Lower back pain seems to be one of the most prevalent health complaints of adults in the UK. In fact, it was named the leading cause of disability world-wide in 2010. It is the second most common reason that we visit our GP, and the most common reason to miss time off work. So how can a simple mechanical lower back pain, which is so common, be so mismanaged by mainstream medics? Get a cup of tea, this is going to be a long one!
By Any Other Name
The phrases we use to describe our back pains is deep rooted in the English language, but some of them carry quite dramatic misconceptions. Here are a couple of my favourites that I hear in clinic all the time…
“I felt my back go!”
Where did it go? Sorry, I can’t help it – this really is one of my favourites, because it is just so bizarre if you take it literally. All parts of your back are strong and stable – even if there is injury. It takes a very considerable force to compromise the structural integrity of a spine – everything stays more or less where it should be; remember there are no gaps in the body, so there really is nowhere for anything to go to!
“My disc just slipped right out!”
As with the previous statement, there really does have to be something seriously wrong to make a disc move. They don’t shift, and they can’t be popped back into place… What can happen is that the donut-like disc structure can leak out a bit of it’s jammy centre – that causes a massive immune system reaction and tissue swelling, which in turn leads to pain.
These dramatic statements can incite fear of moving in many patients; and that reduction of relaxed, easy movement of the spine is on of the biggest obstacles to recovery from mechanical lower back pain.
Over the Counter…
The most recent British Medical Journal study found that over the counter anti-inflammatory drugs like ibuprofen don’t work for lower back pain. Literally no one understands how paracetamol works, and the studies show it certainly doesn’t work for lower back pain.
10 years ago, lower back pain meant laying on the floor for two weeks, but now we know that’s just about the worst thing you can do. And when you do start moving, the fear of pain can restrict your spinal movements, even subconsciously, so that your back is left feeling stiff and sore almost constantly.
Wear and Tear is Normal!
The vast majority of people who don’t have lower back pain would have scan results that show a problem. As an example; a 2014 study found that in a population of 20 year olds with no back pain, 37% of their MRI results would show degenerative intervertebral discs.
So when you have a scan for your lower back pain, the results may show something slightly amiss that has been there for years, and never caused any pain before. Our bodies don’t stay in perfect condition forever – but having spinal degeneration doesn’t always have to equal being in pain.
Equally, the level of damage to the spine is not always equal to the level of pain experienced by the individual. Remember, pain is just the brain’s interpretation of neurological signals coming from the rest of your body – if the brain is sensitive because you’re worried about it, you will feel the pain more intensely.
So how do you move forward from pain?
The current UK National Institute for Clinical Excellence guidelines recommend manual therapy in conjunction with physiotherapy exercises. So that’s hands-on therapy like Osteopathy and Sports Therapy, coupled with rehabilitation exercises to strengthen the body.
Visiting an Osteopath can (and should!) be an educational experience. By learning more about the mechanics of your spine – how stable a structure it is, and the normal nature of wear and tear – patients can come away from their appointment feeling empowered to self-manage mechanical lower back pain more effectively.
Aside from all this, very best thing you can do is to stay active – this will reduce the brain’s sensitivity to pain signals coming from the lower back, and increase the strength and stability of the lower back and core muscles.
Moving little and often during the acute stages of pain is very important. Recovering from a major trauma like a prolapsed lumbar disc should be like a full-time job for the first few days – I recommend patients put themselves into a cycle of 3 separate 20 minute sessions an hour – one for gentle exercise like walking, another for applying a cold pack to reduce tissue swelling, and the last to rest in a comfortable position.