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Low Back Pain: FAQs

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Low back Pain: Q & A Basics

By JayDee Vykoukal, DPT

Who is affected by Low back pain?

Low back pain (LBP) is a health issue that all of us will deal with in some form over our lifetime. It can happen  anytime in a person’s lifespan, but is particularly relevant in the 40 to 80 year age range (1) It is estimated by Medline that 8 out of 10 people will experience LBP at least once in their lifespan (1). It is the leading cause of job-related disability and the biggest contributor to missed work days.

What causes low back pain?

LBP is a very ambiguous condition that is typically caused by more than one variable.  The spine and its associated muscles create the “core” of our body, giving us the strength and flexibility to do all of our daily activities and hobbies.  Any kind of imbalance related to the spine itself or surrounding tissues (muscle, ligaments, tendons, discs) can lead to pain.  Factors that can cause or exacerbate low back pain include stress level, diet, repetitive movements, poor posture, sedentary lifestyle, poor lifting habits, genetics, high impact work/hobbies, and age.  With these factors in mind, the most common physiological/underlying causes of LBP include disc injury, narrowing of the spinal canal, compression of neural tissue, fracture, arthritis, and facet joint irritation.

No matter what the cause LBP is typically associated with painful muscle tension, trouble completing typical daily activities and an increase in pain when staying in one position for a prolonged amount of time. It is always important to keep in mind that any underlying organ issues can also cause radiating pain to the low back.  This is why if pain persists or feels unbearable it is always good to get screened by a primary care physician or doctor of physical therapy.

How can low back pain affect me?

Acute LBP can cause temporary stress in a person’s life but can typically resolve on its own in 2-4 weeks. If symptoms do not improve by then, seeking medical attention to address any underlying issues is important. A physician and/or physical therapist can help you determine what is causing the pain with the goal of getting you back to your normal life activities.

LBP can have major psychological consequences, especially as the problem becomes chronic in nature. Sleep typically starts becoming disturbed.  People begin to avoid certain situations or activities due to fear of pain: affecting their hobbies, everyday activities, and social life.  People may begin avoiding physical activity altogether. The body’s physiological response to low back pain changes as time goes on and the body tries to adjust and cope. As pain becomes a long term, chronic issue it wears not only on physical but mental well-being as well. Thus, it’s not surprising that any type of chronic pain is a common cause of depression. Avoiding physical activity is very detrimental to recovery from LBP and should only be done acutely when pain levels are typically high.

What can I do to prevent low back pain?

Balanced and healthy lifestyle choices have a large impact on how we will deal with pain and injury.  A survey from 2006 indicates that LBP is more associated with people who characterize their health status and lifestyle as “poor to fair” (2). Factors found to increase risk for LBP are a history of smoking, repetitive lifting/bending with daily activities or work, age, and any unhealthy lifestyle choices related to nutrition and exercise. Exercise is an important component of life, keeping us fit and balanced. Exercise regulates our body’s metabolism and releases endorphins that keep up “happy.” Leading a healthy lifestyle is associated with fewer injuries and quicker recovery when they do happen.

Whether an injury has occurred or not, the most crucial component for a happy spine is always a strong core.  Without good spine habits and body awareness, an injury can happen from an activity as simple and bending over to tie a shoe to more stressful heavy lifting.  Without a strong core, our bodies don’t work efficiently and cause unneeded stress on the spine.  Unfortunately, even the majority of people who do participate in some type of regular ab exercise do not demonstrate good control.  Good control is illustrated when the belly can stay flat and the spine neutral no matter what type of exercise is being completed.  This is where the eyes of a therapist can help find faulty movement patterns and re-train muscles to work in a way that will prevent further injury and promote healing of injured tissues.

What are my treatment options?

Typically the first step in getting the correct treatment is seeing your doctor. They can provide a variety of options that are available, including medications, injections, imaging such as x-ray or MRI, chiropractic, acupuncture, physical therapy, and possibly surgery. All options can be helpful and typically the “less invasive” ones will be tried first to see if there is any benefit.

Building clinical research indicates that it is most beneficial to remain active after an injury (3).  Staying active can bring benefits of increased flexibility and blood flow in an area that is trying to heal.  Being active does not mean that someone should push themselves until they have severe pain.  The goal should be to find activities that are relatively pain free. This leaves many people nervous, as some aren’t always sure what even caused the initial injury.  This is where a physical therapist can be very helpful. They are specialized in movement analysis and can do a full evaluation to help determine what mechanisms are contributing and how to adjust habits accordingly.  More often than not, LBP can be alleviated with simple education in body awareness. A surprising number of people are not aware of slight differences in their movement patterns that are causing their pain. This is where making simple habitual changes can make a BIG difference in daily function. As physical therapy treatment begins, the key is a balance of strength and flexibility in a safe and pain free range. “NO pain no gain” is not a phrase that should ever be followed when recovering from a back injury, as it can cause muscle guarding and additional injury. Several research articles have shown that core muscles do not activate as quickly when there is chronic pain (4). This means we have to “retrain” our core muscles to work correctly to make the spine less vulnerable when initiating any type of activity. No matter what form of treatment is used to treat LBP, if the underlying poor movement patterns aren’t addressed there is a much higher change that re-injury will occur; this makes seeing a PT crucial for the treatment process !!

What kind of outcome can I except?

Outcomes depend on many variables related to the underlying spine injury, motivation level and prior strength, flexibility and health status. In general, everyone eventually recovers from their LBP. With the help of the right professionals, this pain can potentially be treated quicker and get you back to your normal daily life!

References:

  1.  “Back Pain- in the face of pain fact sheet.” http://www.inthefaceofpain.com/content/uploads/2012/05/factsheet_Back.pdf. Accessed June 6th, 2014.
  2. National Center for Health Statistics. Health, United States, 2006 with Chartbook on Trends in the Health of Americans. Hyattsville, MD:86.
  3. Hagen et Al. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database Syst Rev. 2010 Jun 16;(6):CD007612.