Lower Back Pain - Freedom Physiotherapy & Pilates
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Lower Back Pain

Hey, everybody. Welcome back. Let's talk about lower back pain.

Lower back pain probably accounts for 85% of all expenditure in the healthcare system in the Western world when it comes to musculoskeletal pain. Muscoloscautal pain, including spinal pain, well, it's about the third or the fourth largest category of expenditures. So if you look at lower back pain being 80% of musculoskeletal pain, it's a pretty big deal.

It's quite debilitating. People are quite concerned about it, and it's, in my opinion...actually, not just my opinion, but according to research it's poorly diagnosed and it's certainly very poorly managed. Lower back pain probably accounts for a lot of abuse of narcotics or opiates, and if you're wondering what they are, Panadeine, Panadeine Forte, Endone and those types of drugs. Highly addictive, and unfortunately prescribed way too often for lower back pain.

When I talk about back pain, we're talking about pain in the lower back. You may have isolated back pain, or perhaps you have pain shooting down the leg. There's a couple of types of referred pain down the leg or legs. Sometimes it can be nerve pain, which is sharp and shooting, or sometimes it's just more of an ache that spreads down the leg. Okay?

But having said all this, if you look at one of the biggest problems with back pain, it's fear of back pain, or fear of back pain returning. So all we ever hear about in occupational health and safety is, you know, keep your back straight and don't do this and don't do that, and there's automation and whatnot, and we do a lot less manual work. But if you think about it, the biggest cause of back pain is actually sitting still, like I am right now.

I wanted to discuss some of the myths about back pain. Number one is you need a scan. It's not true. For the vast majority of back pain, you do not need an X-ray. You don't need a CAT scan. You don't need an MRI. It doesn't help with diagnosis, and the reason for that is 85% of lower back pain does not have a diagnosis. It comes under the category of benign, nonspecific lower back pain, which is, there's bits and pieces there causing pain. Muscle, ligament, disc, joint, whatever. But there's no specific diagnosis.

The diagnosis does not help treatment. Yes, in about 15% of cases a scan is needed, certainly in the presence of night pain or loss of appetite, weight loss, things that indicate a medical cause of your back pain. Sometimes it can be gynecological referred pain. In some rare cases it can be a tumor or an infection. But generally speaking, in those cases, a blood test is very handy as well.

When you are speaking to a client, hearing their story, as a clinician, you generally get an idea of what category people fall into. If you're experiencing back pain or back pain with leg pain, it's very, very important that the person you see takes the time to listen to your history, because your story tells us a lot more about what to do than anything else. Your history, your interpretation of what's happening, it tells us a lot more than the physical examination ever will.

When you're looking at seeking help for lower back pain, you need somebody who takes the time to listen and puts things into perspective. The clinical examination shouldn't drive the treatment. It's part of the overall evaluation. So looking at lower back pain, examination isolation without your story doesn't really help.

Myth number one, you don't need a scan. Not all the time. Okay? Number two, you don't need a diagnosis. It doesn't help you get better.

Generally speaking, lower back pain, or assessing lower back pain, is ruling out those people who do need further investigation. But for the vast majority of us, we need some education, some advice, and some motivation.

The biggest cause of back pain that I see clinically is sedentary lifestyle, a lack of movement, a lack of exercise, lack of strength, and the other big one is stress. Believe it or not, stress drives musculoskeletal pain, and there's two areas that really get affected by stress. One is the lumbar spine, and another area, of course, as we all know, the neck. So what do you do about this?

Well, you need to find a clinician who takes the time to listen, who then formulates a plan because there's no quick fix with back pain. You need a specific exercise program to strengthen your back, to strengthen your core, but not only that, you also need to lift your aerobic fitness because if you are aerobically fitter, that is your general fitness, you have a higher pain threshold. So you need strength, you need fitness. Okay?

It's a little bit hard when you're struggling to get around because your back is causing spasm and you can't move very well. That's where a physiotherapist can help you with specific exercises to get out of that rut that you're in and try and help you move ahead and change your lifestyle, change the way you think about your pain. You know, why I use the term de-medicalizing back pain, getting away from all those scans and tests and actually being coached and taught a program of exercises, and also helping you change the way you think about your back pain. They are the sorts of things that make a huge difference to people's lives.

Certainly, in my clinical practice, it's the clients who actively engage and actually go home and do the things I tell them to do, they're the people that I see results in. You know, unfortunately, if you've had back pain for a long period of time, sometimes it's going to take you three months before you really feel a difference. But it is about perseverance, and it's about persisting with those changes that you need to implement.

So if you would like to discuss in person a little bit more about how to go about helping your back pain, feel free to contact us here at the clinic. We do free telephone consultations. We can give you a call, or you can come in and, you know, book a free half-hour discovery session where you can tell us your story and we can certainly outline to you what might be useful for you. Thanks for watching.

Joshua Hayter, MAPA, B.Physio
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