Low back pain is common and impacts the majority of individuals at some stage in their life. [1]
According to the Australian Journal of General Practice, although around 90% of patients experience recovery from an acute episode of lower back pain, it is common for the condition to recur. If not treated appropriately, low back pain can be disabling, causing significant pain and become a disability which affects an individual’s day to day function. Hence, it is important to recognise low back pain and address it before it starts causing pain and progresses to chronic back pain.
1. Identifying Low Back Pain
Low back pain that persists can get worse over time. The important thing is not to put up with pain. Instead, identify the issue and get it investigated.
Some people experience radiating pain from your lower back down to your legs. This can be due to the nerves being irritated at the spinal cord.
Often, limited range of movement such as difficulties bending sideways, backward, or forwards are symptoms to take note of. Some individuals have these symptoms without feeling any pain. However, it is important to address these issues because pain can occur and cause the body to go into spasm.
2. Diagnosing Low Back Pain
There are several approaches to diagnosing low back pain and often a combination of obtaining your health history, imaging scans, and physical examination is usually required to have a comprehensive diagnosis.
Medical History Review
The first point of diagnosing low back pain is to obtain a comprehensive medical history. Information regarding your medical history, including previous injuries or surgeries must be discussed. Even your occupation will provide good insight into your situation.
Getting all the relevant information about your past injuries can aid in ruling out other health problems while narrowing down potential causes of your pain.
On the other hand, if you had previous surgeries that are connected to the spine or other areas near your lower back, these may contribute to the current health concerns that you are experiencing.
Physical Examination
A spine specialist or your physiotherapist will also undergo a physical examination to understand how your body works before your physiotherapist is able to provide you with a diagnosis regarding the symptoms that you are experiencing.
The physical therapist will have a thorough assessment of your bodily reflexes, posture, range of motion, and quality of movement. Based on these findings, your therapist will start to form a better understanding of the issue and work out a possibility of what is causing your back pain.
Imaging Tests
Images of your bones generated by an X-ray machine can show an overview of your spine and determine whether there are fractures or problems surrounding it. X-rays should not be routinely requested in individuals with non-specific low back pain. [2] This is important to note as less than 5-10% of all low back pain is due to a specific issue of the spine.
Of course, there will be exceptions. For example, if you sustained back pain from a fall, then it is likely your physiotherapist or doctor will request an X-ray to rule out any broken bones or fractures in the spine.
On the other hand, Magnetic Resonance Imaging (MRI) provides in-depth pictures of your ligaments, muscles, and tissues by not using any radiation. A Computed Tomography (CT) Scan creates cross-sectional views of your spine by combining X-ray pictures. These types of imaging tests are generally requested when an individual is showing severe or progressive neurologic deficits like sudden weakness, or signs of bladder dysfunction. These tests are normally used to rule out any suspected underlying conditions on the basis of history and physical examination, like spinal cord nerve root impingement leading to cauda equina syndrome. [2]
For complex cases, nerve conduction tests or electromyography can be requested by your physician.
3. Treating Low Back Pain
Medications
Whenever your body is in pain, the natural response of the body is to protect the area by stiffening the area. Pain affects mobility. Even though you are in pain, it is important to continue to be able to move around. Taking medications like pain relievers, eg. panadol is recommended to help get some relief.
If you sustained an acute low back injury, taking nonsteroidal anti inflammatory drugs can help with your acute low back pain and reduce inflammation in the area. [3] Muscle relaxants can sometimes be prescribed by your doctor with great effect. [4]
However, it is best to call your doctor if you start to feel pain occurs or are experiencing more severe pain. Your doctor may provide you with prescription drugs depending on the severity of pain.
Cold and Heat Therapy
Cold therapy, ice packs or cold compresses is recommended for the first three days you experience severe back pain. Cold therapy is used to numb any irritated tissues and reduce swelling in the area.
Afterward, heated therapy can be used to promote relaxation in stiff muscles and enhance blood flow to the painful area. You may have a hot bath or apply a hot pack for pain relief.
Early Return to Activity
It is important for you to be able to move around at home and do simple day to day activities. Gone are those days when bed rest is recommended by doctors until you feel better. Pain reduction and functional improvement are the main aims of treatment. So don’t be surprised if your physial therapist prescribes you simple exercises after your first session.
