Do you have ongoing back pain or referred pain in your leg?

Low back pain is common and can have a detrimental impact on the ability to continue to work and your favourite activities. Despite the large impact on life, most cases of low back pain are not serious and do not require medical intervention. Even persistent and disabling chronic low back pain is not synonymous with significant tissue damage and pathology. It may seem counterintuitive, but severity of pain does not directly correlate to the severity of injury.

Did you know...

Recent MRI studies have shown that disc bulges, degeneration, osteophytes and other scary sounding findings are actually very common and many people have these findings on imaging but have no pain at all. In fact many of these changes may occur naturally as we age. Furthermore, we know that unnecessary x-ray and MRI among people with low back pain can lead to fear avoidance behaviours and negative coping strategies that can delay their recovery at best, and lead to poorer outcomes at worst.

Although unlikely to be serious, the specific cause of your low back pain may be complex with many factors contributing to your pain. It’s not all about injured tissues. Contrary to common belief, the degree and type of tissue injury is just one factor among many that will directly influence your pain. Moreover, if your pain has lasted longer than 3 months, factors other than tissue damage are more likely to be contributing to your pain. This is because tissue (i.e. nerve, muscle, joint, disc) healing occurs within the first few weeks to months.

So, if tissue damage is not the cause of your long-standing back pain or associated leg pain then what is? 

Low back pain is best seen as a protective mechanism in response to your body’s perceived level of danger, threat or disruption to maintaining a balance within your body systems. Many contributing factors can have a beneficial or negative impact on the presence of your pain. This multi-factorial blend of physical factors (load management, tissue injury), psychological factors (ways of thinking about your injury, fear avoidance behaviours), social factors (stress, job demand flexibility, and home environment), lifestyle factors, among others can be involved and should be considered in treatment of your low back pain.

So what does this mean? Even in cases of severe pain, your low back pain is unlikely to need medical or surgical intervention. Treatment of your low back pain should include consideration of all potential factors contributing to your pain - not just the tissue that you have injured. Also, you are unlikely to need imaging to identify the source of your pain. In fact, this may work against you if you are responding well to physiotherapy care.

We know that a positive mindset is associated with lower levels of pain and disability. Once serious red flags are ruled out, a focus on movement within tolerable levels, graduated return to activity and exercise is recommended. Knowing the facts better prepares you to progress towards recovery. Check out these top 10 facts below:

10 FACTS EVERYONE SHOULD KNOW ABOUT BACK PAIN

• Persistent back pain can be distressing and disabling but is rarely dangerous. Your physiotherapist is trained in identifying these rare cases and will be able to refer you to the appropriate specialist if required. More likely, however, conservative treatment will be effective in controlling your pain.
• Ageing does not cause back pain. Evidence-based physiotherapy treatment at any age can help lessen your pain.
• Persistent pain does not mean significant tissue damage. Backs are resilient & strong. Tissue healing happens within the first 3 months so if pain persists longer there may be other contributing factors responsible for your pain. Back pain can occur with no injury during everyday movements - factors such as fatigue, stress and unaccustomed movement/activity may be present making the back sensitive.
• Scans rarely show the cause of your back pain. Scans frequently show lots of scary-sounding findings like bulging discs or osteophytes - even in people who do not experience any back pain! These findings won’t necessarily align with your level of pain severity or disability and should not be heavily relied on to determine how long your recovery will be or what you need to get better.
• Pain with exercise and movement may hurt but it is not harmful. When pain persists, the surrounding structures become sensitized. Getting moving again can hurt, but it is more a reflection of the sensitivity of the surrounding structures rather than a sign that you are causing harm. In fact, increasing your movement and exercise are effective treatments for low back pain.
• Poor posture does not cause back pain. A variety of postures is best for our backs. In other words, the body functions best when it is moving throughout the day. Moving the spine when we lift, sit and bend is efficient and safe. Also, taking a load off and using our backrests when sitting at our desks also gives the muscles a break and can help to reduce your pain.
• Back pain isn’t caused by ‘weak core’ muscles. In fact, people with back pain tend to tense their muscles as a protective response. This can actually amplify the pain. Imagine clenching your fist all day long! Strength and tension in the muscles when you need it is important, but learning how to relax those muscles when they are not in use or needed is very important as well.
• Backs do not wear out with everyday bending and loading. Moving and loading your back makes it stronger and healthier, just like lifting weights at the gym makes you healthier and stronger. The secret is to start at a moderate level and gradually increase. Returning to running, bending, lifting and twisting are achievable and safe to do if done gradually and practised regularly.
• Pain flare-ups do not mean increased tissue damage has occurred. In other words - hurt does not equal harm. Although pain flare-ups are scary and can happen often with low back pain, it does not mean that you have caused tissue damage. Instead, typical triggers for pain flare-ups include increased stress, low mood, worries, or unaccustomed activity. Acknowledging and trying to control these triggers can help lessen flare-ups. When flare-ups do occur - rather than treating it as an injury, try to stay calm & keep moving.
• Spine surgery, spine injections and strong medications like opioids are not a cure for persistent back pain. These treatments have risks, side effects and have been shown to not be effective in attaining long-term relief from back pain. The key is to keep moving within tolerable limits, identify contributing factors to your pain, gradually build up your strength and find low-risk ways to put you in control of your pain.

Adapted from O’Sullivan, Caneiro, O’Sullivan, Lin, Bunzli, Wernli & O’Keefe. (2020). Back to basics: 10 facts every person should know about back pain. British Journal of Sports Medicine, 54(10), 698-699. DOI: 10.1136/bjsports-2019-101611

What we can do to help

No referral is required to receive physiotherapy care. A clinical assessment by one of our physiotherapists will first rule out any red flags indicating serious pathology (with imaging only if necessary) followed by a physical assessment and a tailored treatment plan.

Your physiotherapist will work with you offering manual therapy to manage pain, expertise in load management and exercise prescription, assist you in developing positive coping strategies, identification of your specific contributing factors to your pain and assistance with a graduated return to doing the things you love. If required, other healthcare practitioners may be included in your treatment such as sports doctors, pain specialists or surgeons. You can expect expert advice and treatment allowing you to feel better, sooner.

Want to get started right now? General advice for people suffering from low back pain includes keeping active within tolerable limits, avoiding bed rest, using non-steroidal pain medication if required and continuing to work if possible (with job modifications if necessary).

Not sure if physiotherapy can help you? Book a complimentary 15-minute telephone consultation to discuss your specific case with a physiotherapist and receive advice on your next best move.

The Lumbar Spine Careway Pathway

Are you eligible for the Careway Pathway? Careway is an escalated care pathway that ACC fully funds. If eligible, an individualized treatment plan will be devised on entry by a physiotherapist to assist you in achieving your goals. Following this, you will be connected with a team of healthcare professionals ensuring faster, coordinated care in diagnosis and delivery of treatment, facilitating a faster recovery. Your healthcare team may include sports physicians, physiotherapists, orthopaedic surgeons, vocational therapists, and pain management specialists. With no out-of-pocket costs and a connected team of health professionals, you will get the treatment you need -when you need it. Allowing you to get better, faster.

Learn more about how physiotherapy can help you with your low back pain and determine if you are eligible for the Careway pathway. Call us or book your appointment online today.