The Lower Back Can of Worms…

Low back pain (LBP) is the most common musculoskeletal complaint globally and is the leading cause of activity limitation. A google search for LBP will open a large can of worms, with an array of quick fixes, magic exercises and specific DON’T DO’s… all great attention grabbing headlines. The reality is, LBP is complex and the cause is often multifactorial. 

We understand LBP can be really challenging to navigate and can significantly impact quality of life and that’s why we are here to help! The purpose of this blog is to provide some evidence-backed advice to manage your LBP and get back to doing the things you enjoy!

The role of imaging

Getting a scan for LBP is becoming less common in practice, due to strong evidence highlighting a poor correlation between scan findings and pain. In fact, the Royal Australia College of General Practitioners guidelines for acute lower back pain state “Do not request imaging for acute lower back pain unless you suspect a serious cause.” 

A serious cause is in reference to scenarios where cauda equina syndrome (compressed bundle of nerves at base of spinal cord), high impact fractures, cancer or infection are suspected. These conditions account for approximately 1% of LBP episodes.

Causes

The term ‘non-specific low back pain’ is used regularly in healthcare circles now, as clinical diagnostic tests have not shown accuracy in identifying the exact source of pain.

The graphic below highlights known factors that can correlate to LBP. Yes, it is way too small to read, however we included this to highlight the multifactorial nature of LBP. Factors such as stress, metabolic health, immune health, can all play a role in LBP, similar to biomechanics or tissue damage.

 

The great news with this… if there are many contributing factors, then there are many factors which we can look to address, to assist with recovery from LBP. 

The Role of Exercise 

Exercise can be incredibly beneficial in the recovery from both acute or chronic LBP. It can positively influence each individual in a variety of ways, including;

• Reduced nervous system sensitisation (movement can help calm down a ‘heightened’ nervous system)
• Improved overall health. We know that various health markers, including metabolic health and cardiovascular health, can influence our pain experience. 
• Weight loss. Not only can losing weight reduce the load on our joints, it can also reduce chronic inflammation which can play a large role in pain. 
• Increased strength, mobility and stability. 

Tips to begin exercise with LBP;

• Pain does not = damage. Some pain is okay when moving. Light movement, even in the presence of pain, is often the best place to start.  
• Find exercise that doesn’t sharply aggravate your pain and gradually progress how much you do this. This will be different for everyone. Swimming, walking, upper body strengthening or light mobility exercises can be nice places to start. 
• Resistance training. Strengthening around your back and hips can help provide you with more confidence to move freely.

We acknowledge everyone’s pain experience is different and requires an individualised approach to rehabilitation. If you would like some guidance with your recovery journey, reach out to the team to see how we can help you best!