Back Pain: The facts and what to do if you have it
Well-being awareness article written by Chartered Specialist Physiotherapist, Emily Tims of Vitality360 who are experts in the delivery of bespoke rehabilitation programmes for people with persistent pain and fatigue.
Low back pain is very common, and most people have it at some point in their lives. It affects people of all ages and all socio-economic statuses. It is the leading cause of disability worldwide and the number of people affected is increasing.
The good news, however, is that 90% of people recover from back pain within 6-8 weeks and less than 1% of back pain has a serious cause.
What to do if you have a new episode of back pain:
Stay active
People recover more quickly from back pain if they stay active, rather than the out-dated advice to have bed rest. Staying active, however, does not mean pushing on through and continuing life as normal. It means short walks, breaking up periods of sitting with standing and moving and doing gentle movements.
If you are struggling, take medication
If you are in pain which is severely impacting your ability to do your day-to-day tasks, consider taking medication. The latest evidence recommends Ibuprofen and not paracetamol. Reducing the pain will enable you to move more, feel less down and sleep better, which will all help your recovery.
Plan more restorative activities and allow time for plenty of sleep
This may sound like a contradiction to staying active, however there needs to be a balance between staying active and allowing your body to recover. Restorative activities are whatever those things are which help you to feel well rested and relaxed. Poor sleep can increase inflammation and affect your mood, so allowing plenty of time for sleep at night is important. If you are struggling with sleep, have a look at The National Sleep Foundation’s tips for improving sleep.
Think about the cause, and this will help you to recover
My experience of working as a physiotherapist for 16 years with people who have low back pain is that understanding the wider causes, enables full recovery. It is often not one factor but an accumulation of factors which lead to the ‘straw that broke the camel’s back’. People often describe experiencing the beginning of the pain after reaching down to pick something up or moving suddenly; and attribute this sudden movement to causing the pain. Sometimes the pain comes on gradually with no obvious cause.
Usually there are several physical, environmental and psychological factors contributing to the pain beginning, which if addressed, enable recovery. These might include a change in work, taking up a new hobby, a new pair of shoes or mattress.
In my physiotherapy school, we were well trained at finding out if anything had changed in the person’s life around the time the pain started, what factors make the pain better or worse and we were excellent at assessing any biomechanical factors relating to how the spine and muscles move.
In my personal life, I often noticed that people I knew well might get back pain around a time of stress (for example, my Mum would often get severe pain around Christmas and recover quite quickly afterwards), so this led me to ask clients I was seeing about emotional factors, which were often – but not always – a factor in how the pain started.
So, this leads to my next tip...
Address any emotional factors
Sometimes emotional causes are obvious and sometimes they are not. Let’s face it, most people do not lead an entirely stress-free life. It is worth considering any causes of stress in your life and how they may be affecting you and if you notice that the symptoms you are experiencing change in response to stress. Often, just being aware that stress may be a factor, helps people to notice how symptoms may change in response to emotions. Examples of increased stress might be; an increased workload, a dispute with a neighbour or caring for a loved one. If there is something going on in your life causing distress, what can you do help the situation? Can you start by talking it through with someone?
When to see a Doctor if you have back pain:
These symptoms are relatively uncommon, but you should see a Doctor if you have any of the following:
Difficulty passing urine or having the sensation to pass water that is not there
Numbness/tingling in your genitals or buttocks area
Loss of bladder or bowel control
Impaired sexual function, such as loss of sensation during intercourse
Loss of power in your legs
Feeling unwell with your back pain, such as a fever or significant sweating that wakes you from sleep
When to seek treatment:
If the initial pain is very severe, psychologically distressing and the pain covers multiple areas of the body, this increases the chances of pain persisting, so getting treatment is beneficial.
If pain is not improving or worsening
The facts... What does the research say about low back pain?
What is low back pain caused by?
For less than 1% of people with low back pain, there is an identifiable cause or disease. For most people who experience low back pain, it is not possible to identify a specific source of the pain. This type of back pain is classified as non-specific low back pain. It is thought to be a complex condition with multiple contributors, including psychological, social and biological factors; affecting the mechanisms by which pain is processed (Hartvigsen et al., 2018.).
What makes people more likely to get back pain?
Previous episodes of low back pain
People who have other chronic conditions, e.g. asthma, headaches, diabetes
Depression
Lifestyle factors, e.g. low physical activity, being sedentary, obesity, smoking
People from lower socioeconomic status
Possible genetic factors
Physically demanding work, e.g. working in awkward postures
What are the best treatments for low back pain?
The best resource which summarises the current state of evidence for many health issues are the National Institute for Clinical Excellence (NICE) Guidelines. The most recent resource for managing low back pain and sciatica was published in 2016 and reviewed in 2018.
Some key points from this resource are:
Encourage normal activities as much as possible. This includes staying active and returning to work.
There is good evidence for exercise treatments.
Massage and manipulation treatments should be used alongside exercise as there’s not enough evidence for them to be used as a treatment on their own.
Acupuncture, manual traction and electrotherapy is not recommended.
Foot orthotics, corsets and belts are not recommended.
Paracetamol is no longer the first option for managing low back pain. Non-Steroidal Anti- inflammatory Drugs (NSAIDs), such as ibuprofen or aspirin are recommended.
For those people who have not experienced an improvement in pain, or who have significant physical or psychological barriers to recovery, combined physical and psychological (talking therapies) treatment are recommended.
Conclusion:
Ideally, we would all take care of our backs in how we are living our lives to minimise the risk of suffering with lower back pain. If you do though, especially during times perhaps of emotional stress, then this article has offered some tips and advice of how to deal with it based on my extensive experience as a physiotherapist professionally and personally which I hope has been helpful.
For any further advice if suffering with chronic or persistent pain please visit our website to book a free 15 minute consultation to see how one of our bespoke programmes may support your recovery.
Resources:
Chartered Society of Physiotherapy: 10 things you need to know about your back:
https://www.csp.org.uk/publications/10-things-you-need-know-about-your-back
Hartvigsen et al. 2018. What low back pain is and why we need to pay attention. The Lancet.
https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(18)30480-X.pdf
Low back pain in over 16s. Assessment and Management. 2016. NICE Guidelines: