So you bent over, and BANG! Pain in the back. Or maybe not. Maybe you’ve just noticed that slight niggle in the low back you’ve had for a while gradually worsening, for no apparent reason you can think of, and its just getting worse and getting you down. Well good news!!! The guru of low back pain himself, Mr Peter O’Sullivan, has just released new research on helpful facts for low back pain. Don’t worry though; we’ve summarized it for you so you don’t have to trudge through medical journals! Well the first thing you’ll probably notice is, it hurts! And that’s a good thing. Pain is your bodies guidance system, and most commonly pain flare-ups are more related to things such as changes in activity, stress and mood rather than actual structural damage. So being a bit more aware of what is going on with your body (and your mind!) may help to highlight things you need to pay more attention to and change positively. Tissue ‘damage’ can certainly can occur, however this is normally very minor (like stubbing your toe, hurts a lot but generally not much actual damage occurs!), however we know now that commonly it is other factors such as having a negative mindset about pain, being told to ‘be careful’ from other family members or friends (fear-avoidance behaviours), negative thoughts about recovery and poor pain coping behaviours are strongly associated with persistent pain. And unfortunately, no matter what Bob from down the pub says, scans aren’t the ‘be all and end all’. They can help to determine potentially what is going on by giving us a snapshot in time (of your spine), but not the full picture. Occasionally they can assist in determining the medical severity of a diagnosis, they do not show pain (as that is what you feel, not what you see) but don’t provide a true diagnosis or determine the prognosis of the current pain you are in (you can help decide that!!). Another favourite from Bob, is talking about your posture… that P word, urgh. Just because you sometimes sit slumped a bit, or lift with a bit of a bend in your back, DOES NOT predict low back pain or if it is going to persist. The spine is stupendously strong, and made to bend and flex and MOVE. Train it gradually, progressively and you get structural resilience. Ok, so trying to lift a heavy weight with a ‘non-optimal’ position MAY put you are increased risk of hurting yourself, but how may times a day do you bend your spine with NO PAIN (try this tomorrow, take count of how many times a day you do this. You’ll get bored FAST as that number climbs and climbs!). And so you end up at the physiotherapy clinic. Will they massage it better? Will they put some acupuncture needles in me and the pain will go away? Nope! As low back pain is very rarely dangerous, physiotherapists can, and should, do so much more for you than lay you on their treatment bed and try ‘manipulate’ the pain away. Physiotherapy care will be patient-centred, focused on educating and coaching you about the best management strategies for YOU to put in place, for YOU to take control of YOUR body. Your back may be sore, but it is safe. Safe to move, in all directions. Safe to exercise. Safe to work those muscles that surround your spine. But what isn’t safe is to think about ‘weak core muscles’ and ‘popping out a disc’. Because these things either don’t exist, or could never happen (who doesn’t love a social myth or two eh!).
Helpful facts for Lower Back Pain
Peter O’Sullivan et al, BJSM 2020
1. Pain – pain flare-ups are more related to changes in activity, stress and mood rather than structural damage.
2. ‘Tissue damage’ – normally very minor, however factors such as negative mindset, fear-avoidance behaviours, negative recovery expectations and poor pain coping behaviours are more strongly associated with persistent or chronic pain
3. Scans’ – DO NOT determine prognosis of the current episode of low back pain, the likelihood of future lower back pain disability and do not improve low back pain clinical outcomes.
4. Posture – spinal posture during sitting standing and lifting DOES NOT predict low back pain or its persistence
5. Loading and bending – spine movement and loading is safe and builds structural resilience when it is graded.
6. Rarely dangerous – In the vast majority of cases, Lower Back Pain is not a serious life threatening condition.
7. Aging – Incidence of lower back pain DOES NOT increase as we age, and most episodes of pain improve naturally of their own accord over an average of 6-8 weeks.
8. Sore… but safe – graduated exercise and movement in all directions is safe and health for the spine
9. Strength – a ‘weak core’ does not cause low back pain, and some people with low back pain tend to over-tense their ‘core’ muscles. While it is good to keep the trunk muscles strong, it is also helpful to relax them when they aren’t required.
10. Care – Effective care for low back pain is relatively cheap and safe. This includes: Education – patient centred and fosters a positive mindset about their symptoms Coaching people to optimize their physical and mental health through engaging in physical activity and exercise, social activities, healthy sleep habits and body weight and remaining in employment