Understanding and Managing Low Back Pain
Overview:
Low Back Pain. The name itself is pretty self-explanatory. It is pain that arises at the lower part of the back that can include all of the structures in the surrounding area. Unfortunately, over 80% of Australians will suffer from back pain at some point in their lifetime, making it by far the most common musculoskeletal complaint. As low back pain is so predominant in our society, along with it comes many myths on diagnosing and managing it. Who hasn’t heard the old ‘slipped disc’ or ‘my back’s out’ analogy before? And for those who suffer from back pain – who hasn’t received advice from their family, their friends and their expert-on-everything-neighbour on what they should be doing to ‘fix’ it? Fortunately, here in Australia we have many fantastic University trained professionals who have their area of expertise to help treat and manage back pain from Surgeons and Doctors to Allied Health professionals such as Osteo’s, Physio’s and Exercise Physiologists and not to mention those who compliment the above such as Pilates instructors, Personal trainers, strength and conditioning trainers and Massage therapist (there are many more that I haven’t listed).
Low back pain comes in many different forms (all of which are discussed below) and will present in many different ways. Some people will have mild pain that doesn’t require treatment, and some will be at the other end of the scale where their back pain is so extreme, they can’t even get out of bed.
Back pain requires a broad approach from health professionals beyond just identifying and treating the symptoms. Often, low back pain is the result of faulty mechanics from above or below the area, hence why it is very important to recognise the causes (not just the symptoms) behind each individuals back pain to appropriately manage their treatment/medication/surgical intervention and exercise/movement/stretching plan.
Symptoms:
Type of Pain: Symptoms of back pain can present in many different ways and can be direct pain at the source or even result in certain types of pain that refer to other parts of the body, such as run down the leg (even as far as the foot). In a consultation, your practitioner will spend time talking to you about your symptoms as it’s very important to understand exactly what you are feeling. The ability to narrow down the symptoms you are feeling goes a long way in helping us form a diagnosis. Below is a list of symptoms commonly used to describe the type of pain occurring to the low back region.
Dull ache
Acute pain that limits your ability to move
Worse on one side or centralised
Short or long term pain
Numbness and tingling down the leg
Pain into the buttocks
Grabbing pain
Muscle spasm
Throbbing
Stabbing pain
Burning pain
Shooting pain
Small area of pain
Large area of pain
Select area of pain but unable to reproduce it with touch
Aggravating movements / activities: People suffering from back pain can find themselves unable to perform everyday activities to the level they are used to. Some may find that quite simple tasks can bring on pain. For example, if leaning down to tie up your shoelaces causes pain in your back and results in numbness/tingling down your leg - the chances you’ve injured an intervertebral disc becomes more likely. Often, patient’s will omit this type of information when filling out new intake forms, or when first describing the nature of their back pain as they don’t think it’s important. Well let me tell you - it is very important! Being able to identify and understand which daily activities exacerbates your symptoms will ‘add another piece to the puzzle’ and help us in forming a diagnosis.
Below is a brief list of common everyday activities that that can aggravate low back pain:
Getting up out of a chair
Tying your shoelaces up
Standing in one place for long periods
Waking up sore after sleep
Long drives in the car
Leaning over in the garden for long periods
Lifting an item and twisting at the same time
Sitting at an office / computer for long periods
Squatting or deadlifts at the gym
Post exercise soreness
Washing the dishes
Walking
Running
Lifting heavy loads
Twisting quickly (with or without load)
Increased strain over time – eg. Repetitive poor posture
Sudden impact to the low back area
Starting a new activity or sport
Walking down stairs
Sitting on a hard surface
Red flags:
Red flags relate to the possibility that something appearing quite simple could in fact be quite serious.
Below are some examples of Red Flags for low back pain:
Numbness and loss of control of bowel and / or bladder (Cauda Equina Syndrome)
Diffuse low back pain that feels ‘deep’ or spreads to the abdomen (Aortic Aneurism)
Sudden back injury that results in the loss of feeling either into the legs or feet (Neurological Impairment)
Ongoing low back pain combined with unexplained weight loss, night sweats, history of cancer (Tumour / Bone cancer)
Conditions of the Low Back:
There are many conditions that can lead to low back pain. Some conditions that result in damage to soft tissue / structures of the low back include but is not limited to the following:
Lumbar Disc bulge (also known as a ‘slipped disc’)
Disc tear
Disc herniation
Disc sequestration
Facet joint restriction / sprain
Muscle spasm / tightness
Muscle strain
Ligament sprain
Vertebral fracture
Pelvic fracture
Sacroiliac (SIJ) sprain
Sciatica
Lower rib fracture
Lower rib sprain (costo-vertebral)
Arthritis / degenerative changes / spondylosis
Spinal canal stenosis
Lateral spinal stenosis / foraminal stenosis
Degenerative disc disease
Spondylolisthesis
Spondylolysis
Ankylosing spondylitis
Who gets Back Pain?
As mentioned in our intro - many people suffer from, or will suffer from, low back pain. But who is more likely?
