- EVERYBODY GETS BACK PAIN -
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Essentially everyone will experience low back pain (LBP) at some time in our lives. About 25% of us will have back pain this year. More than 10% of us have back pain right now.
LBP is a leading cause of disability in the general population, with millions of Australians suffering at any one time. Total treatment costs in Australia exceed $4 billion a year. LBP is the seventh most common reason to seek healthcare, the number one most common musculoskeletal reason to seek healthcare, and the number one most common reason for radiological investigations. LBP is a common reason for lost playing time amongst competitive athletes. Because it’s so common, we have a lot of information about it... |
HOW LONG DOES BACK PAIN LAST?
On average, people suffer with back pain for a period of 14-21 days. Some people are sore for a couple of days, some people are sore for a couple of months or longer, but the average is 2 to 3 weeks.
After the initial episode, 70% of people have a recurrence of back pain within the following 12 months. It is very common to have a recurrent pattern of your back "playing-up" for a week or two, once or twice a year.
The initial period of back pain we call “acute”. If the pain continues for more than 3 months, we call it “chronic”. If the pain recurs at regular intervals over a number of years, each episode can be called “acute on chronic”.
After the initial episode, 70% of people have a recurrence of back pain within the following 12 months. It is very common to have a recurrent pattern of your back "playing-up" for a week or two, once or twice a year.
The initial period of back pain we call “acute”. If the pain continues for more than 3 months, we call it “chronic”. If the pain recurs at regular intervals over a number of years, each episode can be called “acute on chronic”.
WHAT’S WRONG WITH MY BACK?
If we MRI every person with back pain, to try and get a nice clear picture of what’s going on, in the vast majority of cases we can’t see anything serious.
In a very small percentage of people with back pain we see something serious like a fracture, infection, or a tumour. Another 4% of back pain is caused by a structural injury that may need investigating, for example a disc injury such as a herniation or extrusion.
However, in 95% of back pain we can’t see any pathology that we can be sure is causing the pain. We can tell that you’re in pain, and we may see a few ugly things on imaging, but it’s not possible to identify the specific anatomy that’s causing the problem. Is it the disc, muscle, joints, ligaments, nerves, bone, or inflammation?... We can’t always tell you exactly. So the majority of back pain gets called “non-specific” back pain, or “mechanical” back pain, because we don't believe anatomical structural damage is the problem.
Back pain is less a case of something being damaged or injured (like an ankle sprain), but more a pain problem. There's nothing broken, or "out of place". It's not a structural injury. It's a pain condition, like a headache.
In a very small percentage of people with back pain we see something serious like a fracture, infection, or a tumour. Another 4% of back pain is caused by a structural injury that may need investigating, for example a disc injury such as a herniation or extrusion.
However, in 95% of back pain we can’t see any pathology that we can be sure is causing the pain. We can tell that you’re in pain, and we may see a few ugly things on imaging, but it’s not possible to identify the specific anatomy that’s causing the problem. Is it the disc, muscle, joints, ligaments, nerves, bone, or inflammation?... We can’t always tell you exactly. So the majority of back pain gets called “non-specific” back pain, or “mechanical” back pain, because we don't believe anatomical structural damage is the problem.
Back pain is less a case of something being damaged or injured (like an ankle sprain), but more a pain problem. There's nothing broken, or "out of place". It's not a structural injury. It's a pain condition, like a headache.
WHAT IS PAIN?
Pain is one mechanism your body uses to protect itself from potential harm. If it thinks you are in danger, one way your brain can communicate the need for action, is to make something hurt. Discomfort = behavioural change = protection.
The same potential threat can hurt a lot more, or a lot less, depending on a range of variables, for example:
The same physical insult can hurt more or less on different parts of the body. The more important the body part, the more protective attention (pain) it gets allocated. For example, the tiniest pinprick really stings our skin, because skin is important for keeping things out - it serves an important role. And a pinprick on our hands, feet, face, or genitals, hurts even more, because of how important those structures are.
Probably the most important part of our body is our brain. Our body shows us this by protecting it with thick, strong bone (our skull). Similarly, our spinal cord is very important - it also gets protected by thick, strong bones (the vertebrae). Our head, neck, and back are strong, resilient structures that are very hard to break. We rarely see structural injuries to our head, neck, or and back. We are 100-times more likely to fracture our ankles, wrists, and collar bones before we fracture our skulls or spines. Our backs are made inherently super strong because they’re important.
