Have you hurt your back ?

If so, here are 8 things you should know

Low back pain is a common problem so if you suffer from low back pain, you are not alone. Managing your low back pain may not be a simple matter. You need to be aware of a number of factors to help you decide what to do to treat the problem and how you can influence outcome. Here are some things you might like to consider:-

1. It may not get better on its own

In most instances of lower back pain, the problem may settle within a few weeks. However, many people are still affected in some way by their pain 12 months down the track. Also, flare-ups are very common. So, whilst you may get better doing nothing about your back pain, to ensure the quickest and best outcome you should seek assistance.

2. Physio can help

Physiotherapy can help you overcome an episode of low back pain. The goal of physiotherapy is to restore pain free movement, and to help you maintain this improvement over the longer term. Physiotherapists use a range of modalities to achieve these goals. These can encompass things such as hands-on type treatments, exercise therapy, dry needling or electrical modalities to name a few.

3. There may not be an overnight cure

Recovery can take time and can be related to various factors. These include the severity of the problem and also the state of your tissue prior to injury. For example, if you are a 55 year old manual worker, your spinal tissue may be degenerated (worn out) prior to injury. This may mean a slower recovery than in a 21 year old with less degenerative changes in the spine. Other contributing factors can include your general health, your weight, whether you are a smoker, your fitness and if you suffer from depression.

4. Anti-inflammatory medication

You should be wary of over reliance on anti-inflammatory medication. Whilst it may play a role in some cases, it should not be the only intervention you use to you treat your low back pain. Other modalities such as tailored exercises should be incorporated into the management program. Remember, a study in the USA a few years ago suggested that for every $1 spent on anti-inflammatory medication, a further 75 cents had to be spent treating the adverse side effects.

5. “Core” stability

“Core stability” is a buzz word in low back pain management. Improving your “core” muscles may help you overcome resistant back problems and avoid recurrence. These exercises need to be specifically tailored to your needs, usually by a physiotherapist with skills in this area.

6. Ongoing exercises

One of the biggest risk factors in suffering a back injury is a previous back problem. As such, you need to continue general fitness, mobilising and “core” exercises long after you recover from your back injury to try to help prevent recurrent problems.

7. Posture and work

Your posture and the work you do can contribute to the development of low back problems. Prolonged sitting, working in a bent forward position and heavy or repeated lifting can all be factors in you developing a back problem. These need to be addressed if you want a good outcome.

8. X-rays

There is very little value in having X-rays early on to help manage lower back pain. They have no value predicting who will get back problems, who has back problems or identifying what the problem is. Having too many X-rays throughout your life can be harmful to your health.

Low back pain

What helps?

Low back pain is a common problem seen by physiotherapists. In most cases, physiotherapy can help, but as in all problems, early assessment and treatment is vital.

Prognosis. The longer you have the problem, the more recurrent it is, the further down your leg the pain travels and the more severe your symptoms, the worse your prognosis. If you have signs of nerve involvement (weakness in the leg, numbness/ pins and needles in your foot) this may indicate a longer recovery or a worse outcome.

Diagnosis. In about 80% of low back pain the exact diagnosis is not apparent. This means that no-one can tell exactly what structure is injured. Physiotherapists usually use a biomechanical diagnosis. This identifies areas of the spine and surrounding structures, that have dysfunctional movement. Treatment is aimed at restoring pain free movement and function in the spine. This helps in the majority of patients.

Is your back out? A common “diagnosis” offered to some patients is that their “back is out”. This is a false and outdated representation of the true nature of one’s back pain. Acceptance of this diagnosis should be taken very cautiously.

Treatment. Physiotherapy management in most cases seems to be beneficial in helping overcome back pain. Using a biomechanical model, modalities such as joint mobilisation/manipulation, exercises, soft tissue therapy, traction and patient education can lead to a good outcome. Self treatment strategies are very important.

Medical treatment. Unfortunately, not all patients respond to physical therapy. Though knowledge about back problems is not a core part of medical training, your doctor has access to advanced diagnostic options such as blood tests and advanced radiology (such as CT and MRI scans). If there are no serious underlying medical problems (such as infection or cancer), the basic medical tools would be medication, injection or surgery. There is no guarantee these will work in all cases. A combination of physiotherapy plus medical treatment can be helpful in more difficult cases.