Lower Back Pain

Lower Back Pain – Will There

Ever be a cure ?

In most modernised countries lower back pain (LBP) will affect between 50% - 75% of the population and about 40% will experience it at some stage each year . Apparently , only 10% 20% will never have it . Most sufferers would have short duration pain and only a few would develop a chronic ( long term ) problem . It is thought that 80% - 90% will recover in approximately 6 weeks regardless of the type of treatment used , or indeed , the lack of. Musculoskeletal disorders tend to be the most common of chronic ineffectiveness and LBP makes up a large proportion of these . Most chronic pain is of low intensity with few people having a persistence of high intensity pain .

The amount of different treatments available is staggering but there is no conclusive evidence as to which is the most effective . The treatment is more likely to be down to who you see rather than what your presenting problem is . A person living in the U.S. A. is 5 times more likely to be a candidate for surgical intervention than a person living elsewhere – back surgeries increase at the same rate as surgeons that appear in that location which indicates that it may be the presence of of more surgeons that dictate the intervention

and not necessarily the presenting problem . In the world of physical therapy, there is also a lack of a clear direction in the most effective protocols to use in the treatment of back pain. Studies indicate that treatments vary from heat therapies, to electrotherapy, to massage, to exercise, to mobilization, to manipulation, all depending on who you see as opposed to what is wrong with you. The use of manual therapy combined with exercise seems to be the least favoured in many quarters. In general terms the evidence seems to show that passive treatments do not work, yet these passive treatments are common place in attempting to combat back pain with traditional physiotherapy. Underuse Many people spend all day sat behind a desk then go home and spend the evening on the settee – this causes the muscles at the front of the body to become short and tight and the muscles on the back of the body to be over-stretched . In both cases they also become weak because they are simply not being used . This leaves the spine with very little support ( see the article ' Injury Prevention – the Importance of Keeping Opposite Muscles Balanced ' ) . Overuse Many jobs entail doing the same thing all day , every day . If you are constantly bending down and standing up ( especially with poor posture ) the muscles become strained and no longer function properly leaving the spine with little support . You can get a sudden injury by lifting too much weight ( living whilst twisting is the biggest culprit ) . The human body cannot cope with the lazy modern life nor with constant repetition – it needs variety . For us to combat back pain we must face some home truths as therapists and as patients. 1) Passive treatments are limited and not evidence based. 2) Persuading the injured party to accept some responsibility in

managing their pain in very important and worthwhile. 3) Bed rest often makes the problem worse, while correctly prescribed exercise enhances recovery. 4) Back pain presents it’s self by means of episodes, flare ups, recurrences, often becoming chronic and it is therefore important to aim at long term management as opposed to symptom treating.  Education of the injured person as to the reality of their needed management interventions is essential to them being able to adapt their behaviour to enhance pain free activities. The cure is prevention i.e. don't do the things that cause back pain ! For Manual Workers People who lift for a living tend to get problems in the bones of the spine – to avoid this the No.1 thing that you must not do is to bend very far forward for at least 1 hour after getting out of bed – this is because the discs in your spine are at a high pressure and you can damage them .

We have always been told to lift items off the floor using this technique ; This is nonsense – unless the item is small or thin it's impossible to do this. The trick is to do 3 things ;  Keep the curve in the lower back  Keep the object as close to the body as possible  Use your legs to pump your body upright

Top picture is wrong - bottom is right

If you are lifting a box , try this ;

If you want to pick up something small off the floor try the golfers lift ;

For Sedentary Workers People who sit for a living tend to get problems in the spinal discs – to avoid this we have always been told to sit upright in a chair – this is also nonsense .If you sit in any one position for more than 10 minutes the muscles begin to tire – try changing your position frequently ;

Every 20 minutes or so , stand up and slowly stretch for 20 secs;

The ideal working day is an equal mixture of manual and office work . Until industry accepts this and makes the necessary changes LBP will always be a part of working life . In General There is no better general exercise for the lower back than walking – but not mall walking – you must walk fast enough to get your arms swinging . This engages all the back muscles . To effectively treat back pain, the therapist must educate the injured person on their responsibility in managing the injury . This will involve their active participation in modifying behaviour that may have previously aggravated the injury. The therapist must have a clear understanding of the correct and timely use of exercise in achieving long term improvement, rather than using techniques to treat symptoms . The therapist and injured person must accept that not all back pain will be curable and may require life long strategies . It must be noted that passive treatments show little if any evidence of aiding back pain while manipulation and exercise do . Exercises need to be selected carefully and should favour endurance rather than strengthening or mobility . Exercise for rehabilitation is not the same as exercise for healthy individuals.

Warning Not all LBP is muscular in origin – it can be due to a number of other causes such as urinary tract infection or spinal cancer . If you have any reason to believe that this may be so , for instance if you have any swelling or pain at night , then see your GP immediately .

Val O'Halloran Massage Therapist