Low back pain is a huge issue in modern society, and one which we encounter on a daily basis in our clinics. The role of the highly skilled physiotherapist in assessing, treating, and rehabilitating a patient experiencing low back pain, be it acute or chronic in nature, will depend on many factors, including the individual’s presentation, history, prior experience of back pain, beliefs, general health etc.
The treatment and rehabilitation of any lower back pain patient, be it of an acute or chronic nature, will involve a collaboration between the patient and therapist in combining both clinical treatment and the patient’s home exercise programme.
Acute Low Back Pain
Acute episodes of low back pain, of either sudden or gradual onset, are typically the result of loading or challenging the lower back in a way t which it is not accustomed or sufficiently conditioned for. The protective response of the body to such “overload” is the production of pain and or guarding muscle spasm. Such mechanisms often manifest in simple everyday activities, such as lifting an item from the floor, of twisting left or right. In such cases, the role of the physiotherapist is to treat the acute symptoms, and rehabilitate the patient back to normal spinal and core function, to prevent future re-injury. Treatment of acute back pain will always include the undertaking, on the patient’s behalf, of a home exercise programme, alongside the clinical treatment provided by the physiotherapist, to essentially address any physical dysfunctions (stiffness, poor movement control, weakness etc.) to minimise the chance of symptoms recurring.
Chronic Low Back Pain
Chronic low back pain can be the result of a multitude of lifestyle issues, often in combination. Patients are sometimes aware of many common issues such as sciatic nerve entrapment, lumbar disc migration, and core stability dysfunction. In truth however, there is actually very rarely any such structural injury or compromise. The physiotherapist must consider a vast array of alternative conditions while seeking a clear clinical diagnosis. Such entities rarely occur in isolation however. In such cases, it is the role of the physiotherapist to not only treat the acute symptoms of pain, stiffness, pins & needles etc., but to also identify and address any underlying or associated dysfunctional systems so are to prevent re-injury in the future. Failure to sufficiently strengthen a lower back following a period of pain is a common reason for symptoms returning. Treatment of chronic back pain will always include the undertaking, on the patient’s behalf, of a home exercise programme, alongside the clinical treatment provided by the physiotherapist.
Why does my low back pain seem to return episodically?
This is a very common question we get from our patients. Similarly, we often hear the phrase “I’ve had a bad back for years”. To the experienced physiotherapist, this theory of “having a bad back” is rarely justifiable, typically only in the case of some long standing medical issue, or some previous condition which has required a surgical procedure.
In the eyes of the experienced physiotherapist, a condition of low back pain which continues to return on a regular basis indicates that some underlying dysfunction has not been addressed previously, or the lower back has not been rehabilitated to a level of “normal” mobility, strength, stability etc. Consequently, the back remains easily vulnerable to overload, & every time this occurs, the body produces pain as a protective response.
Can my work habits contribute to my back pain?
A significant amount of the patients we see for lower back pain tend to have sedentary jobs, be it desk based or undertaking long drives on a regular basis. Essentially, the human body is a mechanism designed to move, and this is particularly the case with our lower back (lumbar spine). The body is not designed to remain immobile for hours at a time, especially in a slumped, seated position. The resulting pain and symptoms are our body’s way of telling us as much, and that we should move and change such unhelpful postural and lifestyle habits.
It is recommended that we move position approximately every 30-45 minutes, be this simply to take a short walk to the water fountain and back to our desk, or to stop at the services while on a long drive and have a brief walk before returning to the car. These small adjustments serve to maintain lower back health via maintaining general systemic circulation, to maintain joint mobility, and to also allow us a chance to “reset” our posture to the ideal position upon returning to sitting
Our clinicians regularly attend offices and work sites to undertake workplace (desk) ergonomic assessments also. When sitting, especially in an office based setting, the correct use of office furniture and equipment also exerts a significant effect on our posture, and subsequently on our general back health. A poorly positioned monitor, keyboard, or mouse can lead to repetitive strain injuries or neck conditions, which often lead to nerve irritation of the arms and hands.
A poorly fitted chair may also predispose to lower back pain or irritation, typically due to a lack of spinal support or by the individual sitting in a position from where they must strain the neck and/or arms to access their desk equipment. We commonly see expensive, highly adjustable chairs which have not been adjusted to the specifics of the individual’s individual body type and height, which therefore simply serve to irritate the client while they work.
Our workplace assessments are focused on assessing the layout and ergonomic friendliness of an individual’s workstation and chair, while also assessing work habits and routines which may further feed into his/her symptoms. Following this assessment, adjustments are made to the workstation, advice is provided to the client regarding their unhelpful work habits, and any ergonomic equipment deemed necessary by the assessor is recommended to the client’s employer.
What can I do to help myself when I have low back pain?
The primary self help intervention is to assess one’s lifestyle. Do you sit for in excess of 45 minutes at a time, on a regular basis? Do you sit in a slumped position regularly? Do you exercise for even 15 minutes on a daily basis? Are you overweight? Do you continue to be overly manually active (painting, lifting, hoovering, prolonged driving) even when your back is acutely painful? If any of these questions are applicable to you, then you have identified the first step that you can take in addressing your back pain.
When a lower back is acutely painful, a combination of mobility and heat is often the best approach. This term “mobility” refers to striking a balance between resting the back to allow it time to heal and recover, but also keeping mobile enough to maintain back mobility and prevent stiffening, which is likely to cause further pain in itself.
Gentle, non- weight bearing exercises (swimming) or low impact exercise (Pilates, cross trainer, walking, aqua aerobics) are ideal for those suffering from low back pain, as such activities will get the acutely sore lower back moving (to reduce pain and associated symptoms) without risk of exacerbation.
There is very rarely a case in which we cannot offer some help and relief to the patient experiencing low back pain, regardless of how long it has been present. Ultimately, it is unnatural for low back pain to interfere in our daily life, and dictate to anyone what we can and can’t do on a daily basis. It this is the case with you, perhaps it’s time to take a positive, proactive step and change this situation…