By Andrew Miners, Director, Sports Therapy and Rehabilitation and Marlo Goldstein, Personal Fitness Trainer as told to Tania Haas
Back pain is extremely common. Up to 70-85% of adults will experience an episode of back pain in their lifetime, and it’s probably why you clicked on this article.
That being said, not all lower back pain is the same, nor should it be addressed in the same way.
In this article we are referring to non-specific, back-dominant pain. It is called “non-specific” because clinically, and even from a research-based perspective, it can be very hard to differentiate from muscle, joint, sacroiliac joint or pain originating from the disc itself. Non-specific (back dominant) pain is by far the most common type of lower back pain, with 90 to 95% of patient cases categorized as non-specific back pain.
Additionally, this article is referring to different approaches that could benefit (i) acute and (ii) sub-acute types of non-specific, back-dominant pain. Acute lower back pain lasts less than 4 weeks, and sub-acute lower back pain lasts between four to 12 weeks. The next category, and not addressed here today, would be pain that lasts longer than 12 weeks. This is referred to as chronic back pain or chronic intermittent back pain.
The spectrum of pain also includes chronic-complex pain, which is widespread body pain and is not restricted solely to the back. If you’d like to read more on chronic and complex pain, please read here.
The Big 5
Here are five approaches, based on the latest guidelines, that you can do for yourself if you know you have acute or sub-acute non-specific, back-dominant pain:
1. You can adopt a positive outlook because science is on your side
Remember that the prognosis is good. The vast majority of acute onset lower back pain will get better from 10-14 days or up to four weeks. That’s if you do nothing to treat it. The natural history of back pain — despite the level of pain or intensity of pain — is that people do get better. This is important to note because many people seek help with an accompanying fear that they’ve injured their back and they are going to have persistent, on-going pain. The research shows us that, in the vast majority of cases, that fear is unfounded.
2. Realize that the risk of a serious back problem is low (even when it hurts a great deal)
Despite that level and intensity of pain you experience, the actual chance of having serious, underlying problems with your back is small. The level of pain does not correlate to the amount or presence of tissue damage. Remember, your prognosis is good and your recovery is closer than you think.
3. Immediate imaging is (usually) not needed
For this type of lower back pain, using X-ray, CT scanning or MRIs is usually not beneficial for your diagnosis, treatments or directly pertaining to your outcomes of care. In the vast number of cases it is a clinical examination that sets your diagnosis and treatment plan.
Sometimes people think ‘If I only had the imaging, I’d know what is wrong with my back’, but the pictures do not always correlate to the pain. Upwards of 40-50% of people, who are not experiencing back pain, could potentially have a disc bulge if they had an MRI done of their back. So getting imaging done is usually not necessary during the first visit to your physician or chiropractor. A careful examination is.
4. Keep moving
Bed rest is the worst thing to do for acute and sub-acute low back pain. Stay active. Activity is good. You want to keep as active as possible within your tolerance of pain. Move to pain, not through pain.
5. Learn self-care strategies and/or exercises
Doing things early in the injury is better than waiting for the pain to disappear. If you are scared to keep moving or to stay active, it may be necessary to manage your perception of pain and any fears that you may have. Your perceptions around pain and any fear that is stopping you from moving could actually prolong your pain. Remember #1: that in the vast majority of cases, the pain will diminish and you will return to functioning as you were before the pain started.
It’s important to move properly when you have lower back pain, so technique is key. The recommended exercises will likely include hip hinging (where you move from your hips); glute progressions; and mobility and stability movements. Speak with your chiropractor or personal fitness trainer for a set of personalized exercises you can do daily that are best for you and the pain you are managing.
So here’s a recap:
Get a clinical diagnosis so you can rule out non-spinal causes, serious conditions unrelated to back pain, and the leg-dominant radicular pain
The current guidelines say that your prognosis is likely very good, you probably don’t need an X-ray, and the amount of pain does not parallel the amount of tissue damage (#1, #2, #3)
Do not hesitate to move (#4)
The next posture is the best posture; and movement is medicine (#5)
Managing expectations of recovery: The actual course of lower back pain recovery
This is an excerpt from the recent live webinar “Real relief from back pain – yes it’s possible”, which covered a wide range of topics, beyond what is covered in this article. You can watch the full webinar recap video here.