Low Back Pain is the most common musculoskeletal condition. You have probably experienced low back pain, or know some one who has had back pain. It can vary from a mild annoying ache to severe disabling spasms.

Back Pain is now known as a BIOPSYCHOSOCIAL condition…       

Which includes:

Musculoskeletal Factors like the health of muscles, joints, discs, connective tissue, and nerves.

Health Issues, such as having too much chronic inflammation, nutritional factors like Vitamin D, Iron, Magnesium, & more, being overweight, smoking, GUT health and so forth.

Psychosocial Issues including our worries, stresses, relationships, beliefs, anxiety, depression, and how we think about the problem/condition.

Lifestyle issues – such as being too sedentary, and holding fixed (UNMOVING) postures.

AND Using your body poorly so it has too much tension.

A major issue with back pain can simply be the anticipation of pain, and the belief we are causing harm or damage. This can lead to over tensing and bracing ourselves, which then keeps the process of pain going.

A New Way of viewing Back Pain

We have often viewed back pain as an injury which requires healing or fixing. HOWEVER,  a modern way of viewing low back pain is to treat it as a (benign) ISSUE which comes & goes. It is NOT an injury. It can be effectively managed and is generally NOT a serious problem, just a HURTFUL one. No need to worry…

Based on the time frame, back pain can be acute: usually less than 6 weeks, or chronic: greater than 12 weeks (3 months), or recurrent:it keeps coming back.

There have been many attempts to classify back pain historically. One system which is growing in acceptance is categorising Low Back into 3 main types:

1. Back Pain with specific pathology such as a fracture, infection, inflammation disease, or cancer. This type of back pain is very rare, usually less than 1%.

2. Radicular Syndrome – this is back pain with related leg pain and possible nerve related symptoms such as numbness, pins & needles, and weakness. This is often associated with some type of irritated or sensitised nerves. One type of Radicular Syndrome is more commonly known as ‘sciatica’ which describes the symptom of an irritated sciatic nerve. This presents in only about 5 to 10% of back pain issues.

3. The most common type of back pain is called NON SPECIFIC Low Back Pain. This is usually categorised when the other categories have been excluded. This is the category where pathology is not so relevant and the BIOPSYCHOSOCIAL factors become even more important.

This type of back pain is often associated with an accumulation of factors which eventually tip you over the edge into pain including: wear & tear, being too sedentary, fixed postures, stress, and lifestyle.

There can be sub categories in the Non Specific Back Pain such as whether aggravation is worse with bending forward (flexion)/sitting, or Bending backwards (extending)/standing. Also neurophysiological factors (nerve and brain) may influence the low back pain, including factors outside of the spine or pelvis. Sacro-iliac joint issues can also be another factor affecting low back pain.

Consider for yourself what may be triggering your back pain?

Consider all the factors contributing to it. One consideration is conveyed by the Bilby in the bath story. The bilby is a small animal which hops in the bath causing the water to over flow. What is forgotten is the bath is already full with the alligator. Often the blame is on small recent issues, and  one may have ignored the big picture issues. (Story care of noigroup.org)

What long term big factors do you need to address?

Being Sedentary

Wear & Tear and accumulating strains

Fixed postures

Mechanical issues such as stiffness in connective tissue

Chronic inflammation factors such as smoking, poor diet, & being overweight

Build up of stress and tension

Worries in your life

Concerns about the back pain such as anticipation of pain

Ageing

When low back pain becomes CHRONIC (over 3 months), nervous system factors can also come into play where the nervous system becomes more sensitised, and body structures can become more de conditioned from being less active, where the back can HURT with minimal stress ie even light touch or activity. Pain in this situation becomes a particularly poor indicator for harm. It can hurt bad, but there is actually no trauma or danger happening to the spinal structures. Further damage is 

not occurring.

Often with chronic pain there is more expectation of the pain, and even fear of the pain. This can all aid the pain experience and associated disability, ie you stop doing all the things you love or want to do.

Become a good self manager

(These tips are focused around the commonest type of Low Back Pain (LBP), Non Specific LBP)

The following are some useful tips (based upon science & experience) to managing or helping to prevent low back pain. Because back pain can involve many factors it take patience to work out which things work best for you…

√ SEEK GUIDANCE (& support) from a support team like a doctor, physiotherapist, counsellor, exercise physiologist, other trained back care professionals, and so forth, if required.

√ STAY ACTIVE and mobile as possible and work at changing any fixed postures such as slumping too much.

√ Try to move as NORMAL as possible. For example if you limp, then using a stick to walk evenly may help. Get up from a chair using your legs, rather than tensing & using your upper body too much.

√ EXPLORE MOVEMENT and find ways to move comfortably with awareness.

