to a particular source or structure.

What To Expect From Physiotherapy If You Have Back Pain?

Physiotherapy for back pain includes a detailed assessment where your physio may ask you about your daily physical activities, postural habits, aggravating factors and what makes your pain better.  Your physio would then thoroughly assess your range and quality of movement, your gait, your muscle strength, and a neurological assessment if indicated.  Depending on a patients level of pain, education regarding aggravating and easing factors can commonly be the most powerful tool at your physiotherapists disposal.

Other techniques used may include:

  • Spinal mobilisation to help promote mobility and ease pain

  • Soft tissue massage to help ease muscle spasm and relieve pain

  • Taping the back to help offload the back and provide postural feedback

  • Prescription of mobility and strengthening exercises to get you moving sooner

  • Postural education to help reduce your risk of re-aggravating your back

It is important to remember that occasional lower back pain is a common and most episodes settle within a few weeks.  Seeking advice form your GP or physiotherapist is recommended however to rule out any significant pathologies, reduce your time in getting back to normal, and learn about what you can do to reduce your risk of aggravating your back in the future.

References

Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., ... & Wald, J. T. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811-816.

Steffens, D., Hancock, M. J., Maher, C. G., Williams, C., Jensen, T. S., & Latimer, J. (2014). Does magnetic resonance imaging predict future low back pain? A systematic review. European Journal of Pain, 18(6), 755-765.