Understanding Low Back Pain

If you are experiencing an episode of low back pain (LBP), you are not alone, over 60% of the UK population have experienced LBP at some point in their lives[1]. It can feel very debilitating, and the pain can be scary; triggering feelings of stress, worry and anxiety about your ability to function and continue your usual activities and work. However, the good news is that LBP is rarely due to serious causes (accounting for less than 5% of cases) and most episodes will resolve on their own.

It is important to acknowledge how robust we are. Movement when we are in pain can feel scary or dangerous but pain during movement doesn’t always signal harm, in fact it is seldom the case, and the pain that we do feel often doesn’t correlate with tissue damage[2].

Myths about LBP are pervasive and often cause fear and confusion around causes and treatments with things like core strength, posture and forward bending often suggested to be the main culprits for LBP. Blaming one tissue type, one structure or one movement is not supported by the evidence which shows that LBP is multifactorial; with factors such as negative outlook and fear-avoidance, more strongly linked to persistent pain than physical damage[2].

Scans aren’t always necessary and are often not recommended unless there are red flags suggestive of serious pathology. This is because many of the spinal degeneration signs found on imaging are caused by normal age-related changes, and not necessarily indicative of the source or severity of pain. The high prevalence of image findings in asymptomatic individuals supports the idea that these changes are not always causative of pain, therefore imaging results should be interpreted with caution[3].

If you are in the first few days of experiencing LBP, try to remain calm and manage the discomfort in a way that suits you. This may be with over-the-counter pain killers, heat, stretches or ice. It is important to try and stay as mobile as possible, gradually increasing activity as the pain lessens. If you can, try to continue with your life as normal and avoid prolonged bed rest as this can delay recovery.

Effective care for LBP should be person-centred and include safe, graded movement to build resilience and confidence in undertaking your normal daily activities again. Hands on manual therapy can help with initial short-term pain management as well as providing reassurance but it is important to acknowledge that there is no silver bullet when it comes to LBP; and manual therapy cannot change or “fix” structures. Any treatment should also address other factors in your life that may be contributing to your pain, like stress or lack of sleep.

If after a few days you are still experiencing pain and feel you would benefit from some professional support, book in for an initial consultation and we will work together to get you back to your normal movement and activity as quickly as possible.

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[1] Koes BW, van Tulder M, Lin C-WC, Macedo LG, McAuley J, Maher C. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 2010;19:2075–94

[2] O’Sullivan PB, Caneiro J, O’Sullivan K, et al Back to basics: 10 facts every person should know about back pain British Journal of Sports Medicine 2020;54:698-699.

[3] Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, Halabi S, Turner JA, Avins AL, James K, Wald JT, Kallmes DF, Jarvik JG. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6. doi: 10.3174/ajnr.A4173. Epub 2014 Nov 27. PMID: 25430861; PMCID: PMC4464797.