Daniel Reeves (Physiotherapist – Burnie)

Acute low back pain is a very common condition that most of the population will encounter at some point in their life. As such, acute lower back pain is the most common condition we see here at Coastal Physiotherapy.

People with acute lower back pain can usually recall a specific incident that caused their pain. It may have been picking up something from the floor while twisting, putting socks on or performing an exercise in the gym. Pain is usually felt in the lower back and even in the legs.

The good news is that most acute episodes of lower back pain (90%) are self-limiting and will resolve within 6 weeks.

Improvements are usually rapid in the first 6 weeks with the rate of improvement slowing after that period.

What to do if you have an episode of acute pain

Continued aggravation is not helpful for resolution of pain so it can be beneficial to seek advice from a physiotherapist or exercise physiologist who can advise you on what you should and should not be doing during your recovery.

Current guidelines recommend an ACTIVE approach that encourages self-management, addresses psychosocial factors (e.g. stress, beliefs about pain, self-efficacy and job satisfaction) and focuses on improving function. It is important to continue moving within your tolerance limits and encourage movement improvement. This is where your physiotherapist or exercise physiologist can be of great help. We are able to provide you with specific advice and exercises to help you get back on track.

Everyone is different and as such there is no best exercise for low back pain. Exercise selection must take into consideration your individual goals, preferences, current abilities and needs.

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Will massage, adjustments, manipulation fix me?

Notice the above current guidelines do not mention passive treatments.

Passive treatments such as adjustments, manipulation e.g. from a chiropractor, massage, joint mobilization, cupping, acupuncture, dry needling and heat therapy may provide short term pain relief but WILL NOT change the natural healing process. Short term pain relief from passive treatments may be beneficial, via neuromodulation, to help reduce muscle guarding or allow you to move more freely and reduce sensitivity of the affected area.

Improvement over time is due to the natural progression of healing and not due to perceived benefits of passive treatment.

But my chiro/physio/doctor/massage therapist told me I am out of alignment!

Some health professionals will tell people with back pain that their pain is due to some sort of structural fault e.g. “You have a rotated pelvis”, “Your spine is out of alignment”, “You’ve slipped a disc”.

This language is harmful because your beliefs will often shape your response to pain and misconceptions (such as those above) can have dramatic consequences on long term outcomes.

Not only that, but it creates a dependency on treatment and needing a health professional to “fix” you. This is where you can be persuaded into seeing a health professional 2-4x week for passive treatment over a number of months, which is great for their business but not great for your recovery or bank balance.

It creates an injury mindset where you (the patient) are focused on all the things you cannot do and all the things that are ‘wrong’ or ‘broken’ with your body.

Instead, you should focus on what you can do, what you want to get back to and what small steps you can take to work towards it.

Here’s an excerpt from an article by Peter O’Sullivan highlighting the issue with this fragile body thinking where minor or imagined disruptions in alignment, pressure or activation are supposedly related to major issues. To read more click the link: https://blogs.bmj.com/bjsm/2014/08/22/common-misconceptions-about-back-pain-in-sport-tiger-woods-case-brings-5-fundamental-questions-into-sharp-focus/

“My sacrum was out of place and was put back in by the physio.” What role do manual therapies play to treat back pain?

Passive manual therapies do not prevent nor change the natural history of back pain; they have a limited role in the management of persistent back pain disorders (Rubinstein, Middelkoop et al. 2009). Passive manual therapies can provide short-term pain relief. Beliefs such as ‘your sacrum, pelvis or back is out place’ are common among many clinicians (and patients).

These beliefs can increase fear, anxiety and hypervigilance that the person has something structurally wrong that they have no control over, resulting in dependence on passive therapies for pain relief (possibly good for business, but not for health). These clinical beliefs are often based on highly complex clinical algorithms associated with the use of poorly validated and unreliable clinical tests (O’Sullivan and Beales 2007).

Apparent ‘asymmetries’ and associated clinical signs relate to motor control changes secondary to sensitised lumbo-pelvic structures, not to bones being out of place (Palsson, Hirata et al. 2014).

In contrast, there is strong evidence that movements of the sacroiliac joint is associated with minute movements, which are barely measurable with the best imaging techniques let alone manual palpation (Kibsgård, Røise et al. 2014).

So if I’m not out of alignment what have I done, why do I have pain?

There are many potential mechanisms for pain that have little or nothing to do with alignment and structure. That’s a topic for a future blog post.

Most acute low back pain (90%) will be classified as non-specific low back pain. That is, back pain without a clear or specific cause. It may be that you have aggravated an intervertebral disc, facet joint or have some muscle spasm and guarding but at present there is no reliable or valid classification system for most cases of non-specific low back pain.

Specific low back pain is caused by specific pathophysiological mechanisms such as hernia of the nucleus pulposus, infection, osteoporosis, rheumatoid arthritis, fracture, nerve root problem or tumour.

For non-specific low back pain the diagnosis is not as important as what you can focus on doing to help yourself.

Final thoughts…

Your back alignment is not an issue. Discs don’t slip. Scoliosis, increased spinal curves, disc degeneration and disc bulging are very common findings in people without pain. No one is symmetrical. Even Usain Bolt, the fastest man on earth has a scoliosis.

Your back is very strong, very robust and very good at healing itself. Don’t get tricked into funding a health professional’s holiday house, don’t become dependent on passive treatments and respect the natural healing process of the body..

If you have acute low back pain make an appointment with us at Coastal Physiotherapy to seek advice about how to best get moving again.

For further reading on this topic please see the below links and remember…

Your Spine is not a Rubik’s cube, it does not go out of alignment.

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For further reading here are some good links:

https://www.painscience.com/articles/structuralism.php

https://www.painscience.com/articles/does-chiropractic-work.php

https://www.painscience.com/articles/spinal-manipulation.php

References

Menezes Costa, L., Maher, C., Hancock, M., McAuley, J., Herbert, R., & Costa, L. (2012). The prognosis of acute and persistent low-back pain: a meta-analysis. Canadian Medical Association Journal184(11), E613-E624. doi:10.1503/cmaj.111271

Koes, B., van Tulder, M., & Thomas, S. (2006). Diagnosis and treatment of low back pain. BMJ332(7555), 1430-1434. doi:10.1136/bmj.332.7555.1430

Foster NE, e. (2019). Prevention and treatment of low back pain: evidence, challenges, and promising directions. – PubMed – NCBI Ncbi.nlm.nih.gov. Retrieved 18 April 2019, from https://www.ncbi.nlm.nih.gov/pubmed/29573872