Low Back Pain

Tricia Hayton

Low back pain is one of the most common musculoskeletal complaints.   It is a significant cause of disability, dysfunction and missed work in our society.  Yet even though it is so familiar, traditional medicine is not highly effective at treating it.  So, what can we do?

​Medical testing - not usually the best place to start:

Traditional testing such as MRI and X-rays are not typically useful when treating low back pain.   Your doctor may order tests to rule out serious pathology, but these results are used to rule out serious issues and are typically less valuable at pinpointing the actual cause of pain.   For example, it may clearly tell you that there is no fracture of the bone, or tumour in your spine.   However, it is misleading to say that the Degenerative Disc Disease (DDD) or disc bulge is the cause of your pain.  

​Studies have tested people with and without pain.  The results are the same – prevalence of DDD and disc bulges were evident in symptomatic and asymptomatic patients (people in pain, and not in pain).   Furthermore, the most common age to complain about low back pain is 40 -59 and as people age DDD continue to progress whereas the pain typically resolves.  If DDD were the direct case of pain, the pain should increase as we age instead of getting better.  This supports the belief that pain is actually a result of other, possibly related, factors.

What to do?  Have a trained physiotherapist, registered massage therapist or chiropractor look at your movement patterns.  If you are not moving ideally, muscle and joints can be stressed resulting in pain.  X-rays, CT scans and MRIs are pictures taken when you are VERY still.   They do not indicate how well things are moving.   In life, we need to keep moving.

Change of attitude:

We need to get away from thinking that bedrest is helpful for low back pain.   Although reduced activity may be necessary in an acute situations it is important not to stop completely.   Gentle movement and strengthening can help to break up spasm and decrease inflammation.   Perhaps more effectively then ice and heat, and definitely better than bed rest. 
With mild to moderate low back pain, exercise and strengthening decreases back pain significantly.   This is done partially by adding muscular support to your spine.   However, pain responses are much more complex then that.    Simple movement and strength teaches your brain what normal movement feels like and helps your nervous system adapt to tissue changes.     Knowing how your back moves and exercises that reduce discomfort, gives people control over their pain.   It may not resolve completely but having the knowledge to reduce the severity and frequency of bad days is great power.
Non-Steroidal Anti-inflammatories (NSAIDS – Like Aspirin, Advil, Voltaren etc.), surgery or more complex medical care is useful in only a few cases and typically should only been prescribed when exercise and education have not been successful in returning function and controlling pain.

Tricia Hayton is a Registered Physiotherapist and Partner at Physio Sport Med