The truth about treating lower back pain

Published: October 21st, 2021

“85% of people experience lower back pain”

 

Lower back pain is very common with up to 85% of people experiencing back pain at some point during their lifetime, and an unfortunate 20% of people developing chronic back problems.

 

Because it’s such a common issue, there’s a huge number of misconceptions about how to treat back pain.

 

The best way to dispel these myths is with a good understanding of anatomy and function that explains why we get back pain.

 

Why do we get back pain?

 

When people think of back pain they often think it is due to “structural” or “postural” tissue damage, like a disc bulge (commonly referred to as a slipped disc). Structural issues can cause pain, but the pain is complex, and psychological, lifestyle, and dietary factors should all be taken into consideration.

 

 

The anatomy of your back

The lumbar (lower back) is made up of different tissues and structures. Your lumbar spine is designed to provide stability to the trunk region (chest, shoulders, abdomen, and back) and assists in supporting the upper body.

 

The lumbar consists of 5 vertebrae (L1 – L5) which are the small bones that protect the spinal cord. The intervertebral discs sit between the joints to absorb compression and movement forces from the body.

 

The lumbar region responds to flexion (bending forwards), extension (bending backwards), rotation, and lateral flexion (side bending).

 

Facet joints attached to the vertebrae allow nerves to pass through the joints to a local region and down the legs.

                                   

                                       

   

 

 

So, what is lower back pain and where does it come from? 

“Do back exercises. Pain is distracting.”

Lower back pain is pain, muscle tension, or stiffness below your ribs and above the buttocks, and is chronic when it persists for 12 weeks or more.

 

It can be extremely difficult to pinpoint the origin and reasoning behind why we experience back pain.

 

Pain in this region is often “non-specific”, a term demonised by health professionals that fail to look at the bigger picture and often make a case for pain due to a mechanical reasons, for example “incorrect posture whilst sitting”.

 

Sitting for long periods can increase pain sensitivity in some positions, but it doesn’t mean that it is the origin of your pain.

 

Pain is frequently due to factors you may think are unrelated.

 

These factors could include a poor workstation associated with stress and anxiety, a lack of sleep due to long working hours and lack of rest, or a major life event such as a wedding, move, or the birth of a child.

 

Perhaps you’re experiencing financial difficulties which have led to a decline in your mental health, or maybe you injured yourself playing a game and you’re less active.

 

The list is endless.

 

With so many potential causes, how do you find and treat the origin of back pain?

 

A combination of things could be contributing to your discomfort, so your practitioner needs to listen to your story and ask questions about your lifestyle that may seem unrelated to your pain.

 

Providing your practitioner with as much information about your life and current concerns will help your practitioner assess and treat your pain.

 

If your practitioner isn’t taking into account multiple or listening, it’s time to find a new one.

 

This is not to say that mechanical back pain doesn’t exist, it does. Issues like joint inflammation or sciatica can cause localised or referred pain, but due to the core function of the back in enabling everyday function, it can be difficult to provide conclusive diagnoses.

 

The point is because back pain is so prevalent and difficult to diagnose, you’re going to come across misinformation in your search for answers.

 

Myths about back pain 

 

  1. “Poor posture causes back pain”

 

This is the number one most common misconception about back pain.

 

This myth originated in the 1600s when soldiers were encouraged to stand or sit up straight (tuck their chin and hold their shoulder back), the belief that any other posture was bad form spread into the physiotherapy profession and was eventually associated with ill health.

 

The truth is there’s no one good or bad posture.

 

If there was one bad posture it would be the one that you’re in for too long.

 

Make sure to move.

 

  1. “You always need a scan for diagnosis for your back pain”.

 

No, you don’t.

 

Healthcare practitioners including physiotherapists, sports therapists, and sports rehabilitators are can rule out sinister illnesses without the need for imaging.

 

Imaging often shows natural abnormalities that may then be misrepresented and correlated with pain.

 

Many times we experience pain without any identifiable abnormality on a scan.

 

It’s equally true that we can experience no pain at all and while something classed as abnormal appears on a scan.

 

  1. “Repeated load to the spine during movement will increase wear and tear”

 

People have been led to believe that lifting with a bent spine will cause them pain and injury.

 

The research doesn’t support this.

 

Our backs are strong, resilient, and adaptable.

 

Beware the form police. 

How do you treat and rehabilitate back pain?

 

Treatment for back pain is dependent on the person and everyone’s recovery experience is slightly different.

 

Back pain is complex and happens for many or unknown reasons, so we must adapt our treatment and rehabilitation to suit you.

 

The gold standard in treatment is exercise and education.

 

Exercise has many benefits beyond “building fitness” which is important.

 

Exercise can also spike happy chemicals which affect our moods such as dopamine and serotonin.

 

Other benefits include desensitisation of the painful area, confidence-building, and progression into a challenging range.

Tracking realistic goals and milestones is important during rehabilitation so you can see your progress and celebrate your wins.

 

 

Education is important to use as a coping mechanism tool if you’re catastrophising (worrying about your injury) and will help you build healthy habits to be able to manage if you experience something similar in the future.

 

It is important to note that natural history and simply time is a great healer.

 

There aren’t any magic solutions or tools which will instantly get rid of your back pain including massage guns, foam rollers, acupuncture, spinal manipulation and other fads with poor evidence.

 

 

Takeaways

  • Back pain is complex and does not have to be related to structural injury or abnormality.
  • A well-structured exercise rehabilitation programme, education, and support from your practitioner are the best treatments for lower back pain.
  • It’s normal to catastrophise your pain, so trust that your pain can and will improve with progressive rehab and exercise.