Low Back Pain – Common misconceptions and the role of Physiotherapy

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According to the World Health Organization (2023), Low back pain (LBP) is the single leading cause of disability worldwide with most people experiencing LBP at least once in their lifetime. In 2020, it was estimated that LBP affected approximately 619 million people around the globe. This prevalence should help put your mind to ease if you have, or are currently, experiencing an episode of LBP. As one of the most prevalent cases of musculoskeletal disability, many of our practitioners have become familiar with the nuances of LBP and its variety of presentations. This includes its most common cause, Non-Specific Mechanical Low Back Pain.

Non-Specific Mechanical Low Back Pain

The low back is anatomically surrounded by a variety of structures. A common curiosity following an episode of LBP is, “what exactly happened?”. O’Sullivan & Lin (2014), found that over 90% of patients admitted to primary care were subsequently diagnosed with Non-Specific Mechanical Low Back Pain. This type of pain typically originates from the spine’s mechanical structures, such as the muscles, ligaments, intervertebral discs, or facet joints and the pain is typically reproducible with specific movements, postures, and loads (McKenzie, 1981). A thorough evaluation from a healthcare professional can help determine whether your pain falls within this category.

Imaging

Another common curiosity following an episode of LBP is, “Do I need an X-Ray or an MRI?”. What’s important in the discussion of imaging is that it does not necessarily help identify the specific underlying cause of your pain (Hall, M. et al, 2021, Chiarrotto & Koes, 2022). This is because most degenerative changes are normal and more common with age (Brijinkii, 2015, Hall, 2021). In fact, Brijinkii (2015), found that 70% of individuals over the age of 40 years had signs of disc degeneration and over 50% of individuals in their forties showed signs of disc bulging. Importantly, none of these individuals were experiencing any LBP! In some cases, an X-Ray or an MRI is necessary, however, it is recommended only if a serious underlying pathology is suspected (Wang, 2018, Hall, M.  et al, 2021, Chiarrotto & Koes, 2022). A healthcare professional can help guide you through an assessment to determine whether this is the case and if imaging may be indicated.

Posture

 

Is sitting up straight the answer to LBP? And what exactly is “good posture”? The link between posture and pain has long been a highly contested topic. However, back pain is not caused by poor posture alone (O’Sullivan et al., 2020). Rather than trying to achieve an optimal posture, breaking up more movement between long periods of sitting should be the focus. Prolonged uninterrupted sitting is associated with an increased risk of LBP and breaking up sitting decreases the frequency of LBP (Christenson, 2008, Korakakis, 2019, Kallings, 2021). It is easy to get lost in a good book, puzzle, or TV show and before you know it, you have been sitting in the same position for hours on end. The information presented above encourages us to take awareness of that, and to split up our seated activities with standing/walking breaks, as able. This is a more powerful habit than constantly trying to maintain a flat back.

Assessing Low Back Pain

If you have never seen a healthcare professional before, you may be wondering how an initial assessment is carried out. Typically, it begins with a conversation. We start with questions related to what happened, when it happened, the quality of your pain, and other relevant questions related to your past medical history and your goals. Then, we perform a series of movement related tests that help us better understand your pain. Based on our findings, one of our main goals is to provide you with the education and self-management techniques that you will need to better understand what you are experiencing and how we can help you recover.

Role of Rehabilitation

The amount of time you spend with a healthcare practitioner is next to none when it is stacked against the amount of time you spend without one. This is why our appointments are geared to provide patients with self-management techniques, so you can learn to cope with your LBP in the absence of a clinic. The following is a list of self-management techniques your clinician might provide education on during your appointment:

  • Activity modifications
  • Load management
  • Ergonomics
  • Heat/Ice
  • Mind/Body therapies
  • And more!

Conclusion

LBP is a highly prevalent experience, worldwide. There is a lot of information out there on what could be contributing to your symptoms, and what you can do manage it. However, this overload of information can be hard to navigate. Clinicians at Dynamic are equipped with the knowledge needed to put individuals with LBP on the right track. Please consider us for your rehab needs.

 

References

Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., Halabi, S.,          Turner, J. A., Avins, A.          L., James, K., Wald, J. T., Kallmes, D. F., & Jarvik, J. G. (2015). Systematic literature review of imaging            features of spinal degeneration in asymptomatic populations. AJNR. American journal of             neuroradiology, 36(4), 811–816.            https://doi.org/10.3174/ajnr.A4173

Chiarotto, A & Koes, B. (2022). Non specific low back pain. N Engl J Med. 386:1732-1740 DOI:             10.1056/NEJMcp2032396

Christensen, et al. (2008) Spinal curves and health: a systematic critical review of the epidemiological      literature dealing with associations between sagittal spinal curves and health. J Manipulative          Physiol Ther. 2008 Nov-Dec;31(9):690-714.

Hall, A., et al. (2021). What do the general public believe about the causes, prognosis and best     management strategies for low back pain? A cross-sectional study. BMC public health, 21(1), 682. https://doi.org/10.1186/s12889-021-10664

Hall, M et al. (2021). Do not routinely offer imaging for uncomplicated low back pain.             BMJ; 372:n291 doi: https://doi.org/10.1136/bmj.n291

Kallings, L.V., Blom, V., Ekblom, B. et al. (2021). Workplace sitting is associated with self-reported         general health and back/neck pain: a cross-sectional analysis in 44,978 employees. BMC Public Health 21, 875 https://doi.org/10.1186/s12889-021-10893-8

Korakakis, V et al. (2019). Physiotherapists perception of optimal sitting and standing posture.     Musculoskeletal Science and Practice. 39: 24-31

McKenzie, R. A. (1981). The lumbar spine: Mechanical diagnosis and therapy. Spinal Publications New   Zealand Ltd.

O’Sullivan, P & Lin, I. (2014). Acute Low Back Pain. Beyond Drug Therapies. Pain Management Today. 1(1): 8-13

O’Sullivan, P. B., Caneiro, J. P., O’Sullivan, K., Lin, I., Bunzli, S., Wernli, K., & O’Keeffe, M. (2020).       Back to basics: 10 facts every person should know about back pain. British journal of sports        medicine, 54(12), 698-699.

Saraceni, N. et al. (2019). To Flex or Not to Flex? Is there a relationship between lumbar spine flexion      during lifting and low back pain? A systematic review with Meta-analysis. JOSPT 28:1-50

Walker, M. (2024, January). Best Practice Care LBP [Lecture].

Wáng, Y., Wu, A. M., Ruiz Santiago, F., & Nogueira-Barbosa, M. H. (2018). Informed appropriate           imaging for low back pain management: A narrative review. Journal of orthopaedic   translation, 15, 21–34. https://doi.org/10.1016/j.jot.2018.07.009

World Health Organization. (2023, June 19). Low back pain (Fact sheet). https://www.who.int/news-        room/fact-sheets/detail/low-back-pain