Some quick facts;
– at any one time in Australia a quarter of all Australian adults have low back pain 1
– between 10 – 40% of people who have low back pain will end up with persistent or chronic pain 1
– 70-90% of Australians will suffer from low back pain in their lifetime 2
– low back pain at least ‘moderately’ interfered with daily activities for 2 in 5 people with back problems 2
– in 2017 – 2018 there were 181,000 hospital admission for low back pain in Australia 2
- Rest will make my back better
Complete rest in the form of bed rest may in fact make you feel worse and may make your recovery longer. We advocate for people to stay gently active within their pain limits. It is ok and normal to have some pain and you may find the more you get going the less pain you have. In lower back pain, your pain can be out of proportion to the tissue trauma (if any) that has occurred. Think about a paper cut on your finger, they hurt like mad even with the slightest movement but the cut itself is so small and doesn’t worsen even if you knocked it. This can be the case with low back pain as well, in fact you may have no tissue trauma but the pain can be coming from all the muscle spasm and your worrying thoughts contributing to the sensitivity and pain you feel. Encouraging regular and gentle active movement will gradually help to alleviate the pain.
However, if in doubt it is always best you seek guidance from a physiotherapist who can make recommendations specific to you. In rare cases bed rest may be recommended but this is likely due to things like fracture, post-surgical or other medical conditions.
- Movement will injure my back more
As the saying goes “Motion is Lotion”!! With the exception of people who have fractures or other serious pathology the sooner you get moving the better. This goes for both those with acute low back pain and chronic low back pain. If you have acute low back pain and your physiotherapist or doctor has excluded any serious pathology getting moving as soon as possible is the best option. You may have some pain with movement for the first few days but it doesn’t mean you are doing harm. You may need to modify your usual activity and work initially and then gradually increase your activities as the pain settles.
We place a great focus on FUNCTION and not pain in people with both acute and chronic low back pain. We know that as your function starts to increase your pain will also decrease. Our clinic frequently consults with people with many year (I’m talking 10-20 year) history’s of low back pain. Despite the long duration of pain we are still able to help you! A common theme amongst these people is saying things like;
“I have stopped carrying the grocery bags inside and instead will unpack each item individually so I don’t have to carry a bag”
“I don’t bend down to pick things up off the floor as bending will injure my back”
“I don’t twist my back as I will be flared up for weeks”
These people have lost faith in their back as being a strong and resilient structure designed to bend and move. Much like my mention of function above, these people have found that as they have restricted their function/movement their pain has worsened. They end up coming to see us when they have altered their lives so much it’s taking a hefty toll on them and their families. We still focus on improving function with these people however it can be a long road to getting back to all activities.
- You must have a scan before you come to physiotherapy
For most people it is not necessary to have any imaging performed prior to attending your physiotherapy consultation. Imaging is indicated for people who have been in high force accidents where fracture or serious injury is suspected or where other more serious conditions are being considered. However, this category only accounts for 1-2% 1 of all lower back pain.
In most instances, your physiotherapist will be able to make a diagnosis and implement a highly effective treatment plan based on your history and findings from our assessment. If your physiotherapist is concerned about more serious pathology and for some reason would like imaging they will discuss this with you. In a 2018 study, it was found 59% of imaging for low back pain was unnecessary and only contributed to financial burden, increased stress and anxiety and costs to the health care system.
- My scan will tell you everything you need to know about my back
There are many different types of imaging available that vary in quality, diagnostic capability, cost and radiation exposure. It is important to remember that medical imaging (especially MRI) will go through with a fine-tooth comb and identify every single change in that area of the body. For the most part a lot of these ‘abnormal’ findings are actually quite normal and are just incidental findings. That is, if we hadn’t imaged you we wouldn’t have known and a lot of these findings are likely not causing you any problems. For example; If you take a group of people the same age as you (eg 40 years) and add 10 to your age (40+10 = 50), 50% of people in your age group will have a lumbar disc pathology on imaging that is not causing them any pain or issues. They are walking around your suburb pain free! Unwarranted imaging can make patients worse contributing to poorer health outcomes, greater disability and higher work absence.1
Quick Fact: Only 8-15% of people will low back pain will have a pathoanatomical diagnosis.1 So before you pay big bucks for your next MRI see your physio first!
