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x-ray of upper back vertebrae
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14th December 2017
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The truth about back pain

Sad face to happy face truth about back pain

Back pain will affect most of us at some point in our lives. The World Health Organisation quote it at 60-70% likelihood. It is reported that it causes more disability than any other condition and it is also the leading cause of work absence throughout much of the world. Lower back pain can affect your ability to work, travel, to do things with your family, your sleep and your ability to exercise.

So what causes lower back pain?

Often people are told things like they have osteoarthritis or spondylosis, ‘degenerative disc disease’ or ‘bulging discs’. So what if we were to tell you that all those things can be found in lots of people with NO lower back pain? Multiple studies over recent years have xrayed and MRI scanned large numbers of people without any lower back pain. And what do they find in these people?…. osteoarthritis or spondylosis, degenerative disc disease and bulging discs! So this has completely changed our way of looking at back pain and scan results. Scans can be useful in ruling out very rare serious pathology such as a tumour but aren’t the be all and end all.

Did you know 1/3 of people with acute back pain can't recall any trigger/reason.

So let’s try to dispel a few myths about lower back pain

Am I getting pain because I am getting older (wear and tear)? Well the answer is no, Is that really the thing that is causing your pain? Your hair will get greyer and your skin more wrinkly as you get older.

Wear and tear is the same NORMAL age related process occurring on the inside too. It has been shown repeatedly that a gradual increase in exercise and fitness levels is the number one best thing to do for any osteoarthritis in the body.

Myth "The spine is easy to harm and hard to heal"

There is no evidence to support the belief that your back is easy to harm OR hard to heal. People sometimes think their spine is "vulnerable" and needs to be "protected".

This can lead to bracing and tensing and avoidance of activities in fear  or worry of causing any "damage". The unfortunate thing is, that this can cause more pain as the nervous system begins to deem the area under threat and alerts you to it by causing pain.  This can sound weird but is true!

Myth "Rest helps"

It has been discovered in a study looking at people with back pain over a 5 year period that rest, avoiding things and passive therapies have been shown to predict your back pain lasting LONGER!

"I have got a slipped disc"

Unfortunately this is quite an unhelpful phrase and does not accurately describe what is going on. The discs themselves are VERY tough. They NEVER slip ‘in or out’. However, sometimes over time, with repetition of poor bending/lifting and sitting plus some bad genes (blame Mum & Dad) you can develop a tear in the outer part of the disc and some of the more gel like inner pushes out. This can cause sciatica and is most common between the ages of 25-45. Most people still don’t require surgery, just good management and back pain rehab and let the body do the rest. Studies show that the natural course of most disc problems is that they resolve and you get better!

Evidence Based Treatment for Lower Back Pain Rehab

In late 2016 the National Institute for Clinical Effectiveness (NICE) produced updated evidence-based guidelines regarding the management of lower back pain and sciatica. It says DO NOT offer traction, insoles, rocker shoes, belts, ultrasound, interferential or acupuncture. Don’t offer manual therapy treatment without combining exercise. So what does work?

Typically pain starts due to some overuse, strain or injury. This can lead to some joint stiffness and muscle weakness, both of which you can change. Did you also know that stress and lack of sleep can cause or affect your pain?! The other modern day problem is back pain due to disuse - too much sitting and not enough exercising. You can change this too.

So if you do have back pain see someone who can offer you an examination, a diagnosis that makes sense to you, and a customised plan for recovery based on your individual needs so you don’t miss out on the things you need to do or enjoy doing in life. And make sure they are not using anything in the NICE ‘no’ list above. With the right plan, you can reduce or eliminate lower back pain and get back to what you love doing.

Get evidence based treatment NOT 'machines'!

Spinal injections are no better than placebo! = TRUE

Spinal Fusion Surgery is no better than rehab exercise! = TRUE


Key messages

Stay active and do as much of your normal routine as possible.
Bed rest for longer than a day can slow your recovery.

Electrotherapy is NOT recommended for anyone with back pain. This includes ultrasound treatment, interferential machines and laser.

How can I reduce my chances of having lower back pain?

Maintain a regular physical exercise routine that involves regular strengthening exercises. This helps to maintain the strength AND flexibility research has shown.

What about posture?

Well if you are a sedentary worker it is good practice to get up regularly or even just wriggle around in your chair. Use the lumbar supports in your chair to keep the normal lower back curve, and position the monitor up at eye level. Your body just wants to move. Motion is lotion!

We cannot give you an opinion on your individual problem without seeing you first so if you should experience any of the following symptoms you should seek immediate medical attention as these could indicate cauda equina syndrome (CES).

  1. Sciatica in both legs
  2. Loss of skin sensation in the genital or back passage area.
  3. Altered bladder function
  4. Loss of anal tone (the muscle that controls your bowel movements)
  5. Loss of sexual function

If you need help with your back pain rehab call us on 01625 422825 or book online at www.hoganandmitchell.co.uk or why don't you try one of our Pilates clases?!

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