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Back pain management

Who gets back pain?

It is likely that if you’ve come to read this article, you yourself have experienced, or are experiencing back pain. What might come as a surprise is that 80% of Australian adults will experience at least one episode of low back pain in their lives1. With many experiencing back pain for months and even years.

Here’s what the statistics in Australia2 say about back pain:

  • About 4 million people or 1 in 6 Australians (16%) had back problems in 2017-18
  • In 2015, back pain was the second leading cause of disease burden, accounting for 4.1% of Australia’s total disease burden
  • Pain at least “moderately” interfered with daily activities for almost 2 in 5 (38%) people with back problems in 2017-18
  • In 2017-18, there were 181,000 hospitalisations for back problems
  • Aboriginal and Torres Strait Island people are affected by back pain at a similar rate (17%) to non-Indigenous Australians in 2017-18
  • People living in lower socioeconomic areas were 1.4 times as likely to have back pain problems compared to those living in higher socioeconomic areas

What is low back pain and what causes it?

Low back pain is often defined as pain occurring between the lower ribs and buttock creases that can include neurological symptoms that radiate into one or both legs3. However we know that back pain isn’t always felt in the lower back, with many people experiencing pain around the mid-, and upper- back, as well as around the neck. It is important to remember that back pain itself is not a disease, but a symptom.

When we look at the many causes of back pain, they can include biophysical factors (i.e. what is occurring inside your body), co-morbidities (i.e. your pre-existing health conditions), and poor mental health4. We tend to split the causes of back pain into two different camps – specific and non-specific.

For acute low back pain, a specific pathology is identified in only 8-15% of low back pain cases5. The remaining 85-92% of cases of LBP are given the label of non-specific low back pain. This is the type of back pain that isn’t attributable to a particular pathology.

Regardless of whether your back pain is specific, or non-specific, please remember – your back pain doesn’t need to be permanent, your body is designed to heal and adapt, and with a bit of work, every person has the capacity to help themselves through their pain.

What do we look out for if you present to us with back pain?

If a new or existing client presents to us with a new acute episode of low back pain or with a history of chronic low back pain, our Exercise Physiologists will always perform an assessment for “red flag” signs and symptoms of specific pathologies that are known to cause back pain.

Examples of these signs and symptoms6 include:

  • Pain occurs after a traumatic event, such as a car accident or a fall
  • Pain wakes you during the night
  • Pain does not reduce or change, no matter how you move or change position
  • Pain accompanies numbness, tingling, or ‘pins and needles’ in your bottom, legs or feet
  • Pain accompanies changes to your bowel or bladder control

If red flags are identified in our assessment, or if you are reading this and think you may be experiencing any of these signs or symptoms, we recommend visiting your local medical professional for further investigation.

It is important to note that 80% of non-specific cases of low back pain have a least one identifiable red flag symptom7, however, as stated earlier, it is very uncommon for back pain to be caused by an acute pathology.

What is the best treatment for back pain?

Current treatment guidelines are always based on the best and most up-to-date clinical evidence we have available to us. As you can expect, recommendations for back pain have changed drastically over the past 20 years as guidelines continually evolve with emerging evidence.

Old way of doing things:

  • Take a couple of anti-inflammatories
  • Rest in bed and stay inactive
  • Rely on passive therapies, such as spinal manipulation, massage, and acupuncture, as the primary focus of pain treatment
  • Imaging (x-ray, CT scan, MRI) to find any possible cause of the pain
  • Surgery to repair structures that may be causing the pain
  • Research reviews have found that this method, which follows an over-medicalisation of treatment of back pain, has long term damaging effects to the patient

Current treatment guidelines:

  • Stay active! The primary focus for the person with pain is to stay as active as often as they can within their current pain limitations
  • There is currently no evidence that identifies a specific selection of exercises that will work a perfectly for every case of back pain, so the treating practitioner will use their clinical judgment to choose exercises they judge to suit a particular person’s condition, preferences, and capabilities.
  • Along with physical activity and exercise having a demonstrated benefit to cases of back pain, there is also a long list8 of beneficial side effects from exercise
  • Spinal manipulation, massage, and acupuncture are all recommended as second line or adjunctive treatments to exercise therapy and should not be the primary focus of treatment
  • Referral to a psychologist for particular cases of persistent back pain may be necessary

What can an Exercise Physiologist do for my low back pain?

