Expert solutions for debilitating chronic back pain

Chronic non-specific low back pain … What a frustrating diagnosis to receive when you’ve had low back pain for a long time and all you want are answers. As a physiotherapist, I’ve often thought that I wouldn’t like being told that my pain was non-specific.

I know exactly where my pain is, I know how it aches and I know how it makes me feel.

I feel irritated when I can’t walk as far as I like; I feel annoyed when I can’t get comfortable in bed, and I feel embarrassed when I can’t bend over to put my shoes and socks on. There is nothing non-specific about that!

So, if you’re told you have chronic non-specific low back pain, what does it actually mean?

Types of pain

Chronic pain is pain that has been present for more than three months. It is generally persistent, but it can also come and go. It describes pain that lasts beyond the expected time frame for tissue healing to occur.

It is often a complex combination of how the tissues in your back respond, your thoughts, feelings and fears, as well as how you move, how much support you have, and even how confident you feel to exercise and go to work or social gatherings.

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And then there is the ‘non-specific’ diagnosis. Sometimes we can attribute low back pain to a specific structure in the back or a specific cause. Low back pain is occasionally caused by the nerves or discs in the low back, fractures of the vertebral bodies, inflammation, infections or cancer. However, for up to 90 per cent of people with low back pain, the specific cause of the pain cannot be identified by clinical tests or scans, and these are the people who are told that their pain is ‘non-specific’.

Interestingly, when we see abnormalities on MRI scans or CT scans, we also find these same changes in people who do not have low back pain, so we can’t always say the changes are causing the low back pain.

Occasionally, injections can help with pain relief, especially for people who have nerves that are causing their pain. But injections are not recommended as a first treatment and are reserved for people who are not improving with conservative treatment. They also only provide short-term relief so need to be combined with exercise and physical activity for longer-term results.

So why do we so often get caught up on the merry-go-round of trying to find a diagnosis, having expensive scans and even more expensive appointments? Perhaps we should be focusing instead on trying to find out what might help to relieve our pain or get us back on track and moving more freely.

What works is different for everyone

Once any red flags have been ruled out (such as severe spinal stenosis, malignancy or fracture), it might be time to start focusing on what works for you, rather than what is wrong with your back.

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For some people, that might be a specific set of exercises or stretches to do daily. For some, it might be a routine they have for short-term relief when their pain is flaring. For some, it might be going for a walk or doing some laps at the pool. For others, it might be hot packs or warm showers to relieve the muscle aches and pain. Recent research has even found that some people feel better after a strong session at the gym. What works is different for everyone.

What are the current clinical guidelines for managing non-specific low back pain?

  • Try to keep moving as normally as you can and avoid going to bed for a prolonged period.
  • A combination of exercise and education is usually the most successful way to manage low back pain.
  • Exercise can be anything that you enjoy and feel comfortable doing. Walking, swimming, pilates, yoga and strength workouts have all been shown to be helpful.
  • Education about self-management strategies, how to slowly increase the exercise that you do and how to increase your self-confidence to move despite your pain, have been shown to be helpful as well.
  • Over the counter NSAIDs are recommended if you really need some help, but most doctors and pharmacists will suggest you try hot packs, warm showers and gentle exercise before you decide to use medication for pain relief. Sometimes stronger medications are prescribed, but it is important they are only used for a short time if possible.
  • A visit to your preferred manual therapist has been shown to help with short-term pain and some people find they are able to move more freely after a session of manual therapy, which helps them stay active when they have more chronic pain.

What is most effective for managing low back pain?

There is no consensus about exactly which type of exercise is the best. The most effective is the type of exercise that you are likely to do regularly. Exercise is Medicine recommends people with low back pain should aim to do the same amount of exercise as people who do not have low back pain.

Based on the World Health Organization guidelines, everyone should aim to do at least 150 to 300 minutes of moderate to vigorous aerobic activity every week, as well as muscle-strengthening activities at least twice a week.

If you have low back pain, start slowly and keep it simple until you build up your confidence. Keep aerobic exercise low impact (think walking and swimming) and consider doing several short sessions per day rather than one long session. Build up from there.

Some people prefer to exercise alone and some prefer to exercise in a group, so if you think you prefer the support of others around you to stay motivated, consider joining your local gym, exercise studio or community classes. If you prefer to exercise alone, consider keeping a diary or using an app to track your progress and maintain your enthusiasm.

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When it comes to strength exercises, you can use your own body weight, resistance bands, light weights or heavy weights. If you have never performed strength exercises before, it is probably best to seek some advice about how to strengthen safely before you go it alone.

If you feel confident that you can strengthen safely, then start with light loads and build up from there either by increasing the weight or the number of repetitions of each exercise.

Make sure you warm up and cool down to minimise any muscle soreness you might experience in the days following your strength session. But remember that a little muscle soreness might actually be a good thing as it is indicating you’ve found the right muscles and you’ve exercised them!

If you have been struggling to get on top of your low back pain and your doctor or treating therapist has ruled out the red flags, then you might find some of these strategies will get you moving and back on top of your pain.

Focus on what you can do rather than what your low back pain stops you from doing and slowly you will start to see improvements in your physical activity and, hopefully, your pain.

Study: Researchers at the University of Sydney and Charles Perkins Centre have partnered with NSW Get Healthy Service® to see if they can help people stick to the advice they’ve been given by their treating therapist. Head to the Get Back to Healthy Study website for more information.

Kate Roberts is an experienced physiotherapist and PhD candidate at the University of Sydney. She has a passion for helping older Australians manage their aches and pains.

Are you troubled by low back pain? Have you been able to find relief? What worked for you? Why not share your journey in the comments section below?

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