Lifestyle Modifications
Observing good posture whenever you are sitting, standing, or carrying things is helpful for your back. By practicing better posture and engaging your abdominal muscles, this can help you prevent straining your muscles and experiencing low back pain.
Simple modifications may include an ergonomic review of your work desk, a review of your lifting technique or it can be modifying how you sit in your chair to help relieve pain.
Also, avoid spending too much time sitting in awkward and uncomfortable positions which can cause additional unwanted pressure on your back. In fact, prolonged sitting or standing isn’t beneficial to the body and can make the pain worse.
Depending on your situation, you may benefit from getting a supportive mattress and pillow that can help support your neck and lumbar spine in a proper position. A proper supportive will aid in supporting your spine while resting. At the same time, it can help promote better sleep.
Treating low back pain often includes a combination of education, exercise, lifestyle modification and possibly weight loss. In general, back pain tends to improve between four to six weeks.
4. Physiotherapy for Low Back Pain
The Benefits of Physiotherapy
There are several benefits of physiotherapy for low back pain.
Physiotherapy can help relieve low back pain, allowing individuals to return to their day to day activities. In addition to that, physiotherapy can help improve function and mobility in the affected area. By working on strengthening the muscles around the spine, this reduces the risk of future episodes of low back pain.
Physiotherapy use a range of therapy including massage therapy, dry needling, spinal manipulation, spinal mobilisation and exercise prescription.
Of course, postural awareness and lifestyle changes will be part of the long term management of chronic back pain. To assist you in avoiding future injuries, your physical therapist will support you with education and instruct you on improving body mechanics.
Treatment Techniques in Physiotherapy
Physiotherapists use various techniques based on the needs of each patientto help relieve pain. Manual techniques include spinal mobilisation and spinal manipulation which can improve mobility in the joint and help relieve pain. Taping is also a technique frequently used to help provide relief.
Different massage techniques can be used to improve circulation and reduce swelling around the injured area. There are also options to use electrical modalities like ultrasound, Transcutaneous Electrical Nerve Stimulation (TENS) to provide back pain relief.
A big part of physiotherapy is offering specific exercises that are tailored to your individual needs to help with flexibility, strengthening weak muscles, and addressing imbalances that cause low back discomfort. Physical therapists can also provide suggestions on how to alter your living or working space to lessen lower back stress.
5. Alternative Treatments for Low Back Pain
You can also try complementary or alternative therapies as part of your treatment plan.
Acupuncture Treatment
In acupuncture treatment, your specific body spots are treated with tiny needles to promote healing and the ease pain that you are experiencing. The idea is that acupuncture can balance the flow of “Qi” in the body, which is also known as the life force that flows through the body along different pathways known as meridians.
When acupuncture is paired with other therapies like moderate stretching and regular exercise, it can significantly contribute to your healing.
Visceral and Neural Manipulation
Visceral manipulation is a type of manual therapy that works on the manipulation of the internal organs and surrounding tissues. The idea is that tension in the surrounding tissues or restrictions in the organ can contribute to pain or dysfunction in the body.
Physiotherapists use a gentle technique to release tension of these areas which restore balance to the body and improve function.
Doing Yoga and Pilates Exercises
These types of exercises promote core muscle development while encouraging flexibility in your body by means of performing different postures and stretches.
Regular Pilates or yoga practice helps reduce lower back pain by enhancing posture, flexibility, balance, and muscular strength. [5]
In Pilates, the exercises focus on muscles that surround and support your spine. By working on improving control through that area, the spinal column is well protected from injury. Some of the exercises that are beneficial for pain management are trunk rotation, pelvic curl, and supine spine twist.
On the other hand, Yoga is a great form of exercise as it help improve your body awareness and helps you move your body through different poses in a controlled manner. Yoga poses also encourage stretching which is beneficial to individuals who suffer from tight muscles from prolonged sitting at the desk.
However, it is important for you to discuss any form of exercise with your physiotherapist to ensure the exercises do not make the pain worsens.
Maintain a Healthy Weight
Many tend to overlook this but maintaining a healthy weight is crucial to a healthy spine. A weight loss of a few kilograms takes a lot of pressure off the joints in the body. This is a great way to stay healthy and keep back pain away.
