Managing Lower Back Pain

posted in: Blog, General Physiotherapy, News | 0

Back pain can be normal. It’s also very common, with 80% of people experiencing an episode of back pain in their lifetime.

What causes the pain?

The lower back is a highly complex structure and it is often difficult to identify the exact cause of the pain. In most cases it is caused by minor sprains, strains or injuries, or a pinched or irritated nerve. The good news is that most commonly the pain or discomfort in this area is not associated with a serious condition.

You can experience acute back pain, where it starts quickly but then reduces after a few days or weeks, or chronic, where pain can last on and off for several weeks or even months and years. The location of symptoms may vary and you can feel pain, ache or discomfort from central, left or right part of your lower back but also your buttocks and / or lower legs. Sometimes the back problems may also manifest itself with other symptoms like tingling or numbness, muscle weakness or other sensation indicating nerve root compression – radiculopathy like for example sciatica. The sciatic nerve is the longest nerve in your body, running from the back of your pelvis, through your buttocks, and all the way down both legs, ending at your feet. Irritation of this nerve is quite common in people with lower back problems but in most cases, it goes away naturally within a few weeks, although some cases can last for a year or more.

Scans aren’t always helpful

Often people think that they need a scan to find out exactly what is going on. But the evidence suggests that scans only show up something important in 5% of people with back pain. In fact, studies have shown that even people who DON’T have back pain have things like bulging discs (52% of people), degenerated or black discs (90%), herniated discs (28%) and ‘arthritic’ changes visible (38%). Many of these things are just an indication of ageing and genetics and do not have to be painful. After an assessment with your health professional, this could be a GP or physiotherapist, they will be able to advise whether a scan is really needed.

Surgery is rarely the answer

Only a small percentage of people with back pain require surgery. On average, the results for spinal surgery are no better in the medium and long-term than non-surgical interventions, such as exercise and physiotherapy.

When to seek help

Whilst very often there is no obvious reason for back pain it can relate to a specific health problem like spinal malignancy, infection, fracture, ankylosing spondylitis or other inflammatory disorders. You should always see a doctor if low back pain is a result of trauma, or if the pain is accompanied by any of the following symptoms:

• Significant leg weakness

• Fever and chills

• Unexplained recent weight loss

• Sudden bowel and/or bladder incontinence

• Severe, continuous abdominal pain

How to deal with lower back pain

After an acute episode of back pain, most people report significant improvements after 2 weeks. After 3 months, 85% of people have made a full recovery. Sometimes, you do need a little helping hand, which is where physiotherapy comes in! But you can always try these measures at home too.

Painkillers & NSAIDs drugs

Paracetamol or other analgesic may help and you should use them as and when you need them. It is important that you take them regularly and at the recommended dose, especially when you’re having a flare up of your back pain.  You should not take them more often than every 4 hours up to a maximum of eight tablets in 24 hours. Ibuprofen or other over-the counter non-steroidal anti-inflammatory drugs can also help. It is advised to use them for a short course of treatment up to 10 days but if you do not feel improvement after that time you should seek advice from a health professional, either your GP or a physiotherapist.

Posture

Try to maintain good posture when sitting at work at home or in the car. Keep your back supported by an appropriate chair with the desk or work top levelled according to your height. If you spend most of your day driving adjust your seat to minimise pressure on your spine and enable your muscles to rest. Avoid staying in one position for long periods. Make sure you change your posture as often as possible. Enabling your body to move even for a short while will give your muscles a chance to relax and will take pressure off your joints.

Lift & carry correctly

Learning to lift correctly is important to help avoid lower back problem as well as prevent further episodes of back pain. Knowing your limits is important; being able to lift something does not mean that you can safely lift it. Avoid heavy lifting if you can or ask for help. Bend your knees when lifting, without twisting your body. Split loads between both hands. Keep the weight close to your body at waist height.

Exercise to release endorphins – your body’s natural painkillers

The general approach to the treatment for low back pain is advice to stay active and exercise. Starting from short sessions of a few minutes of exercise and stretches once or twice a day and gradually increasing will over time make your back stronger, more flexible and this should reduce pain. It is possible that exercise might make your back feel a bit sore at first but it is a normal process and it doesn’t cause any harm. Often people stop exercising as soon as they feel better, and the lower back pain goes away but it is wise to continue with regular exercising to reduce the risk of lower back pain coming back.

Don’t push it!

Not everyone has experience with exercising and it can be difficult and stressful not knowing where to start. Additionally, it is even more difficult when movements increase symptoms and many people fear of making the situation worse and will avoid movements with first sign of pain or discomfort. If you lack confidence with exercising on your own or you are not sure if a particular exercise is good for your problem, a properly trained instructor can help you choose the right kind and amount of exercise as well as guide you to make sure that your technique is good. It is very important to focus on your position, breathing, quality of movement when exercising to get the best results. Sometimes it will take a while to learn how to control particular muscle groups, find a pain free position and relax. Pilates will help you to understand your bodies weak and strong points and teach you how to bring back muscle control and balance. It will also make you more aware of your posture, enable you to understand why some daily activities can cause and aggravate your pain.

Keep moving

Bed rest is not helpful. In fact, prolonged bed rest is actually linked to higher levels of pain, greater disability, poorer recovery and longer absence from work. In the first few days, after an acute episode of back pain, avoiding certain activities is recommended. But there is strong evidence to suggest that keeping active, and returning to work and exercise, will help with your recovery. Getting advice from one of our physiotherapists will help to make sure you are doing the right type of exercise and get you back to your normal routine as soon as possible.

By learning how to cope with pain, avoid bad habits from everyday life and improve your overall fitness you may be able to reduce your back pain and with time get rid of it for good. You may also include other activities into your weekly routine like swimming, walking or the gym to further support your recovery.

Make time for relaxation

Stress, low mood and anxiety can all contribute to back pain. Back pain is often triggered after a stressful event. Therefore, managing your mood by doing things that you enjoy and partaking in relaxation can help reduce your back pain.