Lets start with a summary of this article:
- low back pain is rarely caused by a serious medical condition.
- Your back pain is rarely an indicator of damage, its more an indication of how sensitive its become.
- Low back pain is rarely due to poor posture or a weak core. Most cases it may be the exact opposite !
- Scans of your back are only part of the picture , they may even not be particularly good at identifying the issue.
- A healthy back is usually one that likes to move.
- Good assessment and explanation of your back pain can make all the difference.
Low back pain is rarely a serious medical condition.
Low back pain is really common. About 80% of adults will experience it at some point in their lives. If you’ve had it, you’re not alone!
The fact that low back pain can be very distressing in some cases and have a major impact on your lifestyle it is very rarely caused by serious medical condition.
Hurt does not equal harm.
In the majority of cases we see at the clinic the pain that people experience is not related to tissue that is damaged . it’s more that it has got very sensitive and aggravated.
The levels of pain are often disproportional to the actual issue. Why would this happen ? more often than not the pain and tightness you feel you feel is part of your body effective but crude protective mechanism. So your body is trying to help you …strange as that may seem as you struggle to move or get out of bed.
So in the large majority of cases HURT DOES NOT = HARM.
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.
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.
In most cases 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. The key is to work out where you need to start , what movements will be helpful in the beginning and how to progress them as you get better.
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.
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, get a good assessment and understanding of what’s going on and what to do.
- 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 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