6. Preventing Low Back Pain
Prioritising your health and wellbeing is crucial. Fortunately, there are a number of strategies to avoid or can help you lower the chance of getting lower back discomfort.
Maintain Proper Posture
It’s essential to keep a good posture when you are standing and sitting. It is even more important whenever you are exerting power and lifting objects. Make sure that your spine is always straight and supported. Do not twist and load your spine at the same time. This can cause problems over time and may cause back pain.
Exercise Your Core Muscles
By doing regular exercise, you will improve stability across the body, including the spinal column and the lumbar region. Focusing on the core muscles can help improve stability and support in your spine. This will help protect your back from injury.
Stretching regularly can also help you maintain the flexibility of your back and the muscles that surround it. Following an exercise routine, if done right, can prevent you from experiencing muscle weakness and muscle spasms.
Gentle stretches, such as those that target the hamstrings, can be done on a flat surface which can keep your lower back stretched and provide pain relief.
Proper Footwear
For the spine to remain properly aligned while walking or standing for lengthy periods of time, supportive footwear is important.
Minimise wearing high heels as they put your posture out of place by tipping your body forward, thereby applying stress on your lumbar spine.
Lifting safely
Always practice safe lifting techniques while moving heavy items, such as lifting boxes from the floor. This is to avoid putting undue strain on your lower back and abdominal muscles.
Instead of bending forwards from the waist, bend at the knees to maintain your weight close to your body. Use your leg instead of exerting your lower back when you lift.
By taking these precautions, this will lower your chance of significant trauma causing herniated disc injury and developing low back discomfort.
Different Types of Physiotherapy for Low Back Pain
The aim of these treatments is to prevent further injuries as well as manage chronic pain. Hence, it is a good idea to combine a few treatments together.
Exercise-Based Therapy
Exercise-based treatment is a crucial part of every physiotherapy program. A custom workout program created by a physiotherapist will target specific areas you will need to work on. As you progress with your exercises, different exercises will be prescribed to continue strengthening and conditioning your muscles.
Aquatic Therapy
Exercises that are performed in the water, such as aquatic therapy, can be a great remedy for severe low back pain. Individuals that have trouble doing land based exercise can consider aquatic therapy as a starting point to strengthen muscles.
With the buoyancy of water, it helps take some load off your body. Hence you are able to start doing lower intensity exercises and slowly work on strengthening your body. Over time, you will be able to add resistance in water and eventually aim to progress to land based activity. Aquatic therapy done in a warm pool is called hydrotherapy. This is a great way to do gentle exercises at the same time increases blood flow to promote healing.
Electrotherapy
Electrotherapy like ultrasound involves the use of high frequency sound waves to stimulate tissue healing. Ultrasound therapy is commonly used to treat acute injuries like sprains and strains.
Another form of electrotherapy is Transcutaneous Electrical Nerve Stimulation (TENS) whereby electrodes are placed on the skin. This stimulation works by reducing pain sensitivity to the area when in used.
Stay on Top of Your Low Back Pain
Lower back pain is a common encounter for many people. It can often start as acute back pain and if untreated, can turn into chronic back pain. Hence, it is important we pay attention to our symptoms and seek treatments.
Treatments can often range from taking nonsteroidal anti inflammatory drugs to muscle relaxant, massage therapy and other nonsurgical treatments. The best course of physiotherapy treatment is to control back pain, reduce muscle spasms and promote mobility. Have confidence that most back pain resolves within four to six weeks. Remember, a good exercise routine will be very beneficial in preventing future low back pain.
References:
[1] Hoy et al; A Systematic Review of The Global Prevalence of Low Back Pain. Arthritis Rheum (2012)
[2] Chou et al; Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine (2007)
[3] Van Der Gaag et al; Non-Steroidal Anti-Inflammatory Drugs for Acute Low Back Pain. Cochrane Database Syst Rev (2020)
[4] Gianola et al; Effectiveness of Treatments for Acute and Subacute Mechanical Non-Specific Low Back Pain: A Systematic Review with Network Meta-Analysis. British Journal of Sports Medicine (2020)
[5] Sorosky, et al; Yoga and Pilates in The Management of Low Back Pain. Curr Rev Musculoskeletal Med (2008)