Back pain is the most common area of pain I treat in the clinic. Everybody at some point will have an episode of back pain and for those unlucky few ongoing recurrent problems.
The approach to back pain has changed a lot and challenges many widespread beliefs about the condition. Here is what I have found out throughout my 10yrs of experience.
1. Back pain is common and normal.
Most back pain is due to strains and sprains and usually resolves within 6 weeks. Only a very small percentage go on to develop long standing disabling problems and many of these may improve with the right help.
2. Scans are rarely needed. You would think that a picture of the spine would explain why you are in pain but it is not that simple. The scans will often show up things that are poorly linked with pain. Many people who have no pain are shown to have bulging discs, degenerated discs, arthritic changes etc. If you are told you have these problems it can lead to further distress and avoidance of activity.
3. Back pain is not caused by something being out of place. Many people may feel better after manipulations/mobilisations but this is mainly down to short term reduction of pain, muscle tone/tension and fear. As therapists we use these techniques to help get you moving better not to realign you.
4. Bed rest is not helpful. This can create stiffness, muscle de-conditioning and fear. Stiffness itself is painful and treatment and exercises will be painful to get movement back again.
5. Increased back pain does not mean more damage.
6. Surgery is rarely needed. Many people who have back surgery still have pain after because they have not taken a multi factoral approach to getting better. No one treatment will work on its own.
7. There is no perfect sitting posture. It is about moving and altering posture instead of maintaining posture that is important. The body will never like being stuck in one position for any length of time.
8. Lifting and bending are safe. Yes it may cause a strain in the back but should never be avoided as it is good strength work for the back and body. And yes there are bad techniques that can lead to injury, just remember you have a pair of legs to help you. Don’t lift silly amounts of weight, be smart. The length of the activity also has an influence break it up into smaller manageable amounts.
9. Avoiding painful activities is not the way forward. Fear of pain can heighten your senses of back pain and increase stress on the back due to an altered movement pattern.
10. Poor sleep, stress, low mood and worry all influence the back.
11. Exercise is good and safe and persistent back pain CAN get better with it.
Long standing back pain has to have a whole body and psychological approach. Manual therapy can help but exercise is very important as well. So is general health, looking after you weight, healthy diet, good sleeping pattern and knowing how to cope with stress. Everyone is different so what works for one person will not work for the next.