The Elusive Quick Fix - Education Focus: Lower Back Pain
Updated: Aug 22, 2021
“the easy remedy or solution, especially a temporary one, which fails to address the underlying problems”
As a healthcare provider this is a topic seldom spoken about directly but lies in the subtext of a consultation. As a mom, wife and woman, I am guilty of this desire too. It is so tough to stay on top on everything all the time, work/life balance, family needs and demands. I know this all too well. We all get overwhelmed by it. So when we have an issue, whether it is physical or mental health related, we immediately look to the easiest and quickest fix. The story that we just don’t have the time or resources to confront it holistically but want to buy time to just put a band aid over it and pretend its not real, for now.
The quick fix is a multi billion rand industry, from tonics, drugs, creams and a quick manipulation or brace they do well to mask the real issues and it plays so well in the desires of a consumer who have limited time or money but a lot of wishful thinking. The quick fix is so alluring, yet it is elusive.
This month I had a few clients (and a husband) that reminded me of how much of a problem this is. In a professional capacity it has taught me the enormous value in not falling victim to its allure. I have repeatedly witnessed what effect this near obsession has on people’s health and lives when we try pick up the pieces in the aftermath. Simply put, just because you want something to be true just not make it so.
So what is the solution? Ask more questions, to yourself and to your healthcare provider. Understand that a symptom is not necessarily a cause and to really benefit from better health outcomes we need to ask the difficult questions and seek more detailed answers. If it sounds to good to be true it usually isn’t.
Lifestyle changes are the hardest to implement but the most worthwhile in a long, healthy and productive life. A quick fix is like an addiction, short term solution to a much deeper problem. We are all guilty of this and it is perfectly normal to buy time in dealing with a health problem, as long as we accept that this is what we doing and make time for it later.
This brings me to Jay's back pain of the last camp. Some of you may have noticed he had a sore lower back and had to modify his training to adapt and prevent aggravation. I think its import that we discuss this very common pain and having the example of Jay's lower back pain gives a great example.
Education Focus: Lower Back Pain
The prevalence of non-specific lower back pain (LBP) in adults is estimated between 60-70% according to the WHO (possibly higher from my reading), expectedly much less in children but rising (a scary thought!). The statistics are a fascinating read but do change over the years as our lives are very different to those of our parents. Currently, the burden of LBP marginally affects woman more than men, gradually increasing with age and reaching peak at 40-50 years old and then progressively declining, although mention of chronic LBP (lasting more than 3 months) being for prevalent between 50-60y/o.
Jason has had a few football injuries and short episodes of pain over the years and his psoriatic arthritis has caused an increase in inflammatory pain. This episode was largely related to discogenic pain which proved more difficult for him to "quick fix". Ultimately he is improving with a combination of modified exercise, some manual therapy and a few lifestyle adaptations (sitting postures) which proved to be a bigger than expected factor. It is a very important learning experience for him and teaching him the difference between theory and a lived experience. He has also learned that his measure of flexibility is limited by the compensatory movements our body makes to keep "the range". In his instance, stiff hips means that his lower back has to "bend a little more" to compensate, now he is more mindful of the little things his body does to keep up his mobility, think of an elastic band that has some glue in the middle third, if you pull the elastic to the same stretch length, the other two ends have to stretch further.
I think it is important to discuss the main types of causes for lower back pain and point out that it is usually multifactorial, our bodies are complex and our injuries/pains are seldom one dimensional. Structures that can cause problems range from internal and organ related to neuro-muscular-skeletal origins. I will discuss the latter. It is also very important to point out that even though you may have a problem /pain in one area, sometimes the cause is elsewhere.
Lower back pain can originate from nerves (and the ever complex brain/how we think), muscles and skeletal structures (joints and bones). Different structures cause problems at different ages/stages of life and help us as clinicians to decide the main contributing factors. "Dr Google" can be dangerous if you are experiencing problems and go on an uninformed symptom search. Imaging such as x-rays and MRI's showing pathology have shown very poor reliability and not always the best first line option, often leading to unnecessary and costly interventions. Several studies have shown there is no link between LBP and degenerative changes. Commonly reported risk factors include low educational status, stress, anxiety, depression, job dissatisfaction as well as poor social support at home and work. This links up with my blog on the pain and the brain, with each year more evidence shining a light on the complexities of our pain experience with how we think and how our brains work. The pain might have had a mechanical trigger, but it is our brain that assesses risk and our pain response.
Evidence has demonstrated that LBP is not helped by medication alone. We need to identify the source, which is often a combination of cognitive, mechanical and behavioral. The best evidence based care on non specific LBP is the combination of exercise/manual therapy and heat. Pain neuroscience education having a big impact in improving/preventing recurrence and decreasing disease burden. Exercise, almost any exercise, is MOST beneficial. The goal is to keep moving, just as Jay did, and modify load and technique. Making changes to lifestyle habits is also very important when managing an episode, how you sit (for example not in a deep chair or couch) and seek guidance on your specific causes and optimum management. Cognitive behavioral therapy/mindfulness/ and mental health care is showing to be more and more important for all health related outcomes and especially in pain management.
Your body is the most amazing and adaptable structure, it is also the only one you have got, so please take care of it!