Lower Back Pain

Posted By Ellie & Tate Seckold  
06/06/2019
18:03 PM

Acute Back Pain 101  OUCH MY BACK! 

 

What do I do?

Unless you have had a serious injury (car crash...fallen down a cliff) it is unlikely there is a serious pathology (i.e. fracture). Most cases of acute lower back pain originates from irritated and sensitised joints and/or muscle. This often results in muscle spasm, this is your brains way of protecting your back against perceived damage (whether real or not). 

DON’T push through pain: there is no point, muscle spasm is the brain’s knee jerk way of protecting your back regardless of the degree of injury. Finding movements that don’t hurt will help show your brain that everything is ok and it can start letting you move again. Your physio will help you pick movements and exercises to achieve this. 

Things like heat packs and strapping can be useful in helping you to move more but shouldn’t be used in isolation.

Motion is lotion! Keep your back gently moving! Its a balancing act between not pushing through pain but also continuing to move! Staying still and bed rest may feel great while your resting but it will only increase spasm, stiffness and pain when you start moving again. 

Pain relief and/or anti-inflammatories may help, speak to your pharmacist or GP about this. Currently the evidence does not support the use of simple analgesics or anti-inflammatories when used in isolation. It should also be noted that the evidence strongly recommends againstthe use of opioid analgesics (such as endone, panadene forte etc). These medications should be reserved for post surgical and cancer based pain. 

Anti-inflammatroies may be more useful for conditions such as radicular pain (nerve pain). 

See a physio: We use manual therapy (and other physical modalities) and will prescribe exercise and advice to help you move better and get you back on your feet as soon as possible.

 

Why does lower back pain hurt so much?

Acute lower back pain can be exceptionally debilitating! The good news is that most cases of lower back pain resolve within (or well before) a few weeks. The level of pain we experience with lower back pain is generally way out of proportion to what is actually happening in the back. 

Ankle sprains don’t get better in a day, so we shouldn’t expect that of backs. 

Most people will experience back pain at least once in their life and many of these people will experience it a number of times over their life.

Try not to worry. I know this sounds silly but worrying about your back can actually make your pain worse. 

 

Do I need a scan?

Short answer: most likely not!

The criteria to image (MRI/XR/CT) the lumbar spine includes (but not limited to): 

  • Lower back pain and radiculopathy (lower back related nerve pain) for >6weeks with no success from conservative management. 
  • Lower back pain with continually worsening neurological defects (reflexes, sensation and strength)
  • Signs or concerns regarding serious or specific pathology i.e. cancer, infection, fracture

Why is there a criteria for imaging?

Because abnormalities in a lumbar spine MRI/X-RAY/CT scanare very common without pain! Unfortunately there has been an epidemic where people are scanned too soon or unnecessarily. These people (like most of us) may have an abnormal finding and are then exposed to lots of expensive, overly invasive and unnecessary interventions with no pain relief. Knowledge of incidental findings that haven’t been explained i.e. disc bulges result in a nocebo effect where people experience more pain, problems and recurrence because they believe that their back is damaged. This is well established in the literature. 

Just remember: disc bulges, spurs, arthritis and disc degeneration are present in a large portion of the pain free population. THESE FINDINGS ARE NORMAL!

The 2014 American Journal of Neuro-radiology (academic journal), conducted a systematic review (very high level of research) on the relationship between imaging results and pain. The recommendation from this research was that people should not be scanned for non-specific lower back pain. They only recommended scans for suspected serious pathology or in the presence of serious neurological compromise that is not responding to conservative care.

 

Fun facts: MRI within the first month of lower back pain gives you a 8x greater risk of surgery and results in 5x greater medical costs (Wang et al 2018)

 

Do I need surgery: Unlikely

It is very rare that lower back pain results in surgery. For surgery to be warranted and effective, you must have first failed conservative management and have clear findings in a scan that match perfectly with your clinical signs. Surgery should be reserved for extreme cases of lower back pain with associated worsening neurological symptoms (despite good quality, conservative care). 

 

But I have a scoliosis!!

Don’t worry! Most people do ... to some degree. People who have perfect spines are unicorns! This is part of your anatomy and how you were born, it cannot be changed with manual therapy of any kind. When a scoliosis gets to a particular angle it can become problematic and can be managed with exercise, bracing and sometimes surgery. Manual therapy can help make it feel better, but won’t change the position of your bones. 

 

Remember Motion is lotion!