Lower Back Pain
We’ve all been there – you might have just bent over or lifted something awkwardly, and suddenly, you’re zapped with pain. Or perhaps you tried to get off the lounge and found yourself stuck. Your back then tightens up, gets achy, and makes everything more difficult – walking, standing, sitting, and bending over become monumental tasks. There might even be pain or tingling going down your leg! It can be incredibly frustrating (and worrying), but you’re not alone in your experience: around 75% of people experience back pain at least once in their lives (Thiese et al., 2014).
What’s going on with my back?
There are three main categories of back pain that help us determine the seriousness of the problem. Conditions in each category may require different treatment, or may mean that physiotherapy might not be the right place for you, so it’s important to know what you’re dealing with!
Non-specific lower back pain
The most common type of back pain is called non-specific lower back pain (NSLBP), or mechanical back pain. NSLBP accounts for 90–95% of all lower back pain cases (Bardin et al., 2017), which means that this is the most likely diagnosis for your back pain.
There are many structures in your lower back that can contribute to pain – joints, muscles, intervertebral discs and ligaments. Sometimes, these structures can become irritated due to sudden or unexpected movements, repetitive movements, sustained postures, and many other reasons. In response, your nervous system can “amplify” some of the sensations in the area, leading to the feeling of lower back pain.
The term “non-specific” simply means that we cannot pin down a single source of your pain. Pain is a complex experience. Whilst physical injury can certainly lead to pain, other factors such as psychological stress, the presence of other medical conditions, occupation, and your general health can all contribute to pain, too. The term “mechanical” means that the back pain is triggered by movements and postures, which is why it is common for people to have difficulty bending in a certain direction, or being in one position for too long whilst they have their back pain.
Since there’s “non-specific” back pain, you may be wondering about “specific” types of back pain, too! There are two that we pay close attention to:
Specific spinal pathology
Specific spinal pathologies refer to serious problems with the spine, and include the following:
- Vertebral fracture (i.e., fracture of the bones of the spine)
- Malignancy (i.e., cancer in the spine)
- Spinal infection
- Axial spondyloarthritis (a type of arthritis that causes a lot of inflammation)
- Cauda equina syndrome (dysfunction of multiple nerves in the lower back)
These are rare and make up less than 1% of cases presenting to doctors or physiotherapists. Some of these can be quite serious and may require referral to other health professionals to ensure you are getting the right care!
Radicular syndromes refer to pain resulting from injury or irritation to (usually) single nerves of the lower back, and account for 5-10% of cases seen in clinic. Patients typically report pain, and sometimes tingling sensations or numbness going down the leg.
Radicular syndromes can occur because other structures in the back place pressure on the nerve, resulting in compression and irritation of the affected nerve. This can be due to a disc bulge, cysts, arthritic changes, and anything else that causes there to be less space for the nerves to travel through. Whilst most patients respond well to physiotherapy treatment alone, it is important to note that there are sometimes more serious causes for radicular syndromes (e.g., a tumour) that need to be screened for.
Do I need a scan?
It is unlikely that you will need to get a scan unless your physiotherapist or GP suspects a more serious reason for your back pain. Whilst many patients think that having a scan will help them understand what’s causing their pain, the opposite is often true. Often, there are many incidental findings, which are features that happen to exist but have little or nothing to do with a person’s current pain episode. Common incidental findings include:
- Disc bulges
- Arthritic changes
- Disc height narrowing
These findings can seem worrying, especially if you don’t know what they are or how they affect you. Thanks to modern research, we also know that disc bulges (the biggest concern for most patients) are rarely problematic on their own and are only the culprit in lower back pain in around 1-3% of patients (Dydyk et al., 2022) – that’s a small number! In fact, many people without back pain have disc bulges, too, which further shows that they are only a small reason for why people have back pain.
Other research has also shown that disc bulges can and do change over time (Chiu et al., 2014). Specifically, large disc bulges have been found to reduce on their own over a period of twelve months, which means that findings on a scan you had several years ago may not truly reflect your current state!
Remember, you are much more than just your scan – pain is a complex phenomenon and we would be doing a huge disservice if we treated you based only on your imaging without trying to understand how your back pain affects you.
How can Solutions help?
The first step is to ensure that we correctly identify the type of back pain you’ve come in with. Even though NSLBP accounts for the majority of cases we see, our physiotherapists are diligent in making sure that serious causes of back pain (like a fracture) are ruled out before commencing treatment. They will do this by thoroughly discussing the history of your back pain with you and performing a series of physical tests. If needed, your physiotherapist will refer you back to your GP for further testing.
Treatment for NSLBP
Just because it’s called “non-specific” doesn’t mean we can’t do specific treatments for it.
A thorough assessment of your back movements and pain will help us figure out what movements are most affected, and if there are positions that help relieve pain. From there, we will help formulate a treatment plan to help you get back to what you love doing. There are several treatment options that we have at our disposal:
- Exercise to strengthen the back, hips, and/or trunk
- Spinal mobilisation
- Soft tissue release
- Dry needling
NSLBP is not a serious form of back pain and is generally not a cause for alarm; most people recover well within the first six weeks (Menezes Costa et al., 2012) and are able to return to sport, work and other desired activities.
Treatment for specific spinal pathology
Depending on what the specific cause of your pain is, physiotherapy may or may not be a viable treatment option. Many of the conditions listed above will require medical management through a specialist. Physiotherapy may be recommended as part of the rehabilitation process, but this is usually to support regular physical activity and exercise rather than as a primary form of treatment.
Treatment for radicular syndromes
As mentioned above, many patients respond well to physiotherapy treatment alone. A similar approach to the treatment of NSLBP is taken, where exercise and passive treatments are combined. There may also be an added emphasis on nerve-specific exercises to help improve recovery.
What do I do now?
If you have back pain or other symptoms that concern you, or want to discuss the results of some imaging you may have had, give us a call on 1300 738 609 or book online to see one of our friendly physiotherapists. Let us help you find your Solution.
Chiu, C. C., Chuang, T. Y., Chang, K. H., Wu, C. H., Lin, P. W., & Hsu, W. Y. (2015). The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clinical rehabilitation, 29(2), 184–195. https://doi.org/10.1177/0269215514540919
Dydyk, A. M., Khan, M. Z., & Singh, P. (2022). Radicular Back Pain. In StatPearls. StatPearls Publishing.
Menezes Costa, L. d. C., Maher, C. G., Hancock, M. J., McAuley, J. H., Herbert, R. D., & Costa, L. O. P. (2012). The prognosis of acute and persistent low-back pain: a meta-analysis. Canadian Medical Association Journal, 184(11), E613–E624. https://doi.org/10.1503/cmaj.111271
Thiese, M. S., Hegmann, K. T., Wood, E. M., Garg, A., Moore, J. S., Kapellusch, J., … Ott, U. (2014). Prevalence of low back pain by anatomic location and intensity in an occupational population. BMC Musculoskeletal Disorders, 15(1). https://doi.org/10.1186/1471-2474-15-283