Hands up if you suffer from back pain? Is it affecting your day-to-day life? In this blog Capital Physio physiotherapist Josh Lond helps you get to grips with your back pain. As well as identifying the causes of back pain, we’ll be looking at different types and how to go about treating them. Finally, we’ll address what activities you can do to ease your pain, and when you should seek the expertise of a physiotherapist or medical professional.
Types of back pain
Acute back pain can be split into three categories: Serious spinal conditions, Non-specific low back pain and specific low back pain.
Serious Spinal Conditions
It’s very important to emphasise that although <1% of back pain is serious, you should seek urgent medical attention if you have any or many of the following symptoms:
- Radicular pain – pain shooting down your legs, one side or both
- Numbness in your leg or a feeling of not knowing they are there
- Numbness within the pubic region, inner thigh or buttock and a lack of sensation when going to the toilet
- Bladder or bowel changes, abnormal retention or unexpected accidents
- Falling or legs giving way – feeling as if your legs lack power and could give way
- Impaired balance – more trouble balancing than normal, a lack of sensation of the floor or an inability to lift your feet when walking
If none of these apply to you, then let’s continue!
Non-specific low back pain (NSLBP)
NSLBP is estimated to account for up to 90% of all low back pain. It is normally the result of ‘lumbar strain’ and often stems from overuse of or injury to the muscles that support the lower back.
- Multidirectional pain
- No shooting element down the legs
- Eases with time
The acute period of NSLBP typically lasts from six to eight weeks when managed properly.
Specific low back pain (Discogenic/Radicular)
Specific low back pain accounts for between 5 and 10% of back pain. It refers to when a specific structure is causing pain, such as a disc, joint or nerve. This type of pain generally requires more thorough medical examination and is often hard to alleviate by yourself. The pain can persist for six to eight weeks but, if managed improperly, can go on for months or years.
- Shooting pain down the legs, sometimes with numbness.
Diagnosing which type of back pain you have…
Try each of the movements show in the videos below and note which, if any, cause pain. Don’t be afraid to repeat the movement; your body is designed to move and these will not injure it. Repeating the movement can also be a useful tool to identify if it helps ease the pain or intensifies it.
Most people will have one of three responses:
- It hurts with all movements equally – Muscular
- As above, but some more than others – Muscular/specific
- Or it hurts on one specific movement and causes leg pain – Radicular/specific
Option One – NSLBP
We recommend the following course of action and recommendations for activity:
- Maintain a low level of activity but avoid heavy lifting or competitive sport
- Continue to engage in normal, non-high impact activities
- Avoid prolonged static positions i.e. sitting for periods of half an hour or more – remember to stand up or walk around
- Use heat pads on your lower back to encourage healing and provide a soothing effect
- Take painkillers as necessary and visit your GP if basics like paracetamol aren’t working
- If symptoms persist contact a qualified physiotherapist for advice
- Follow a programme set by your physiotherapist to maintain full lower back movement
Symptoms generally settle down in six to eight weeks, even without medical treatment
Option Two – Muscular/joint/disc/stenosis
If your pain results from muscular/joint/disc/stenosis, take the following action:
- Refer to the videos. If you find that a particular position relieves your pain then repeat this. For example, leaning back, ten repetitions in standing, sitting or lying on your front every hour or use pillows behind your back for support
- Use heat periodically to soothe and ease pain
- Maintain a constant low level of activity and avoid prolonged static positions
- When it is necessary to be in a static posture for more than half an hour – when you’re driving, for example – take short breaks. Pull over and stand for a while or walk if you can and it’s safe to do so. If you have a desk job, walk to the water fountain or kitchen every half hour if possible
- If symptoms persist contact a qualified physiotherapist for advice
Option Three – Nerve/disc/stenosis
If you think your pain results from a specific disc, nerve or joint then this advice is for you. This is often the hardest category of back pain to alleviate on your own.
We strongly recommend that if you have leg symptoms you a) rule out serious conditions with the symptoms mentioned earlier or b) book in with a physiotherapist for a full assessment and to prevent further deterioration.
- Use heat periodically to ease pain
- Directly avoid positions that cause pain
- Use medication to ease pain
What the evidence says
The National Institute for Health and Care Excellence reviewed the scientific evidence for treating low back pain. In the resulting guidelines, physiotherapy came out as the top recommendation for treating back pain. This 2016 report recommended the following guidelines for physiotherapists to follow.
What we should be doing:
- Provide advice for self-management
- Educate clients on the nature of the pain
- Work towards a return to full activity and work as early as possible, with or without sciatic symptoms
- Recommend exercise – based upon a programme tailored to individual needs
- Offer the lowest effective dose of non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen and ibuprofen for the shortest time possible
- Consider offering manual therapy for people with or without sciatic symptoms only as part of a tailored exercise package
- Consider referral for surgery for those with persistent symptoms that are non-responsive to physiotherapy
What we should not be offering:
- Paracetamol alone and don’t consistently prescribe opioids or pain medication for chronic low back pain
- Acupuncture for managing back pain, with or without sciatica
- Ultrasound or TENS
- Support belts/traction/orthotics for back pain, with or without sciatica
- Spinal injections
- Spinal fusion or disc replacement
What’s the best course of action?
Many people are often shocked to hear that the main person who can treat the pain is themselves. Listen to your body; find what helps and what doesn’t. Use the tool above to guide you. If in any doubt or experience persistent pain then book in to see one of our many highly-qualified Capital Physio professionals.
If you think we can help you, then please don’t hesitate to get in touch. Click here to find your nearest Capital Physio clinic, where our expert team of clinicians are ready to help you with a personalised treatment programme. Any questions? Contact our friendly Holborn HQ by calling 033 0333 0435 or emailing firstname.lastname@example.org. You can also find us on Twitter, Facebook and Instagram.