Back Pain – and how to treat it
Lower back pain affects up to 80% of the population at some stage in their lives and is one of the most common reasons for visits to a GP in Australia. Back pain is the single most common complaint we get here at Lane Cove Physio. As a result, we have developed effective treatment approaches for all types of back pain.
Chronic lower back pain
Chronic lower back pain is pain that lasts longer than the usual recovery time-frame for acute lower back pain of 4-6 weeks. Chronic lower back pain, much like the acute version, is also unlikely to be related to any significant damage.
There are factors that we call “yellow flags” that help us predict who is likely to recover quickly and who is likely to end up with chronic pain. Yellow flags include things like high levels of stress and anxiety, beliefs and fears that movement and exercise is going to do further damage and a pathology focused attitude (e.g “my disc is damaged so I cannot lift anything). The most important thing to remember if suffering from chronic lower back pain is that pain is very rarely related to any physical damage in the spine.
We know this because numerous studies have shown that there is a very poor correlation between symptoms and radiological findings. Imaging will almost always show “abnormalities” such as disc bulges or degeneration but these are not correlated with back pain and are consistently seen in pain-free populations. In fact up to 60% of the population will have a disc bulge by the age of 50, but will have no pain, no symptoms and no idea about it unless they have an MRI.
Acute lower back pain
So you were lifting the BBQ on the weekend and you “felt something go” and have been in agony ever since….what does this mean!?
The good news is that serious back injuries are rare. In fact in around 95% of cases there is no evidence of damage on CT scan, MRI or X-ray so we can put the pain down to minor ligament or muscle sprains. We can “sprain” our back just like we can sprain our ankles and they heal in the same way. If you start to walk on your ankle after a couple of days it starts to get better and will normally be fine again within 2 weeks. Lower back pain will also respond in the same way as long as we start to move it again as soon as possible.
Having a physiotherapy session within the first 48 hours of injury can significantly reduce recovery time and help you get back to doing what you love sooner. There are a variety of pain free techniques we can use to get the spine moving freely again and most patients walk out feeling drastically improved.
The most important thing to remember is that an active recovery is the best recovery.
Treatment
There are a variety of treatment options available, all with varying levels of evidence to support them.
There is conclusive evidence that an active recovery is the most effective and this becomes even more effective if it is combined with physiotherapy in the early stages and education about the natural course of low back pain.