Essentially, you are not your imaging study! A physiotherapist will not pick up your scan and straight away treat you based off a 2D piece of film. We need to find the root cause of your issue and this involves a physical assessment to understand how your body moves, any muscle length or strength deficits, movement patterns etc. This assessment is specific to you and your noted problems. As physiotherapists we place great emphasis on function that is how you move, the things you can do and the things you have difficulty doing. Your scan cannot tell us this information.
- Bending, lifting and twisting are bad for my back
The spinal column is a designed to allow us to move, be flexible and be resilient. Our back is designed to have the flexibility to bend forward and the rigidity to stabilise while we lift. These are all normal functions of our spinal column. Sure, while you have some acute low back pain we wouldn’t advocate you repeatedly bend forward as this could be a sensitised movement for the lower back and the nervous system (our pain and alarm system). However, you should aim to return to doing these normal movements as soon as possible. While you alter your activity in the early phases it is vital you stay gently active and moving even if there is some discomfort.
- Massage, heat and manipulation will help my 10 years of back pain
Massage, heat and manipulation are all very passive treatment interventions. That is, someone else does it for you and they don’t involve any active movement. We know that the best management we can offer you when you have chronic low back pain is exercise based. In fact, passive interventions have been shown to have minimal effect on self-reported pain and function. As previously mentioned, we place a big focus on function as we know improving your function will decrease your pain. Passive interventions will not do much towards improving your function. For example, if you came in and said to us “I’m sick of having back pain and I want to be able to start back at the gym”. We know that after 10 years it is highly unlikely to be any ongoing tissue trauma and the pain is rather from sensitised tissue and movements. If the physio spends 15 mins providing massage followed by manipulation and heat you are not doing anything towards your very active goal of going back to the gym. This is like someone saying “I want to lose 10kgs” but I’m not actively going to stop eating McDonalds, it doesn’t make sense. Sure massage feels nice and all but you need to be an active participant in your rehab and the rehab plan.
- Once I’ve injured my back I need to be extremely careful how I move and what I do
In the initial phases of acute low back pain you will likely experience some discomfort with movement. It is important to stay as active as possible and this may mean modifying (not stopping) your usual activities. When we provide rehabilitation to our low back pain patients our main goal is to return them to their pre-injury level of function, if not better. Physiotherapy focuses on restoring normal movement mechanics and allowing you to undertake all tasks comfortably and without hesitation or concern. After rehabilitation you shouldn’t feel as though you need to guard your movements or limit your lifting/bending/twisting. Of course, we recommend that you always lift with good technique and avoid prolonged sitting however this is all preventative and what everyone, low back pain or not, should be doing. The sooner you seek treatment the better as this avoids you entering the chronic pain cycle which can slowly reduce your function.
- My disc has ‘slipped’ or something is ‘out of place’
I’m here to tell you that discs don’t slip…sorry but they don’t! Discs are attached securely to the vertebrate above and below and they do not slip out. When people use this terminology they are likely referring to a disc pathology such as a disc bulge, herniation or protrusion. Fear not however as discs have been shown to heal really well with conservative management. This even includes disc herniations (where the jelly like substance is extruded out of the disc). Studies have shown that spontaneous resorption of disc herniations occur in 66% of cases3 This means, the disc material spontaneously moves back inside the disc and the disc heals. Amazing right!
The only time something is out of place is when you have a dislocation. If you have a dislocation somewhere along the spinal column you will likely be in hospital and not walking around the town. Even when a manipulation is performed on a patient (commonly known as ‘joint cracking’) there are only millimetres of movement occurring.
If you or someone you know is suffering low back pain, you don’t have to put up with it. Get in touch with our friendly team at Carlingford (9871 2022) or Kellyville (9672 6752) today! If you are unsure how to best manage your low back pain it is best to seek individualised advice from a medical professional.
- Kimberley Cochrane – Bachelor of Physiotherapy (First Class Hons), Graduate Certificate Sports Physiotherapy
- O’Sullivan, P & Lin, I. (2014). Acute Low back pain, beyond drug therapies. Pain therapies, 1(1), pg8-13
- Australian Institute of Health and Welfare. (2020). Back Problems. www.aihw.gov.au
- Zhong, M., Liu, J., Jiang, H., Mo, W., Yu, P., Li, X., Xue, R. (2017). Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta Analysis. Pain Physician, 20(1), E45-E52
