lower back pain

Lower back pain is one of the most common musculoskeletal conditions around the world, with up to 80% of the general population experiencing lower back pain at any one point in their lives. The economic burden of lower back pain is also huge, with billions of dollars spent each year on imaging, treatment and research into lower back conditions. Despite this, there is still a lot of confusion regarding the cause, diagnosis, treatment and management of lower back pain. The goal of this article is to provide a basic overview and framework around the assessment and management of lower back pain. 

What is lower back pain?

Lower back pain is defined as pain in the lower back region (from the bottom of the ribs to the bottom of the buttocks) with or without associated leg pain.

When should I be worried?

Lower back pain can at times be crippling, and the slightest movement may trigger severe pain. However, the majority of lower back pain cases (90%+) do not indicate any serious pathology, and will resolve well with appropriate physiotherapy treatment and self management. Yet, there are certain situations in which the cause of back pain can be more sinister, and further investigations and specialist medical attention may be needed. Below is a list of a few of the situations when medical attention should be sought.

1. Cancer - the best predictor for malignancy or cancer is a past history of malignancy. However, other important things to look out for include unrelenting night pain, unexplained weight loss of >5kg in less than 3 months and unusual night sweats. If you notice these      symptoms in correlation with your back pain, please consult a medical      professional.
2. Infection - the clearest sign of infection is a fever accompanied by lower back pain. Intravenous drug use, a previous history of infection (such as urinary tract infections) can also be indicators. Please consult a medical professional if you think you may be at risk of      infection.
3. Inflammatory disorders - back pain that comes on insidiously (comes on slowly, or for no real reason) and is not clearly      correlated with movement. This pain is usually linked to night pain and morning stiffness over 30 minutes, as well as symptoms lasting for more than 3 months. It is most common in people under the age of 40. Inflammatory back pain will normally respond well to NSAIDs (anti inflammatory drugs). Please consult a medical professional if your symptoms match these descriptors.
4. Cauda equina syndrome - a surgical emergency which occurs when the nerves below the end of the spinal cord are compressed. The main signs and symptoms to look out for are bladder/bowel dysfunction (difficulty passing urine or waste, or trouble holding it in), saddle anaesthesia (loss of, or altered sensation around the buttocks, legs and inner thighs), sexual dysfunction, and/or weakness in the legs. If you have these symptoms, please go see a medical professional immediately. 

Should I get scans?

In the majority of cases, scans for lower back pain are not necessary. Scans are a representation of human anatomy, and deviations from an anatomical norm can often be represented as problematic. However, research has shown that the correlation between imaging findings and patient symptoms and presentations are poor. In fact, many people who do not have back pain at all will have abnormal findings on scans such as disc bulges or degeneration, and the older we get, the more likely abnormal findings will be present. However, in some instances, scans can provide valuable information regarding diagnosis, prognosis and treatment. If worried, please consult a qualified physiotherapist or medical professional for further advice.

How should I manage my lower back pain?

Most cases of lower back pain will subside as time passes. The aim of physiotherapy, however, is to help decrease pain and improve symptoms significantly faster than time alone, and to provide education on the most appropriate strategies to manage and prevent any current and future occurrences of back pain. Although not a substitute for personalised medical advice, below are a few general strategies to help manage back pain on your own.

1. Stay active - contrary to popular opinion, a sore lower back loves movement. This does not mean ignoring the pain and pushing through with your day to day activities. Rather, gentle, regular movement, walking and lower back stretches can help reduce sensations of pain and stiffness. 
2. Avoid prolonged static postures - one of the worst things you can do for a painful lower back is to stay still for an extended amount of time. Prolonged stillness can lead to increased sensations of pain and stiffness, and prevent further movement. This creates a vicious cycle of inactivity and worsening pain and stiffness, and can delay recovery. A general rule of thumb is to try and move for approximately 20-30 seconds every 20-30 minutes.
3. Heat - heat can help relax stiff and sore muscles, and can often provide some temporary symptomatic relief. A heat pack, hot water bottle or hot towel are some examples of options which can be used.