Why is low back pain such a pain? How can you fix it?

For some people, low back pain comes and goes. Some might experience muscle aches and pains after working in the garden or sitting in their car for too long. They then take it easy for a day or two and soon after, get back to regular life.

They feel as though they know what caused their pain, it doesn’t worry them too much and they bounce back.

For others, it can be a completely different experience. For these people, their low back pain can be recalcitrant and unresponsive to treatment. They find themselves gradually limiting what they do around the house or with family and friends just in case something aggravates their pain.

They try not to lift anything heavy. The things that aggravate their back can be different every day and they don’t know what exercise they should or shouldn’t do to help.

According to the Australian Bureau of Statistics (ABS), low back pain affects 25-30 per cent of people over the age of 55.

Read more: Tips to manage lower back pain

Almost 40 per cent of those people report that their back pain interferes with their daily activities and, in 2015, it was the second leading cause of disease burden costing the Australian healthcare system almost $2.8 billion.

So why can it be so hard to treat and why can it be such a ‘pain’?
Professor Paulo Ferreira, from the University of Sydney, heads a team of researchers focusing on low back pain. He says: “One of the biggest issues we are seeing for people with low back pain is that they are not getting the right advice or the right treatment for their pain. We are working to help find the best solutions for managing low back pain.”

When it comes to low back pain, it can be difficult to identify the exact structures that are causing the pain. People often want a specific diagnosis, but we can’t always point to one particular source.

Low back pain is usually multifaceted, it usually has more than one simple cause and this makes diagnosis less straightforward, which can be confusing for both the person and the practitioner.

We know that low back pain may be due to specific anatomical structures such as a disc or a facet joint or perhaps even a pinched nerve. However, even an MRI is not able to accurately identify the pain provoking structure most of the time.

An MRI will show that most people over the age of 60 will have some wear and tear, but this does not mean the changes they see are the cause of their pain. Their low back pain may be due to muscle spasm, joint strain, ligaments, discs or nerves, but it is also likely to be affected by other things such as stress, anxiety, fear and even low self-confidence.

When low back pain has been present for more than three months, it can become more difficult for the person to manage. There is a complex interplay of physical, psychological and social factors that interact and shape their experience of the pain.

Fear of moving the wrong way or lacking confidence in being able to function despite their pain often leads to decreased participation in leisure and social activities leading to social isolation, deconditioning and a downward spiral of pain, fear of pain and protective behaviours, as well as emotional distress, poor sleep and decreased ability to function.

Read more: Walk to alleviate lower back pain

This can be quite distressing for the person who is in pain and, understandably, they want a reason for their pain, and they want relief.

For this reason, many people rely on expensive testing such as X-rays and MRIs as well as frequent visits to their manual therapist. But these don’t always deliver the best outcome.

One of Prof. Ferreira’s PhD students, Thomas Patterson, is currently looking into the use of paracetamol for low back pain.

“We know that a lot of people turn to over-the-counter medications to manage their low back pain, but the data is telling us that these medications may have limited effects,” he says.

“We are currently working on guidelines and strategies to guide people with low back pain to manage this condition without the need for medication.”

So, what should you do if you have low back pain?
A review of global clinical guidelines for managing low back pain published in The European Spine Journal in 2018 recommends the best treatment for people with acute low back pain is “reassurance, advice on returning to normal activities, avoiding bed rest and the short-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) if active approaches are unsuccessful”.

Read more: Lower back pain: what’s the most effective treatment?

For people who have more recalcitrant pain, the guidelines recommend “the use of NSAIDs and antidepressants, exercise therapy and psychosocial interventions”.

They also recommend referral to a specialist if concerned about specific pathologies or nerve pain, or if there is no improvement after four weeks.

In other words, if your pain is acute, move as normally as you can, go for a walk with a friend and get back to your normal routine as soon as you can.

If your pain has been around for a while, the right sort of exercise is important as well as staying socially active.

If you don’t feel up to your usual Zumba class or lawn bowls, ask a friend to go for a gentle walk with you or do some slow laps in your local pool.

If you don’t get out of the house much, try joining a local group or club where exercising with other people might help you to get motivated and get moving.

It is also a good idea to touch base with a physiotherapist, exercise physiologist or therapist who can give you advice on how to exercise safely if you are unsure about what sort of exercise to do.

YourLifeChoices and the Sydney University research team want to help older Australians manage musculoskeletal pain, stay active, thrive – and beat back pain.

We’re partnering with researchers from the University of Sydney’s Charles Perkins Centre Musculoskeletal Research Hub on ‘the buddy trial’ – a program that aims to not only get you moving, but also enhance the physical and mental benefits of exercise.

If you are interested in finding out more, please visit the Sydney University website – and tell them YourLifeChoices sent you! Or you can complete the pre-screening form.

Kate Roberts is an experienced physiotherapist and PhD candidate at the University of Sydney. She has a passion for helping older Australians to manage their aches and pains. She is particularly interested in helping people to stay active and strong. When not working, she is kept busy with her three children, her two dogs and her secret dedication to pointing her toes and leaping in her regular ballet class.

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Written by Kate Roberts

Kate Roberts is an experienced physiotherapist and PhD Candidate at The University of Sydney. She has a passion for helping older Australians to manage their aches and pains. She is particularly interested in helping people to stay active and strong. When not working, she is kept busy with her three children, her two dogs and her secret dedication to pointing her toes and leaping in her regular ballet class.