Age - Back pain can affect any one from teenagers onwards, however the older you are the more likely you will be to suffer from low back pain.
Postural issues - Having poor posture doesn’t necessarily equate to back pain, however faulty compensatory patterns that develop around certain types of posture can lead to pain.
Pregnancy - Some women will suffer from back pain relating to their pregnancy. Others will not. And some women can suffer from back pain in one pregnancy and not in another. There are many factors involved.
Occupation heavy lifting - heavy lifting when not performed properly can lead to acute back injuries, or when faulty mechanics are used over a long period can result in earlier onset of degenerative changes to the spine and associated structures.
Occupation office worker - long periods of sitting down at a desk tends to follow a similar pattern:
elevated shoulders
forward carriage of shoulders/arms
rounded posture through the mid-upper back
tight hip flexors / upper thighs
Faulty Movement patterns: Repetitive faulty movements that result in micro-trauma to the low back. A great example of this is having poor lifting techniques that increase the load to the low back, which over time can lead to increased wear and tear (degenerative changes)
Previous back injuries: A history of back pain/injuries increases your chance of suffering future back related pain.
High impact sports: Certain sports can contribute directly to back pain as a result from injury, or indirectly via prolonged stress to the low back from sports such as tennis or golf.
Assessment & diagnosis
When you present to a Health Practitioner such as an Osteopath or Physiotherapist with low back pain, they will take you through a full patient/medical history and a physical assessment in order to narrow down the possibilities to the most likely diagnosis.
Patient History: Thorough patient history where your practitioner will cover all aspects of your low back pain presentation such as when the pain occurred, the location of pain, how it happened, what makes it worse, what makes it better, level of pain, associated symptoms, impacted activities of daily living, lifestyle prior to onset of pain and occupation impact.
Orthopaedic testing: Specific joint testing designed to provoke pain which indicates a certain condition.
Palpation: The use of palpation is subjective but can give the practitioner more information to help form a differential diagnosis. Palpation can help identify tissue texture changes, tightness, stiffness, temperature changes, differences between left and right, lumps, knots and swelling.
Range of motion: Movements of the spine can be broken down into 3 basic plains:
Side-bending (bending to one side)
Rotation (turning around)
Felxion/extension (leaning forwards or backwards)
One of the questions we will always ask is ‘what movement makes the pain worse’. Usually one of these movements will aggravate the pain, therefore giving us a clearer path forward towards a diagnosis. For example – if your pain becomes worse or even shoots pain down the leg when bending forwards the likelihood of a disc injury being the source of pain increases. Whereas if your pain increases when leaning backwards then it is more likely to be a facet joint as the cause of pain.
Diagnostic imaging: X-Ray for fractures, alignment, spacing, inflammation; MRI for all structures including connective tissue such as ligaments/tendons/discs/muscle; Ultrasound for superficial soft tissue such as muscles and tendons.
Treatment - What We Do
The simplest way do look at what we do here at Bay City Health Group is to think about the 2 sides of a coin. On one side of the coin we provide manual therapy services such as Osteopathy or Physiotherapy to help decrease pain, release tight joints and tissue, and increase range of motion. This is achieved using hands on techniques on treatment tables such as massage, PNF stretching, joint manipulation or adjustments, joint articulation and mobilisation, and myofascial release. On the other side of that coin is Exercise Rehabilitation such as Pilates & Physiotherapy which is performed in a highly specific clinical setting. With Pilates & rehab we aim to retrain faulty movement patterns, educate the patient with correct form, and build strength and mobility to areas of the body where needed. Pilates is a particular focus of Bay City Health Group and is a fantastic option for managing Low Back Pain.
Management and treatment of back pain is highly dependent on the type of symptoms, level of pain, onset of pain, limitations, and assessment findings, and is therefore very specific to the patient on that day. One thing to keep in mind with treatment is there’s no recipe. In other words, the type of treatment will vary from patient to patient depending on what their presentation is. For example, if someone comes into the clinic with acute low back pain and barely able to walk or even sit down, our treatment will be completely different to that of a patient who is a bit sore after a round of golf on the weekend.
Management
What things YOU can do to help back pain when it comes on
Things you can do: Keep moving. It is so important keep your body/spine moving when you 1) currently have low back pain or 2) feel it coming on. It doesn’t have to be your regular everyday type activities, but even movements such as gently allowing your knees to go from side to side whilst lying on your back can help maintain range of motion in the facet joints of the spine. Here is a couple of very basic and general tips (please see a health professional for more specific exercises and stretches catered for your body and type of injury/pain):
Squeeze your buttocks when moving from a sit to stand posture.
Pull your belly button in and try and activate your abdominal muscle group prior to any movement
Nothing replaces the knowledge and experience of Health professionals. This blog is for general educational purposes only and is aimed at the general public. If you have back pain and you think it needs to be looked at then please visit or talk a Health Professional.
To make a booking with one of the Health Professionals here at Bay City Health Group please call our friendly receptionists on 03 5229 3220 or head to our online bookings page to book your appointment online.