Your A to Z guide to low back pain

Dion Kapnias
by Dion Kapnias
Low back pain isn’t fun. It can be tiring, stressful, frustrating, and even scary. The pain can be quite debilitating and leave you wondering what on earth you’ve done to your back. You may also be concerned about if and how long until you start feeling any better! You go to search it up on Google and end up leaving with more questions than you started with. However, you may also now be worried about words like ‘disc bulge’ ‘protrusion’ or ‘spinal cord compression.’ Needless to say, terms like these don’t paint a nice picture in your head about your back pain.
With all of this in mind, this blog seeks to serve as a one-stop-shop to help de-mystify, de-riddle and clear up the enigma of low back pain, and hopefully, unlike your Google search, leave you with more answers than questions about your back pain!
Because after all, at the clinic we help more people with low back pain, than any other painful condition. So we understand both the pain, and stress that back pain can cause. 

What causes low back pain?

For the vast majority of low back pain cases, there is no definitive cause or injury to a certain part of your back that is the reason for your pain. For example, unlike in the case of a hamstring tear where there is a specific part of the muscle which is injured and is likely the primary source of pain, backs are a little different. That is why we often refer to most cases (approximately 90%) of lower back pain as ‘non-specific low back pain’ (NSLBP for short).
It may be better to think about NSLBP as being similar to a headache, rather than an injury like a hamstring tear. There’s no specific injury to your brain, despite feeling pain there, and it may be triggered by lots of different things (e.g. being dehydrated, being tired, lots of screen time or stress).

Do I need a scan for my back pain?

This is also probably a good time to speak about if you need to get a scan for your low back pain, as well as what to make of the findings on your scan. For the vast majority of patients, getting a scan for your back isn’t very useful. This is because a lot of findings that appear on your scan report are very normal for people without any back pain! If you have received a scan for your back, it is very likely that the report included terms such as ‘disc degeneration’ or ‘disc bulge.’ As an example, approximately 80% (yes, 80%!) of people over the age of 50 who don’t have back pain will have disc degeneration show up if they were to get a scan for their lower back. This reference is a really nice visual summary to demonstrate this:
Scans may prove useful in a small percentage of scenarios, particularly if there are concerns of things like cancer or fractures (broken bones) in your back. Your trained health professional, such as a physio, will be able to guide you through this process and inform you if a scan is necessary.

What are the risk factors?

Let’s talk about risk factors which put you at a greater chance of experiencing NSLBP.
These include:
–   Sitting for long periods of time
–   Standing for long periods of time
–   Stress and/or depression
–   Repeated heavy lifting
–   Reduced leg and back strength
–   Previously having NSLBP
You can see above that it’s not purely physical factors that may lead to back pain, but also what we call ‘psychosocial factors’ such as stress and depression. You may also notice that there is no mention of posture or core strength! Whilst you may have heard a lot about ‘poor posture’ and a ‘weak core’ leading to low back pain, there is currently no evidence that this is the case.
Now that we know about what may lead to back pain, let’s talk about what we can do about it!

Treatment of low back pain

There are lots and lots of treatment options for NSLBP. What most of them have in common is that they involve moving and getting active. Read more about some of these options in the Prevention section below. Aside from these, treatment following an episode of NSLBP should involve a gradual increase in movement and load. For example, start with 2 minutes a day of walking, then progressively add 1 minute each day. Or, start with some basic back movements like lying on your back and rocking your knees side to side, before gradually moving to movements like glute bridges or yoga style exercises.
There are also some other nice options to try on the side. You may have heard of the term ‘one-percenters’ used in sport; referring to the small extra efforts that add up to make an important difference (for example, my favourite player Marcus Bontempelli laying an important smother in the AFL). In the context of NSLBP, examples may include applying heat to the area, doing some self-massage to your back (or even better, getting a friend to help!) or perhaps spending a few minutes on the foam roller. Don’t forget about things like getting a good night’s sleep or trying to reduce your stress through some meditation – they all add up!
The strategies mentioned above should hopefully act as a nice starting point to get you on your way. However, treatment should be guided by a trained health professional, such as a physiotherapist, for more individualised advice and guidance. They can provide hands on treatment if appropriate, valuable exercises to complete at home, reassurance, and education about how to best manage your back pain. If in doubt, get it checked out!

How to prevent low back pain

Exercise is the only intervention that has consistently been found to help prevent NSLBP. The great news is that there are lots of types of exercise that have been found to be effective, so go ahead and pick one that you love and are likely to do consistently! Some great choices include walking, strengthening of your hamstrings, glutes and back, swimming or Pilates. A favourite saying of mine, which is especially true for low back pain, is that the best exercise is the one that gets done. So whether it be joining a local Pilates class or grabbing your poodle’s favourite ball to take to the park, pick your favourite exercise, make a plan to stick to it consistently and keep moving!
Prevention of low back pain should also consider what demands you place on your back on a day-to-day basis. If you are a tradie and lifting heavy loads each day, prevention should focus on strength to get you stronger and more mobile to be able to cope with these heavy loads. If you’re at the other end of the spectrum in a desk-based role for example, in which you spend lots of time sitting throughout the day, there isn’t as much of a need to get super strong as you don’t need to be super strong to sit down all day!
Don’t get me wrong, getting a little bit stronger through exercise is still valuable, however it may be wiser to focus on moving more frequently by going for short walks (even 2-3 minutes is helpful!) every 45-60 minutes, changing postures and positions through use of a sit-stand desk, or getting out for some fresh air during your lunch break instead of sitting inside. You may also like to incorporate some exercises to help get your body moving, such as foam rolling your back, or adopting a ‘morning mobility’ circuit by doing 5 minutes of some gentle stretches and movements of your hips, lower back and mid back. This video is a nice starting point:
Well there you have it! I hope this blog has helped to clear up some of your questions around back pain, whilst pointing you in the right direction to help manage your own pain.
Want more advice from one of our skilled Physiotherapists on how to manage your back pain? Call us on 03 9752 2368, or Book Online HERE.