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Low back pain

Low back pain! Hands down the most common complaint we see as physiotherapists. Did you know that 4 in 5 adults will experience at least one episode of low back pain in their lifetime?


Low back pain has many sources but most commonly it may stem from:

  1. Muscles spasms

  2. Nerve tension

  3. Nerve root impingement (radiculopathy)

  4. Neuropathic pain

  5. Visceral pain (pain coming from the organs referring into the back)

  6. Arthritis between the joints in the back

  7. Discogenic (coming from the discs between the vertebrae)


BioPsychoSocial Model of Pain


Every back pain case is different because every patient is different. Your physio will work with you to find the contributing factors towards your back pain. These may include:

  • Physical (biological) factors: encompasses the physiological and biomechanical issues that may be at play such as: trauma; overload (lifting too heavy/ repetitively) or underload (being inactive); medical history, genetics and developmental conditions.

  • Psychological factors: often poorly addressed, stress levels can have a major impact on amplifying pain. If ignored, psychological factors are often major predictors of chronic or recurring low back pain. These include: stress levels, poor sleep, unrealistic expectations and low accountability for recovery.

  • Social factors: the individual demands in our work and personal lifes that often tie the physical and psychological factors together. Theses include: work setting/ workplace satisfaction; level of exercise and other physical activity; family dynamics; social commitments.


Together these factors combine to form what is known as the Biopsychosocial model of pain and can be applied to all injuries/ pain conditions but is particularly useful for low back pain. As specialists in treating low back pain, your physiotherapist will help you to identify the major drivers of your pain and help guide you in addressing them.


Assessment


Your physio will complete a thorough history of your condition which will include duration of symptoms, review of any scans, medical history, aggravating activites, treatment history and type of symptoms (pain, restrictions, leg pain, pins and needles).


Your physiotherapist will also complete a thorough examination on your initial consultation. This helps us identify painful movements and restrictions that may contribute to your low back pain. It will also help us to identify any neurological impairment and give us a idea on what structures are contributing to your pain.


Do I have to have scans?

I often prefer people come in prior to getting a scan (xray/ CT/ MRI). The history and examination will give us a firm understanding on whether or not a serious pathology is present that needs to be scanned. Since 90% of low back pain cases are not from any serious structural issue, this will often save you time, money and stress. We also discourage patients from reading their own scan results without the context of an assessment. Scans may often reveal findings that are “false positives” and do not contribute to their pain. For example, did you know that 20% of 20 year olds will have a disc bulge on MRI but have no back pain whatsoever?

As I say to everyone “I treat people, not pictures!”


Treatment

Based on your history and examination, your physio will come up with a treatment plan. This will likely involved:

  • Advice on your condition, prognosis and establishing expectation on recovery rates.

  • Hands on therapy - massage, joint mobilisation or manipulation and possibly dry needling/ acupuncture. This will help to reduce pain and improve flexibility. Please note that this form of treatment is only

  • Rehabilitative exercise - specific exercises prescribed by your physio to begin the recovery process. This will vary greatly from person to person. While it may be tempting to do what your neighbour does or a routine you saw on instagram, poorly selected rehab can often aggravate your symptoms and set your recovery back.

  • Long term management - a graded return to your normal physical activity or sport. For sedentary patients this may mean getting you started on an exercise journey. It doesn't really matter how you exercise, once it's done on a regular basis (3 days a week minimum) and most importantly YOU ENJOY IT!


Stay tuned for further blogs where I will attempt to explain the different sources of low back pain, how we identify them and ultimately how they are treated.


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