It may be reassuring to know that if you have low back pain, you are certainly not alone. About 80 percent of adults experience low back pain at some point in their lifetime. Most low back pain is acute, or short term and will last a few days to a few weeks. This will often resolve on its own with self care and the appropriate advice. Subacute low back pain is defined as pain that lasts between 4-12 weeks and chronic low back pain is pain that persists for 12 weeks or longer.
So we know it’s common, we know that often it will get better by itself but what if it doesn’t?
The first step to improving low back pain is gaining an understanding of what is causing your pain. As a Physiotherapist helping patients understand their condition is fundamental in getting patients better. Getting a diagnosis does not necessarily mean that you need to have any imaging such as an X-ray or MRI scan as often in the initial instance a thorough assessment by a specialist can provide you with enough clinical information to form a diagnosis. However, there will be some cases when imaging is indicated.
The vast majority of low back pain is mechanical. The most common conditions I tend to see as a Physiotherapist are:
This is a generalised term for normal wear and tear that occurs in the joints and discs as people get older but is a common cause of mechanical low back pain.
Muscle and ligament sprains
Over-stretching, twisting or lifting can irritate the soft tissue around the spine.
Intervertebral discs – degeneration or herniation
Disc degeneration (wear and tear) happens as we get older. This means the discs lose their shock absorbing ability. Or we can get herniated or ruptured discs which can occur due to a sudden movement or occur over a period of time. This is often associated with flexion activities such as prolonged sitting at a desk. This can cause sciatica which is pain that radiates down the leg due to compression of the sciatic nerve. Disc problems are usually worse with sitting due to increased weight bearing down through the discs. Gentle walking is usually more comfortable.
A narrowing of the spinal column that can put pressure on the spinal cord and nerves that can cause pain or numbness. This is often worse with walking and eased with sitting down.
This is when a vertebra of the spine slips forwards which can cause irritation or compression of the nerves exiting the spinal column.
Once an understanding of the structures at fault has been established there are many positive evidence based steps to improve pain and functional ability.
Hands on treatment such as spinal manipulation or mobilisation and soft tissue release (massage) can significantly help with the management of low back pain.
It is important that any manual therapy is combined with exercise therapy. Depending on the diagnosis stretching and strengthening exercises can be invaluable in managing low back pain. As Chartered Physiotherapists running Pilates classes we see a large number of people suffering with back pain and it is so great to see how the exercises can significantly help them.
I always provide my patients with lots of advice on posture, work place/desk ergonomic set up and other modalities they could try such as heat or ice treatment. There are alternative therapies such as acupuncture and TENS machines. These are not wholly supported by the clinical trials but some patients do receive benefit from trying them.
In some cases patients may need further intervention and working closely with Mr Andrew Hilton who is a Spinal Consultant in Dorset we can ensure that these patients receive the best care and management.