Our Exercise Physiologists aim to work with you to make sense of your pain. You are the expert on your own pain and experiences after all. Once we’ve developed an understanding of your history and pain, we will plot a path forward that will take a graded exposure to movement and exercise. This journey will be fine-tuned to your personal situation and goals, and move you away from disabling pain and back to living your life to the fullest. You can read more on our Chronic Conditions page.

If you have tried other approaches that haven’t given you the outcomes you desire, or just feel like you need a bit of help making sense of your pain – you can reach us at 07 5441 3850 or This email address is being protected from spambots. You need JavaScript enabled to view it..

Key take home points

  1. Back pain is very common and experienced by many people across Australia and the world.
  2. For some, back pain is a once off, and for others it can be recurrent for a long time.
  3. For some, back pain is mild, and for others it is greatly disabling and stops them from being able to complete many of the tasks they used to perform and enjoy.
  4. Causes of back pain vary, are multi-factorial, and are rarely simply related just to a “tissue injury” or “muscle weakness”.
  5. It is very uncommon for back pain to be related to a serious illness or pathology.
  6. The first line treatment is to stay active and exercise within your pain limits.
  7. If a person is showing no improvements through activity and exercise, other therapies such as massage, spinal manipulation, acupuncture, and yoga are recommended as a second line treatment.
  8. We will take your history, assess you for red flags, plot a path forward, and get you back to living your life to the fullest.

References

  1. Walker, B. F., Muller, R., & Grant, W. D. (2004). Low back pain in Australian adults: prevalence and associated disability. Journal of manipulative and physiological therapeutics, 27(4), 238–244. https://doi.org/10.1016/j.jmpt.2004.02.002
  2. Australian Institute of Health and Welfare. (2020). National Health Survey: Back problems. Australian Institute of Health and Welfare, Australian Government. Retrieved 13 November 2020. https://www.abs.gov.au/statistics/health/health-conditions-and-risks/national-health-survey-first-results/latest-release
  3. Hartvigsen, J., Hancock, M. J., Kongsted, A., Louw, Q., Ferreira, M. L., Genevay, S., Hoy, D., Karppinen, J., Pransky, G., Sieper, J., Smeets, R. J., Underwood, M., & Lancet Low Back Pain Series Working Group (2018). What low back pain is and why we need to pay attention. Lancet (London, England), 391(10137), 2356–2367. https://doi.org/10.1016/S0140-6736(18)30480-X
  4. Grace, S. (2018). Treating low back pain: The evidence. Journal of the Australian Traditional-Medicine Society, 24(2), 78+.
  5. Wheeler, L., Karran, E., & Harvie, D. (2018). Low back pain: Can we mitigate the inadvertent psycho-behavioural harms of spinal imaging?. Australian Journal Of General Practice, 47(9), 610-613. doi: 10.31128/ajgp-03-18-4525
  6. Exercise is Medicine Australia. (2014). Managing a first or acute episode of low back pain. Exercise is Medicine Australia. Retrieved 13 November 2020. http://exerciseismedicine.com.au/wp-content/uploads/2018/06/2014-Low-Back-Pain-FULL.pdf
  7. Henschke, N., Maher, C. G., Refshauge, K. M., Herbert, R. D., Cumming, R. G., Bleasel, J., York, J., Das, A., & McAuley, J. H. (2009). Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis and rheumatism, 60(10), 3072–3080. https://doi.org/10.1002/art.24853
  8. The Department of Health. (2019). Physical Activity. The Department of Health, Australian Government. Retrieved 13 November 2020. https://www1.health.gov.au/internet/main/publishing.nsf/Content/phy-activity