Lower Back Pain is not a disease, but a selection of symptoms with the origin commonly unknown. Often times what an individual is diagnosed with during a scan does not indicate how the individual’s body will present during physical and movement-based evaluation. So, what does it mean for the spine to be imperfect? The table below gives you an idea of just how common degenerative spinal changes are in patients of all ages, with no symptoms!
As research from Brinjikji W et.al (2014) suggests in the graph above you can see a staggering 52% of individuals with no back pain in their 30’s had disk degeneration, and by 50 years of age this has risen to 80%! But what does this information really tell us? This table demonstrates that your back is not inherently fragile, weak and vulnerable to injury. In fact, it is the opposite, a strong stable structure capable of incredible movement, with the capacity to withstand and produce great amounts of force. Some individuals in the health and fitness industry will attempt to convince you that your disk has “slipped” or is “out of alignment” and that you must require manual therapy to “push” or “place” it back into line, and this is fundamentally untrue. Cracking or manipulating your spine to provide temporary relief is not a long-term solution and will not teach you how to manage the underlying problem when it reoccurs. We have to be careful as clinicians not to facilitate a mindset in which the patient feels they need to rely on your treatment to have pain relief, instead we need to give them the tools and education necessary to independently manage their condition as much as possible. When individuals tell you to stop working or performing recreational activities due to a bout of non-specific acute lower back pain, usually this advice leads to further fear-avoidant behaviour, delaying recovery time even further. Research from Stenner P et.al (2015) suggests that fear-avoidance beliefs play a significant role in the potential recovery and maintenance of chronic pain and disability, and that fear-avoidant behaviours are often the result of logical yet incorrect assumptions about chronic pain and spinal deterioration.
Q: What is the best long-term plan to help reduce my back pain?
In most cases, conservative physical therapy that prescribes appropriate and individualised exercises to increase strength, mobility, flexibility, posture and promote self-management can help reduce stress of the spine and often improve symptoms (Rainville J et.al 2009). After all, even if you were to have a surgical procedure performed that acutely relieves pain, would you be equipped with the long-term self-management tools required to prevent back pain recurring? Below we have provided a simple 3 step approach to managing and improving lower back pain long-term:
Step 1 Education and Understanding
Understand the majority of back pain is caused by strain or sprain injuries, and that recovery may take as little as 6 weeks for 70-80% of patients, considering the diagnosis and treatment plan are accurate. (Karlsson et.al 2020)
A complex and/or chronic issue may last longer and will depend on the complexity of the injury / pain. This is why seeking advice and assessment from a qualified health and fitness expert such as a Clinical Exercise Physiologist can not only be productive and educational, but allow you to evade fear avoidant behaviours and remaining sedentary.
Understanding the psychosocial element of back pain. Often, strong emotions and/or psychopathology can result in the worsening of perceived symptoms. Typically anger and stress derived from interpersonal relationships can exacerbate pain. In fact, research suggests 59% of patients with lower back pain have a psychological disorder that can include high levels of anxiety and depression as well as substance abuse (Alhowimel A et.al 2018). These psychosocial factors often present in poor program adherence, an unwillingness to return to work or recreational activities and an exaggeration of symptoms which do not align with objective findings.
Step 2 Progressive Exercise Therapy
Acute pain relief from treatments such as massage and heat therapy certainly have their place in the management of lower back pain, however without a structured and progressive exercise program designed to strengthen the hip, back, abdominals and lower limbs you are unlikely to address the underlying issue. Instead, the focus should be on improving both flexibility and stability concurrently within a pain free threshold, making sure you are progressively overloading in a safe and effective manner. (Dreisinger TE 2014)
In conjunction with a strength-based program, implementing specific mobility exercises prior to your workout to address your individual deficits can improve flexibility and help improve movement capacity in at risk areas. For instance, a large number of individuals with lower back pain suffer from severe restriction in the lower limb musculature such as the hip flexors and hamstrings
This is where an exercise such as the Barbell Romanian Deadlift and Split Squat for example would be implemented to not only improve flexibility and range of motion in these areas (Hamstrings / Hip Flexors), but provide much needed strength and stability also.
For additional information on how best to progressively make your training more challenging at home check out our home support page on our website.
Step 3 Long Term Self-Management
Long term self-management describes the incorporation of physical activity, medical management, role management and emotional management of the chronic condition
The individual must take an active role in the management of their condition, taking ownership and control of tasks such as sticking to a regular exercise routine, finding a long-term nutrition plan that is enjoyable and efficient, utilising pain coping skills, as well as learning to problem solve, communicate, and set achievable goals
Discussing the best individualised exercise programming with your Exercise Physiologist or Physiotherapist, constructing an enjoyable nutrition plan with a Dietitian, or touching base with your Psychologist on mental health outlook can be extremely beneficial in helping to guide and stick to your goals/plan.