Lower back pain

This, together with neck pain, are the most common practice complaints I see. It affects about 80% of people in there lifetime and the leading cause of disability worldwide. Although lower back pain can occur at any age, it is more prevalent as you increase in age, peeking at 50-55 years old and more so in women. Most episodes will resolve by 6 weeks and are known as non specific back pain, with no specific cause diagnosed and about 23% will experience chronic back pain (an episode lasting longer than 3 months)

So have you had back pain?

Here is am not speaking about trauma or specific injuries, here I am speaking about my observations around non-specific lower back pain. Most people seem to give a at least a week before seeking help with either a consultation or medication, unless it prevents them from working. An initial assessment involves a full medical history and understanding the mechanism of pain. How we manage it is dependent on the cause and aggravating factors and this is where is becomes person specific.

So what do I commonly find? I usually see a number of factors contributing to pain, such as:

• Aging is the most common factor in the majority of cases, and by aging I mean that our bodies do not rebound as quickly, we may have old or new injuries, or inflammation that increases with age and arthritis

• General weakness, especially gluteus muscles and core muscles plays a big role in pain due to poor endurance. Muscle imbalances and poor postural strength or tone play a big role. Current research suggests that all almost all exercise is good exercise in preventing pain. Move move move.

• Sedentary jobs with prolonged periods in one position or driving in traffic. We are not designed to be sedentary, our bodies will adapt to that profile and then well we try get up and move, it becomes difficult or painful because our spine is still trying to "straighten" or move again. This is true also in pain emanating from our spinal joints and discs. Just like a sore knee having to get up after being stuck in a position, our back joints have a similar response.

• Stiffness, this can never be underestimated. It is one of the driving influences of back problems leading to pain. It may not always be a direct cause, but a considerable contributing factor. Consider an elastic band, if you pour glue of the first and last third of the band and then stretch it, the middle, unglued section has to do all the work, while the glued ends don't move, this is like the back, if the spine does not move as a whole unit, each section doing its part, often times, one section, like the lower back, has to compensate, this then causes an injury or pain resulting from over or improper use.

• Pain is often elicited after you try do something new, difficult or sudden, without warning your back can have a sudden or progressive pain onset, immediately or up to 48hrs later. It is important to note though, that the incident is seldom the problem, it is usually the trigger, and the resulting pain is as a result of the complexity of contributing factors and injury.

What can you do during an episode of pain with no specific cause?

• It is generally safe to keep moving, especially you everyday functional movement. We often refer to relative rest -NOT BED REST! Slower, smaller movements regularly and just keep walking!

• Heat, most pain responds very well to heat. Do not put heat on a red, swollen or open injury!

• Avoid strong painkillers without medical guidance. Speak to your pharmacist at least. Paracetamol is generally safest, it is best to still "feel" your pain as it is a warning and taking loads of old or others meds is not safe, especially as you can inadvertently do something damaging, not getting the warning as you blocked the pain.

• Gentle rubbing in of topical ointments may be helpful and generally safe, again, if you have allergies or sensitivities, do not do so without medical advise

If the pain does not settle or go away after a few days, I suggest you get an assessment. Seldom are x-rays necessary, and often times pain dissipates with minimal intervention and practical and conservative management. This is where I can say Physio is very helpful, especially to assess what contributing factors played a role in the onset and prevention.

What can you do to prevent lower back pain?

• Stay active and exercise. Even walking regularly makes a big difference.

• Stay flexible. When you start to notice you struggling to get to your feet or twist or turn around, then it time to get moving MORE! When you are not injured or in pain, but stiff, make an effort to regain the lost movement. If your independent efforts don't work, ask for help, with your trainer, physio or trusted medical provider.

• I do recommend a massage if you enjoy it! Keeping those muscles in good health is very beneficial.

• I have clients who come in from time to time, depending on history and needs, for pain management. This may not be for everyone, but can be very helpful to maintain and active lifestyle, minimizing episodes if you have a history of repeat episodes or chronic conditions.