Understanding and Managing Low Back Pain

1. Understanding Low Back Pain:

Low back pain is a leading cause of disability worldwide. Studies show that 80% of people will experience low back pain in their life, and at any given time 30% of people will report pain in the last 3 months. Findings of disc degeneration, loss of disc height and disc bulging are common (see table below) with 37% of individuals having findings of disc degeneration at 20 years old up to 96% of individuals at ages 80 and greater.

***These findings do not always correlate with pain and findings of degeneration***

Even mild disc bulging can be expected with aging. This is all to say low back pain is very common and many of us will experience low back pain at sometime in our life. Imaging findings on X-rays or MRIs are common and a normal part of aging, these findings are not a death sentence to stay in chronic pain. 

Brinjikji, W., et al 2015

2. Risk Factors for Low Back Pain

What are the leading risk factors for low back pain?

• obesity

• smoking 

• sedentary lifestyle 

• strenuous physical work

• psychological conditions such as depression and anxiety. 

• Other common causes of low back include improper lifting form or inappropriate progression of lifting (ie. lifting too heavy too fast). 

If you work a sedentary job, making sure to take a few short breaks throughout the day from sitting to stand and going for short walks can be helpful to reduce back pain. If you do work a strenuous physical job, it is helpful to have a workout routine to improve your body’s capacity beyond what is needed for your job to be better equipped to handle the repetitive load. If you are new to working out, consider working with a fitness professional or physical therapist to learn proper lifting techniques.

3. Benefits of Staying Active with Low Back Pain:

As Physical Therapists our job is to teach our clients how to stay active while dealing with low back pain as well as teach strategies to reduce and manage pain. While your first instinct may be to rest when in pain, bedrest has been proven to actually prolong recovery in low back pain and should not be used as a strategy for recovery. 

Movement should be encouraged and performed as tolerated as it promotes fluid exchange within the spinal discs, increases blood flow to the back's soft tissues, and helps maintain muscle strength and flexibility. Fear of movement is very common in low back pain, however if unaddressed can lead to further pain, disability and loss of function over time.

Sitthipornvorakul E, et al 2018

4. Then What Should I Do for My Low Back Pain? 

Walking! 

Walking is a great low impact activity that has been proven to be beneficial in the treatment of chronic low back pain. Other low impact activities that may be well tolerated include cycling or swimming. It is best to start slow with short intervals and gradually build in length of time and intensity. 

Gentle stretching/mobility exercises

It is important to restore the ability for our spine to bend, extend and rotate in order to complete our daily activities normally. Gentle yoga exercises such as cat cow, small cobras, or trunk rotations can be helpful, however you should not be pushing through pain. It is recommended to work with a healthcare professional or physical therapist to learn which motions are encouraged early on if you are in acute pain. Don’t forget about hip and thoracic mobility! The joints above and below our spine help take strain off the low back if they are moving well!

Core Stabilization exercises 

Core musculature often gets inhibited and weakened during bouts of low back pain. Learning how to reconnect to these muscles to stabilize the spine during movement can be helpful in decreasing pain and restoring good functional movement patterns. We like to include front and side plank variations, weighted carries, bridge variations and rotational core strengthening. 

Functional strengthening! 

This is the phase of rehab we see a lot of people miss! Throughout our day we have to squat to sit down, we have to bend or hinge to pick something up from the floor, we have to carry weight to bring in our groceries, and numerous other ways we load and use our spine throughout the day.  Training these motions and progressively loading them can increase our resilience to the daily stress of life!

5.  When to Seek Professional Help:

Most of the time imaging is not warranted for low back pain in the absence of red flags. Red flags include: history of cancer, urinary or bowel dysfunction, low back pain associated with fever and chills, unexplained weight loss, unrelenting pain not improved with rest or position changes, saddle area anesthesia, progressive or severe neurological deficits, or history of significant trauma especially in older population. In the absence of these findings physical therapy and exercise are typically the first line of defense in managing your pain. 

Citations: 

Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., ... & Wald, J. T. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811-816.

Sitthipornvorakul E, Klinsophon T, Sihawong R, Janwantanakul P. The effects of walking intervention in patients with chronic low back pain: A meta-analysis of randomized controlled trials. Musculoskeletal Science and Practice. 2018;34:38-46. doi:10.1016/j.msksp.2017.12.003

www.psychomaticmedicine.org (2014) Fear Avoidance Model (photograph). Available at: http://www.psychosomaticmedicine.org/cgi/content-nw/full/67/5/783/F117