Back to Basics for Back Pain
Back pain is extremely common and it is estimated that up to 80% of the population experience an episode of back pain throughout their life. While the prevalence of back pain doesn’t appear to be reducing, our understanding of back pain and how to manage it has significantly improved over the last decade. Let’s discover what research shows to be the best way to manage this common condition.
Move it to lose it!
Many years ago, a sore back would probably result in your health care professional telling you to rest and spend time in bed. However, more recent research suggests that an active approach that encourages movement is the most effective way of both reducing pain and increasing function. The best place to start for most people is walking. Short frequent walks of up to 15 minutes in duration increase local blood flow, and gently encourage the core muscles to activate which reduces the sensitivity of the back. It is important to make sure that you walk at a normal pace as walking at a slower pace can actually increase your discomfort. It has even been suggested that wearing a light backpack (e.g. with a drink bottle inside) can assist as the subtle change in centre of gravity activates the stomach muscles more and can help people to stand upright rather than leaning forward as is commonly seen in people with back pain. It is also important not to avoid movement altogether but rather to focus on the movements that you can do without a significant increase in pain and aim to build up this bank of movements.
You need to get the balance right.
There are muscles around the entire trunk that create a supportive cylinder around the spine. Unfortunately many people become obsessed with the muscles at the front of the trunk (aka the six pack muscles). Building strength and resilience in the muscles that reinforce the spine should aim to train all muscles rather than focusing most of your attention on one area. Don’t get me wrong, it is common to see a weakness of the abdominal muscles, however it is equally common to see a weakness of the muscles that stabilise the side of the trunk and these muscles are often forgotten in “core strengthening” exercise programs.
A simple way to strengthen the muscles at the side of the trunk is to practice carrying items in one hand while maintaining an upright posture. To keep the challenge for these muscles high and the external load lower, try to hold a light weight such as a can in your hand with the arm extended over your shoulder. Use a mirror if you can to monitor your body position and try not to lean to the sides.
If you think you will or you think you won’t you are right either way.
In recent years there has been an increase in the number of research studies that have looked at the correlation between people’s beliefs and their recovery outcomes. Put simply, believing that your pain will not go away – catastrophizing about the impacts of the pain on your day to day life – will increase the severity of your symptoms and increase the likelihood that your pain will become long-standing. One of the reasons people can tend to fear the worst about their back pain is the language that is used by healthcare professionals about their issue. It is easy to become anxious when terms such as “bulging disc” and “degeneration” are used to describe the anatomy of your back. What is important to realise is that changes to the discs and joints in the back are a normal feature of ageing, just as changes to your skin are. Many people who are not experiencing back pain will have “bulging discs” and “degeneration” on a scan. Your back is a robust structure that like other parts of your body can experience sensitivity when the balance between loading and recovery shifts. Improvements in back pain don’t typically come from changes to your anatomy, but rather from improved loading and tolerance.
Nothing lasts forever.
Even in the absence of a specific management plan, there are only very few situations where persistent back pain lasts in excess of 10 years. An appropriate management plan including exercise and education will significantly shorten the recovery time frame. If the last 12 months of the pandemic has shown us anything, it is that while in the thick of it we can feel like time is standing still and the situation is going to last forever, in reality this is not the case… this too shall pass!