The same potential threat can hurt a lot more, or a lot less, depending on a range of variables, for example:
- Am I in control of the scenario?
- What’s my mood? Happy? Sad? Am I tired or stressed?
- Has this happened before? And how did I handle it then?
- What will the consequences of being injured mean for work / family / sport?
- How important is the body part being threatened?
The same physical insult can hurt more or less on different parts of the body. The more important the body part, the more protective attention (pain) it gets allocated. For example, the tiniest pinprick really stings our skin, because skin is important for keeping things out - it serves an important role. And a pinprick on our hands, feet, face, or genitals, hurts even more, because of how important those structures are.
Probably the most important part of our body is our brain. Our body shows us this by protecting it with thick, strong bone (our skull). Similarly, our spinal cord is very important - it also gets protected by thick, strong bones (the vertebrae). Our head, neck, and back are strong, resilient structures that are very hard to break. We rarely see structural injuries to our head, neck, or and back. We are 100-times more likely to fracture our ankles, wrists, and collar bones before we fracture our skulls or spines. Our backs are made inherently super strong because they’re important.
SO WHY IS BACK PAIN SO COMMON?
We might not see many structural injuries like fractures in backs, but we do treat an epidemic of pain in backs. It’s the most common pain to complain about.
Back pain is so common because of the importance of these structures. Our protective pain system deems it needs to be more sensitive, as another way to protect these really important structures.
So, we have the “crown jewels” of our brain and spinal cord, protected by big, thick "castle walls” of bone, and our pain system is a super sensitive “burglar alarm” to protect them. The tiniest thing goes wrong with my head (eg, dehydrated or tired) and I get a headache. Similarly, it doesn’t take much at all (eg, sitting too long) and we can get back pain. The intensity of back pain doesn’t reflect the severity of the injury, but rather, the sensitive of the protection alarm. So, people get headaches and back pain, not because there is a lot of structural damage to heads and backs, but because the alarm system is a lot more sensitive in our heads and backs, because these structures are deemed super important to protect. The severity of pain does not reflect the severity of the injury, but rather, the importance of the structures being protected.
Back pain is so common because of the importance of these structures. Our protective pain system deems it needs to be more sensitive, as another way to protect these really important structures.
So, we have the “crown jewels” of our brain and spinal cord, protected by big, thick "castle walls” of bone, and our pain system is a super sensitive “burglar alarm” to protect them. The tiniest thing goes wrong with my head (eg, dehydrated or tired) and I get a headache. Similarly, it doesn’t take much at all (eg, sitting too long) and we can get back pain. The intensity of back pain doesn’t reflect the severity of the injury, but rather, the sensitive of the protection alarm. So, people get headaches and back pain, not because there is a lot of structural damage to heads and backs, but because the alarm system is a lot more sensitive in our heads and backs, because these structures are deemed super important to protect. The severity of pain does not reflect the severity of the injury, but rather, the importance of the structures being protected.
CAUSES OF BACK PAIN
SITTING
There are some common triggers for back pain and common movements that make it feel worse. The most common would be bending forwards and sitting. When we stand up “straight”, there is a curve in the small of our back. When we bend forward or sit slumped in a chair, this curve flattens and even goes the other way. Most of the time this isn’t a problem – it’s how we move. However, when we spend too much of our lives sitting, for example, we can get sore.
From an evolutionary point of view we’ve had 100,000 generations of being hunter-gatherers, moving around, doing different things all day. We’ve only had 10 generations of industry, where we do the one thing all day, commonly including too much sitting. Our bodies just aren't used to sitting for long periods of time.
There has been some media recently suggesting "sitting is the new smoking". I think we will see changes in workplaces over the next few years to limit people's sitting time. Research suggests we need to get up and move around for a minute every 20 minutes. I think we will see more stand-up desks, stand-up meetings, "walk-around" meetings, and enforced limits on sitting time.
STRESS
Another common cause of back pain is lifestyle factors like stress and fatigue. Cortisol is a stress hormone that helps us in "fight or flight" scenarios. Cortisol makes us vigilant to our surroundings and our bodies. A 1/10 pain, that might be ignored at another time, feels like a 5/10 pain when we're stressed. When we are in fight or flight mode, the body doesn't recover from injury, as it has more important, immediate survival priorities. When we're stressed, things hurt more and stay sore for longer. Being stressed or tired makes the alarm system more sensitive.