Try this:

Breathe CALMLY

BE AWARE of your body and reduce tensions

Try movement or even Isometric muscle contractions (contractions with no movement – we use this in yoga)

Ask yourself “Does this feel safe, will I regret it tomorrow?”  If yes, modify the movement & continue to use the above process…

Keep adjusting for comfort (NB if you have chronic pain it may be that you don’t have no pain, but it should be low pain so you are not tensing or grimacing)

√ EXERCISE is one of the most important things shown to aid low back pain, but it may need to be modified for your specific needs. Find comfortable ways to move. There are many types of exercise you can try:

Water exercise

Walking

Other types of aerobic exercise – cycling, rowing, kayaking, swimming

Fun exercise like dance

Ask yourself “ Does this feel safe, will I regret it tomorrow?”

Exercise classes

Strength Training

Exercise you do for your specific needs – prescribed by your therapist

Balance exercises

Tai Chi or Yoga

√ It may help to correct muscle imbalances and activate your CORE antigravity system.

√ Do things in a BALANCED WAY. For example over doing core actions can be as bad  as having a weak core. More is not always better.

√ HANDS ON TREATMENTS especially in acute low back pain can be helpful. The aim of treatment is to normalise things so the brain thinks things are OK, such as mobilising stiffness, releasing muscle tension/spasm or trigger points, soothing inflammation, and enhancing the relaxation response to aid recovery.

√ HEAT & COLD can be great non drug aids to low back p

ain. Trial to see which works best for you. Have the packs wrapped (not direct to skin) & try for 10 mins on & off, check first time for 5 mins  to see if it aids or aggravates. Avoid this if you have numbness to your skin where you are placing the pack.

√ YOGA has been shown to be helpful, especially for chronic low back pain.

√ FIND WAYS TO GET COMFORTABLE such as lying on the belly, side lying with a pillow between the knees, lying on the back with knees bent up or supported on a chair…

√ Learn to LET GO OF YOUR TENSIONS through breathing, relaxing, stretching, meditating… Find what works best for you.

√ TALK issues or try therapies with a psychologist or counsellor (or even a trusted friend) if you have personal or relationship issues.

√ Consider if you have FEAR about your pain, and that you could be causing harm. So you end up anticipating pain (so it becomes a reality), over brace yourself causing tension, or you avoid doing the things which are good for you or you love. TALK about your concerns with your movement therapist.

√ PACE YOURSELF and keep checking that you are not over doing it. Watch “good” days where you feel you can do more and then may over do it. The key is to stay REGULAR and consistent, and include pauses to rest & recover.

Things which don’t work so well

Having lots of test & scans are usually not needed and can cause confusion….. You would only get tests if the problem seems unusual.

MINIMISE DRUGS USE. If they are needed they should be monitored by your doctor for specific reasons.

  • Anti-Inflammatories are probably better than paracetamol – this may be used to aid sleep
  • Opioids are not recommended
  • Relaxants may aid if severe spasms
  • Special medications for chronic pain can help some people      
  • Injections are usually not helpful

Surgery should be a last resort and recommended only in rare occasions usually related to Radicular Syndrome. Speak to your specialist about this.

Never forget the keys to good health: What’s good for your heart is good for your back

√ Movement

√ Healthy Nutrition & managing inflammation

√ Enough Sleep

√ Tension & Stress Reduction

√ Help others

√ Do things you love

Breathing is GREAT for your back

Breathing is the simplest way to aid your back pain…

Find a comfortable position…

Focus on your breathing…

Slow it down…

Allow the gentle movement of the belly – expanding as you inhale, relaxing as you exhale…

Stay focused, using a count or the yoga sounding practice: inhaling, sound to yourself “so”, and exhaling, sound to your self “hum”.

Relax… Practice for 3 to 10 minutes as you need.

Sometimes you can take the breath movement awareness to your spine, feeling it lengthen as you inhale and relax as you exhale.

Allow the breath to soothe your pain away…

You could even try adding some visualisation – seeing your self moving normally, placing yourself in places you love to go, imagining an energy ball soothing away your pain…

Be patient. It may take a little time to settle.

CLICK to Try our gentle Yoga for LOW BACK PAIN (Non specific) Video on our Youtube Channel.  Remember to modify the class for yourself and leave out any exercises which don’t feel comfortable.

References

• Goode et el “An evidence map of yoga for low back pain” https://doi.org/10.1016/j.ctim.2016.02.016

• Wood  P “Back pain is being ‘mismanaged’ with ineffective and harmful treatments, experts warn” ABC News 22 Mar 2018

• Bardin et el “Diagnostic Triage for Low Back Pain: A practical approach in primary care” Med J Aust 2017; 206 (6): 268-273. || doi: 10.5694/mja16.00828

  “Easter Eggs and another nugget”  noigroup@noigroup.com

• Executive Summary on Low Back Pain The Lancet March 22 2018

• Wieland et el  Cochrane Review “Yoga treatment for chronic specific low back pain”  Back and Neck Group (http://back.cochrane.org)

• Almeida et el “Primary care management of non-specific low back pain: key messages from recent clinical guidelines” Med J Aust 2018; 208 (6): 272-275. || doi: 10.5694/mja17.01152