An article by exercise physiologist, Jennifer Smallridge

We all know the feeling - a grab, a pull, a twinge, a tightness in the lower back. It can take our breath away and make us want to try anything to reduce the pain! According to Monash University, 25% of Australians will experience lower back pain on any given day. For most people, lower back pain will come and go without issue, however sometimes it persists and becomes chronic.

Only between 8-15% of people with lower back pain will have a specific cause, so what could be contributing for everyone else? It seems to be a combination of bodily systems at play: namely the musculoskeletal, immune and nervous systems interacting with our psychological processing around pain (thoughts, beliefs, behaviours). This explains why there is often no “quick fix” or cure - multiple factors require multiple solutions!  

 

Rule out red flags 

Of course we want to first ensure that there are no serious abnormalities causing lower back pain. If suspected, it is important to rule out: 

  • Spinal fractures (if an impact has occurred, or osteoporosis in the elderly)  
  • Tumour/infection (having a history of cancer, chills, unexplained weight loss, recent bacterial infection in the body) 
  • Neurological deficits (severe or worsening sensory changes in the buttocks and legs, weakness, bladder or bowel dysfunction) 

Although rare (occuring in 1% of lower back pain cases), these signs and symptoms require further investigation with your health care professional.  

 

Get to know the back pain facts 

Once red flags have been ruled out, being an active participant in pain management can begin. This often involves upgrading your beliefs about lower back pain - gone are the days where bedrest is prescribed! Here are some evidence based, helpful and relieving things to remember: 

  • Persistent back pain can be scary, but it’s not dangerous. It can be distressing and disabling, but it doesn’t mean that it will stay this way forever. 
  • Persistent back pain is rarely associated with serious tissue damage. A lot of back pain begins in everyday life rather than after an incident. Stress, fatigue, tension, inactivity or irregular movement can then increase the lower back’s sensitivity to movement and forces, which can then turn into a vicious cycle. 
  • Pain with exercise and movement doesn’t mean you are doing damage. The spine and surrounding muscles can become sensitive to touch and movement, so it is natural that pain can become stirred up with movement. This feeling is known to decrease over time, by building up in small increments. 
  • Back pain is not caused by poor posture or a weak core. In fact, being in any position for an extended period of time is more likely to cause pain rather than labelling our postures as “good” or “bad”! Likewise, there is no need to overly tense the core muscles on a day to day basis (imagine clenching your fist when you have sprained your wrist). Being in a relaxed state is more likely to lead to pain reduction.  

 

Keeping active with lower back pain  

As mentioned above - prolonged periods of sitting or lying still is no longer recommended for back pain, and can actually exacerbate the pain experience. Sitting or lying can, however, be used as rest whilst breaking up your everyday activities. For example: If you have a physical job, reducing your hours rather than stopping altogether is recommended. If you are an active person, going for a gentle walk is better than hanging up your runners. The body and brain love to move in ways that don’t make you fearful or tense, so listen to your body and see what works for you! 

 

Your healthcare professional may also recommend strategies such as heat packs, massage, hands on treatment or medications - and if they feel good, by all means go for it. We consider these strategies to be the “bridge” in getting us to movement, rather than relying on them alone for passive relief. 

 

Of all of the research done in the world, there is still no evidence that one type of exercise program is better than another for managing persistent back pain. This is actually great news! It means that we can help people to find the style of exercise that works for them, and that they are likely to do on a regular basis. Here are some examples: 

  • Cardiovascular exercise - Swimming, cycling and walking are all low impact ways to get active and certainly will help lower back pain. A common trap that people can fall into is doing too much too soon; so consider what you feel that you could normally do (eg: a 30 minute walk) and starting with half of that (15 minutes).  
  • Strength training - As we all know, life doesn’t stop for lower back pain! Continuing “functional movements” such as squatting, lifting, pushing and pulling are all considered safe and important when it comes to staying strong with lower back pain. This can also help to prevent what is known as kinesiophobia, a fear of movement which often comes after an injury or episode of pain. If you haven’t participated in strength training before, a trusted health professional can be a great coach and give feedback to help you feel confident and in control.  
  • Clinical Pilates - As mentioned above, having “core strength” is not the be all and end all for back pain. Rather, a good Clinical Pilates session gets your body moving under supervision, with a variety of stretches, coordination exercises, stability and balance.  
  • Yoga - Only if you like it, and you want to! Yoga combines breath and movement whilst stretching and strengthening various muscle groups, which also ticks the box for reducing pain sensitivity in the lower back. 

 

In summary, whilst back pain is unpleasant, it is rarely permanent and does ebb and flow with many contributing factors. Trying not to catastrophise and having a good pain plan in place can help you to continue moving through life.  

 

 

References: 

George, Steven Z., Julie M. Fritz, Sheri P. Silfies, Michael J. Schneider, Jason M. Beneciuk, Trevor A. Lentz, John R. Gilliam et al. "Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association." Journal of Orthopaedic & Sports Physical Therapy 51, no. 11 (2021): CPG1-CPG60. 

O'Sullivan, P.B., Caneiro, J.P., O'Sullivan, K., Lin, I., Bunzli, S., Wernli, K. and O'Keeffe, M., 2020. Back to basics: 10 facts every person should know about back pain. British journal of sports medicine, 54(12), pp.698-699. 

 

Verhagen, A.P., Downie, A., Popal, N., Maher, C. and Koes, B.W., 2016. Red flags presented in current low back pain guidelines: a review. European Spine Journal, 25(9), pp.2788-2802. 

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