Let's talk about low back pain...
by Taydo Nguyen, our registered Osteopath.
Low Back Pain - What are we talking about here?
If you have low back pain (LBP), you are not alone. About 80% of adults experience low back pain at some point in their lifetimes. Ranging in intensity from a dull, constant ache to a sudden, sharp sensation that can leave you incapacitated.
Pain can begin abruptly as a result of an accident or by lifting something heavy. More often it can develop over time due to age-related changes of the spine and be triggered by something straightforward like pickup a bag . Sedentary lifestyles (yes you sitting at a desk all day) can set the stage for low back pain, especially when a weekday routine with little exercise is punctuated by strenuous weekend workout.
If it is so common does that mean we all have the same underlying cause?
Not at all, LBP caused by a specific condition such as spinal inflammation, bone infections or metastases would need urgent medical attention. An Osteopath can recognise an underlying disease and refer you onto the appropriate health professional.
LBP that has no specific cause (usually no major trauma) tends to be the result of a complex combination of physical factors and how you have managed them to this point and is the LBP we are addressing to help with…
What is the best and safest way to help LBP? (Evidence informed)
From my experience working as an Osteopath and talking to health professionals, the fundamentals to recovery starts with having an open mind...
Willingness to learn about the nature of your pain – why did it happen
Returning to normal activities ASAP - avoid bed rest please!
Committing to put the physical and emotional effort to help your body heal
What form does this treatment take?
It is a mix of:
Self-management - from understanding the guidelines on medicines for pain relief* to an awareness of what you can and cant do/ should do differently
Exercise - as advised by an Osteopath or Physiotherapist please - you can do more harm than good doing the wrong thing and with acute LBP you will need to build up the intensity of what you do carefully.
Manual therapy - spinal manipulation, mobilisation or other techniques such as massage
And possibly psychological therapies like Acceptance and Commitment therapy.
If you need quick and easy access to professional advice and direction our Osteopaths and Physiotherapists at Training Works are here to help - 6 days a week.
Longer term this will mean adapting what you used to do but shouldn't stop you doing what you need to do. An example may be being more aware say of how you pick up and carry your bag to adapting your routine to include performing specific strengthening exercises.
To get you started, here’s a simple yet effective exercise to help your LBP.
What about other treatments like acupuncture?
Relatively recently treatments like, electrotherapies, acupuncture and orthotics were evalutated by NICE. They confirmed that there is a lack of scientific evidence to say they are a treatment for LBP. This doesn’t mean they should be totally discounted as clearly there are some benefits even if it is the placebo effect, which is a marvellous thing.
What about Surgery?
Surgery is always the last option for non-specific low back pain; only consider that if non-surgical treatments have not worked. Even still, surgical procedures like fusing your spine and replacing your disc lacks evidence for reducing your back pain.
Getting back to exercise?
This can be daunting, especially going back to group/class workouts where you can't always influence the pace of the exercise. At the Training Works we offer 1-2-1 PT with our Rehabilitation Specialists, Melissa and Charley as well as hands on Pilates and Yoga sessions where all our teachers will check in with you to understand any concerns you have and tailor the exercise you do accordingly.
FOR EXTRA SPECIAL TREATMENT - Try our Beginners & Improvers Pilates on Tuesday mornings taken by our own Physiotherapist, Sarah Mckeown.
*A Note on Painkillers
I am in no position to prescribe medicines but let’s bring to light some evidence-based guidelines for the use of painkillers which are popular first port call when suffering with LBP. This is important to know because taking painkillers carry obvious risks such as gastrointestinal issues or liver damage.
The advice below is guidelines provided by the National institute of Clinical Excellence (NICE):
Non-steroidal anti-inflammatory drugs (NSAIDs) aka painkillers e.g. paracetamol and ibuprofen should only be used for the shortest time possible with the lowest effective dose.
Paracetamol alone for LBP is not effective.
If the ibuprofen and paracetamol is not effective, or you cannot take it because of an existing issue like a stomach ulcer, you may be prescribed stronger painkillers. Weak opioids, like Codeine and Tramadol, will deal with the pain, however, codeine and tramadol come with a dependency warning and are not a good idea to take for more than a couple of days without GP referral and definitely not for managing chronic LBP
It is not recommended to take weak opioids as your first port of call for LBP that’s recently occurred.