Low back pain is rarely ever a serious life-threatening medical condition.
Despite the fact that low back pain can be distressing in some cases and have a major impact on your lifestyle it is very rarely caused by serious medical condition.
It is not unusual that the level of pain you experience is actually not an accurate representation of of the problem you have. So if your pain is even very high that is not a good indicator of the severity of the condition. As Greg Lehman said “pain is often an unreliable witness”.
You need a good assessment of your low back pain to understand what is happening and what to do.
A good low back pain assessment should comprise of :
- Identify why you have low back pain back
- Identify what you need to do to get better
- Identify if you need scans or further investigations
- Put your mind at ease about concerns you have about your back pain
- Put together a plan to get you and your back to a happy healthier place
Persistent low back pain is rarely associated with serious tissue damage.
With most low back injuries the tissues will heal, much like if you sprain an ankle. However if pain persists for longer than around 3 months it is likely due not to tissue damage but tissue sensitivity. Your back is hurting you but NOT harming you.
If you think about pain as an alarm system in the early days of an injury it is a useful mechanism to stop you doing more harm. As your tissues heal this mechanism is no longer required and should calm down or switch off. Unfortunately often our alarm system continues to ring out long after the tissue has healed.
Why do low back pain flare ups happen ?
Well it could be due to a mix of the following factors;
- Inactivity due to avoiding pain.
- Tissue strength and fitness decreasing due to avoiding pain.
- Fear of movement.
- Stress about what is happening in your back.
The good news is these are all factors that you have control over and can positively influence to get a happier , healthier, pain free back.
Don’t panic if you a have flare up with low back pain
Following on nicely from above pain flare-ups are more likely related to changes in activity, stress and mood rather than structural damage.
To put a positive spin on flare ups they can actually be really useful to see if you can identify what causes them. This information can help with developing your own effective treatment plan as well as getting a better understanding of the nature of your condition.
Staying positive helps with low back pain
A negative mindset, avoiding activities or exercises due to pain , having negative recovery expectations and poor pain coping behaviours are often strongly associated with having persistent pain than actual tissue damage.
In this case its important to understand the whys and what’s around your back pain. For instance if you have been diagnosed with a disc bulge or arthritis what it actually means and what can be done. As we will we see in the next section it may not even be the real issue , it may be something much more straight forward.
Low back pain and scans
Scans are very useful and sometimes necessary. However they are not good at determining how you will recover from your current episode of back pain or the the likelihood of it causing problems in the future.
Scans should be arranged if we find any of the following scenarios with your condition:
- Neurological changes, weakness , changes in sensation , numbness
- Red flag questions that indicate the potential for serious pathology e.g. fracture, trauma
- Unresponsive to treatment and progressively worsening.
If you’ve had scans its good to talk to your physiotherapist to help put them into context of how you are managing and how your symptoms behave.
Motion is lotion. Low back pain, exercise and movement.
Have a look at a spine, its an amazing feat of engineering. This is a structure that is designed to move and more importantly wants to move. Now I’m not suggesting we all need to move like a gymnast but the point is are backs have an incredible ability to move.
A graduated exercise and movement in all directions is safe and healthy for the spine. As such movement and exercise often forms a fundamental part of your recovery .
It is likely that your back will benefit from a mix of general mobility , aerobic and strengthening exercises. There may be specific exercises that you will benefit more from depending on your own personal presentation. Some people need more flexibility , some need specific strength exercises others just need to get moving again.
This is why working alongside your physio can identify what will benefit you most.
Low back pain is rarely caused by poor posture
“Your best posture is the next posture you are about to move into”.
Spine posture during sitting, standing and lifting does not predict LBP or its persistence. However if changing your posture makes your back pain better chances are it plays a role in keeping that alarm system firing. In this scenario incorporating postural cues may well help in your recovery .
As we said before your back is designed to move so staying in one posture for extended periods of time is likely to be a bigger factor than the posture itself. In this scenario we may encourage you adopt different postures to keep your spine moving.
Core muscle strength is not always the problem with low back pain
Interestingly the evidence suggests that a weak core is unlikely to be the cause of low back pain. However much like posture I’d say your core muscles can contributing to your low back pain if you can relieve your symptoms by “engaging ” your core.
The flip side to this is that some people with Low back pain may actually OVERUSE their ‘core’ muscles which may make their pain worse ! This especially true of people who sit or stand in a very erect posture .
While it is good to keep the trunk muscles strong and healthy to look after your back , it is also helpful to be able to relax them when they aren’t needed.
Lifting is not bad for low back pain
Spine movement and lifting is safe and actually builds a healthier more resilient back when it is used in your exercise plan. The key is to start at an appropriate level with the appropriate exercises and progress steadily .
We take a look at lifting and back pain a bit closer here if you want to know more.
The basic message is the heavier the loads lifted become the better your technique needs to be and the stronger your core, back and hip muscles need to be.
The best way to treat Low back pain
What makes up effective and lasting low back pain treatment ? well its a mix of :
- Understanding what is causing your back pain
- Rule out any serious issues
- Build your confidence in your back and remove the fear of movement
- Get moving again and build a stronger and healthier back
- Keep doing the things you enjoy e.g. social life, activities , work ,going for walks , exercise
- Staying positive
Thanks for reading and If you need help with low back pain and are looking for a long term solution or want to know more book in to see one of the team here
P.S A letter to a friend with low back pain
Here is a link to a letter written by David Butler, pretty much the guru of physiotherapy and pain science. Its an actual letter he wrote to a patient who couldn’t get to see him about an acute sciatica issue that reflects what we’ve just written.
Ref :, et al Back to basics: 10 facts every person should know about back pain
Letter to a friend in pain : David Butler