What does “Non-Specific” mean?
There are lots of things that can cause pain in our spine including bones, discs, joints, ligaments and muscles. In most cases, it is very hard to accurately determine exactly which structure is causing your pain.
A diagnosis of Non-Specific Low Back Pain may be given after a thorough verbal and physical examination has been completed to rule out:
A) Red Flags or serious medical pathology such as
- Fractures
- Infection
- Cancer
- Serious nerve root compression eg. Cauda Equina Syndrome
B) More specific causes of back pain such as
- Disc bulge or herniation
- Radiculopathy or Sciatica
- Spondylosis (Spinal Osteoarthritis)
- Spondylolysis and Spondylolithesis
How common is NSLBP?
Approximately 90% of low back pain can be classified as Non-Specific low back pain (WHO, 2023).
Less than 5-10% of all low back pain is due to a specific underlying spinal pathology (Hall, Aubrey-Bassler, Thorne, & Maher, 2021).
Can a scan tell me what the specific cause of my back pain is?
X-Ray, CT and MRI scans are not pain scans.
It is really common to see abnormalities on imaging in people with no back pain, and conversely to see people in pain with normal looking scans.
How you present clinically is far more important than what a scan says, and if a scan is eventually completed, it is vitally important that any ‘abnormal’ findings correlate with your presenting symptoms and physical assessment findings before we consider ‘blaming’ them for your pain.
So what do I do?
Just because we don’t know exactly which structure is responsible for your pain, that absolutely does not mean we can’t treat it.
After a thorough assessment with your physiotherapist, we will identify the factors specific to you which are contributing to your problem whether that be reduced range of motion, weakness, tightness or any number of physical assessment findings which we will address.
Biopsychosocial model
There may also be factors beyond the Biological which are contributing to your pain, or at the very least, influencing how you are able to cope with your pain.
These include Psychological factors such as thoughts, emotions, beliefs, stress and current coping methods.
And Social factors such as socioeconomic status, cultural influence, family and finance.
Consider this…
Do you think your back pain might feel different if you know you are going on holiday to Hawaii for 3 weeks tomorrow or if you have a very important meeting with your boss which you haven’t prepared for?
References
Hall, A. M., Aubrey-Bassler, K., Thorne, B., & Maher, C. G. (2021). Do not routinely offer imaging for uncomplicated low back pain. BMJ. doi:10.1136/bmj.n291
World Health Organisation. (2023). Retrieved from https://www.who.int/news-room/fact-sheets/detail/low-back-pain