Very commonly I see patients who's back has started to hurt while they are feeling unwell with a virus, a head cold, or the flu. Being unwell makes the alarm system more sensitive.
There are some common triggers for back pain and common movements that make it feel worse. The most common would be bending forwards and sitting. When we stand up “straight”, there is a curve in the small of our back. When we bend forward or sit slumped in a chair, this curve flattens and even goes the other way. Most of the time this isn’t a problem – it’s how we move. However, when we spend too much of our lives sitting, for example, we can get sore.
From an evolutionary point of view we’ve had 100,000 generations of being hunter-gatherers, moving around, doing different things all day. We’ve only had 10 generations of industry, where we do the one thing all day, commonly including too much sitting. Our bodies just aren't used to sitting for long periods of time.
There has been some media recently suggesting "sitting is the new smoking". I think we will see changes in workplaces over the next few years to limit people's sitting time. Research suggests we need to get up and move around for a minute every 20 minutes. I think we will see more stand-up desks, stand-up meetings, "walk-around" meetings, and enforced limits on sitting time.
STRESS
Another common cause of back pain is lifestyle factors like stress and fatigue. Cortisol is a stress hormone that helps us in "fight or flight" scenarios. Cortisol makes us vigilant to our surroundings and our bodies. A 1/10 pain, that might be ignored at another time, feels like a 5/10 pain when we're stressed. When we are in fight or flight mode, the body doesn't recover from injury, as it has more important, immediate survival priorities. When we're stressed, things hurt more and stay sore for longer. Being stressed or tired makes the alarm system more sensitive.
Very commonly I see patients who's back has started to hurt while they are feeling unwell with a virus, a head cold, or the flu. Being unwell makes the alarm system more sensitive.
PROGNOSIS FOR BACK PAIN
The prognosis for back pain is good. If we study how people feel 6 weeks, 6 months, and 1 year after the start of their back pain, the majority have recovered, no matter whether they seek treatment or not. It is generally regarded that back pain is self-limiting. Even if you don't do anything about it, it will get better by itself. Good news.
You can think of it a bit like the common cold - everyone gets it once or twice a year, you're crook for a couple of weeks, and it gets better by itself.
You can think of it a bit like the common cold - everyone gets it once or twice a year, you're crook for a couple of weeks, and it gets better by itself.
TREATMENTS FOR BACK PAIN
There are a range of treatment options, from conservative treatments like heat and massage, to more aggressive medical treatments like injections and surgery. Again, long-term (12 month) prognosis is good, regardless of the treatment given.
In the short-term, based on the best available scientific evidence, The National Health and Medical Research Council recommend:
As a Physio treatment, I like to find a stretch you can do that gives you relief. Then, the more you do it, the better you feel, and that gives you some control, so you know what to do when your back is "playing-up".
I like “hands-on” treatments like massage. I like to use taping techniques to support your back muscles while they are sore.
When you have back pain, the pain inhibits the muscles that normally support your back. So we see trivial events like bending over the sink or putting on your shoes can be really painful. The muscles that normally give you support through those movements are not working properly. So I like to teach you how to deliberately engage those supporting muscles to protect yourself. This is a short term "cheat" to get you through those first painful days.
In the short-term, based on the best available scientific evidence, The National Health and Medical Research Council recommend:
- Staying active
- Simple pain relief medication, taken regularly
- Heat
- Massage
As a Physio treatment, I like to find a stretch you can do that gives you relief. Then, the more you do it, the better you feel, and that gives you some control, so you know what to do when your back is "playing-up".
I like “hands-on” treatments like massage. I like to use taping techniques to support your back muscles while they are sore.
When you have back pain, the pain inhibits the muscles that normally support your back. So we see trivial events like bending over the sink or putting on your shoes can be really painful. The muscles that normally give you support through those movements are not working properly. So I like to teach you how to deliberately engage those supporting muscles to protect yourself. This is a short term "cheat" to get you through those first painful days.
PREVENTION
The best things to prevent future recurrences of your back pain are:
- General exercise
- Weight control
- Doing some specific strengthening exercises for your back
- Limiting your sitting time to < 20 mins
Do you get back pain? What has been your experience?...
