Most people experience low back pain at some point in their lives. People will experience low back pain in different ways, and it will affect various aspects of people’s lives differently also. For some people, low back pain can be severe and frightening; for others, it is mild and familiar. For most people, it will get better relatively quickly, particularly if they are given the right information early on. 

 There are many things you can do to help your pain.

Get/keep active. A lot of people believe that they should be resting or lying down when they have back pain, but it’s important that you stay as active as you can, and if possible stay at work and doing your normal life activities. Start gradually and don’t worry if it’s uncomfortable at first - and remember that hurts doesn’t equal harm.

 Stress, tiredness and anxiety can make your pain seem worse. Try to manage any stress and anxiety, and try to get a good night’s sleep. This may involve talking to family and friends or a health professional about how you are feeling and what is going on in your life, and letting them know that their understanding will help you get better also. Keep a diary of what you are feeling and how it affects your pain, to help you understand the impact it can have.

 Painkillers aren’t always needed, and if they are should only be used for short periods. Talk to your GP or pharmacist about whether simple pain relief is needed to help you get moving again, for a short time only. Painkillers don’t cure back pain, and long-term use of painkillers can be harmful to you and needs to be overseen by your doctor.

 Test such as x-rays and MRIs aren’t helpful in most cases. Your treatment provider can assess you properly by listening to your story and examining you, and a specific diagnosis is not needed to plan appropriate management. Imaging such as x-rays or MRIs should only be done if your treatment provider suspects a specific condition that would require different management to most non-specific low back pain. Structures in the back such as discs and nerves and ligaments can sometimes be the source of pain - but this isn’t obvious from doing imaging most of the time. For most people with low back pain, it is not possible to identify a specific cause, and this isn’t necessary for effective treatment.

 Your pain can come back sometimes at funny times - but this doesn’t mean there is ongoing tissue damage. The feeling of pain takes place in our brain’s pain centre.  Sometimes following injury, the brain can send mixed or false messages through our pain system, even when there is no longer tissue damage or dysfunction. When we first hurt ourselves, our brains pain alarm system sends out a loud signal, so we can take action. But sometimes this messaging system can go wrong and keep producing warning messages. We can ‘re-set’ the system though, by continuing to do and enjoy the things you normally do, even if there is some discomfort with it. Over time, you can reset and quieten down the incorrect pain messages. Some people believe that back pain is always caused by tissue damage or dysfunction within the back - but as we can see, it can also be due to overactive pain messages, without any ongoing tissue damage or dysfunction.

 Most low back pain should be managed in primary care. By primary care, we mean GPs, physiotherapists, and other first line of contact health professionals. A referral to a spinal surgeon/specialist is only needed when there is a possibility of surgical intervention being needed, or if there are signs of serious pathology that need some investigation. If you are referred to a specialist/surgeon, this does not automatically mean you will be having surgery – the specialist will assess you and make a recommendation about this, and in some cases will recommend continued conservative management of your problem. For most cases of low back problems, this won’t be necessary, and won’t change the best course of action for you.

 You don’t have ‘take it easy’ on your back if you have had a previous episode of low back pain. Some people believe that the back is a fragile or vulnerable structure, which is easy to injure or re-injure, and that they should avoid activities that put load or strain through the back. The reality is that our backs are made up of lots of muscles, ligaments and bones that provides strong support for the body, and while it can be strained like other parts of the body, it also heals well much like the rest of the body. It is good for the back to be put through activities that subject it to the normal loads and strains of everyday life - particularly after injury. 

 You don’t need to change the way you stand, lift or bend, to move the ‘perfect’ way. We all move our bodies individually and in different ways, and despite many people’s beliefs, there is no one size fits all way to move - move and bend your back the way that feels normal and comfortable to you. You also don’t have avoid certain movements after an episode of low back pain - studies have shown that bending or twisting, lifting and sitting are unlikely to independently cause low back pain. Changing your posture has not been shown to be helpful in low back pain studies.

 What kind of treatment should I be getting or expecting?

On your initial assessment, your health provider should take a history and do a physical examination to help rule out any serious problems, and in most cases if there are signs of these, reassure you about the normal course that most low back pain follows. Based on the assessment, your treatment provider should then outline what treatment approach is best for you as an individual.

It is important that your treatment provider helps you understand what is to be expected with an episode of low back pain, and give you education and advice that is consistent with the messages we have described above. You should be advised to remain as active as you can be, and to remain at work if you can. Non-pharmacological treatment is recommended initially, and if this isn’t successful, a short course of anti-inflammatories should be used in most cases, rather than opioid medications. 

General exercise is helpful and recommended, and some examples of this are Pilates, yoga, walking, and tai chi. For acute low back pain, treatments such as manual therapy (spinal manipulation) and acupuncture can help to relieve your symptoms and get you moving again, but shouldn’t be needed long term, and should be used as part of a treatment package that also includes exercise, education and advice on self-management. Effective management of your back pain should consider all elements of your life - known as a biopsychosocial approach. Talk to your health professional and to your family and friends about how your pain is making you feel. In some cases, talking to a professional can be helpful.

Interventional procedures such as joint injections have a very limited role in the management of low back pain, and surgery should only be considered in certain circumstances. There is little evidence in studies to recommend the use of spinal traction, ultrasound, bed rest or back supports. 

If you have long-standing low back pain, exercise has been found to be effective in helping with symptoms. There is a wide range of exercise that can be used, and no evidence in studies that one type of exercise is better than another. Ultimately, any exercise is good for you, and comes down to what works for you in terms of individual preference, your needs and capability.  

 If you live in the Waikato DHB catchment area, and have acute or sub-acute low back pain (normally a timeframe from the time when the pain started to about 3 months after) with an ACC claim, and your pain hasn’t settled or is worsening at the 6 week despite having seen a primary health care provider (GO, physiotherapist etc), please be in touch with us. We may be able to asses you to see if you are eligible for our fully-funded ACC low back pain service. If your injury is greater than 1 years duration or is not due to an accepted ACC claim, talk to your local GP – you may be eligible for a low back pain program through the DHB.  Otherwise, we will be happy to give you a recommendtion to see one of our expert team to help you with your problem.

References:

ACC and the National Health Committee. (1997). New Zealand acute low back pain guide. Wellington, New Zealand

 Almeida, M., Saragiotto, B., Richards, B., & Maher, C. G. (2018). Primary care management of non‐specific low back pain: key messages from recent clinical guidelines. Medical Journal of Australia, 208(6), 272-275.

 Mike Roscoe, PhD, MPAS, PA-C Alyssa Nishihira Low Back Pain: Evidence-based Diagnosis and Treatment. Clinician Reviews. 2016 May;26(5):38-45

 O'Connell, N. E., Cook, C. E., Wand, B. M., & Ward, S. P. (2016). Clinical guidelines for low back pain: A critical review of consensus and inconsistencies across three major guidelines. Best practice & research Clinical rheumatology, 30(6), 968-980.

 Oliveira, C. B., Maher, C. G., Pinto, R. Z., Traeger, A. C., Lin, C. W. C., Chenot, J. F., ... & Koes, B. W. (2018). Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. European Spine Journal, 27(11), 2791-2803.

 Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Annals of internal medicine, 166(7), 514-530.

 Shipton, E. A. (2018). Physical therapy approaches in the treatment of low back pain. Pain and therapy, 7(2), 127-137.