If you are reading this and are suffering from low back pain, you are not alone. Currently you are a part of the club with 540 million other people, or 7.3% of the global population, suffering from low back pain at any one time. So what’s the current evidence guiding practice?
Low back pain is now recognised as the number one cause of disability worldwide. It does not matter on your age, gender, socioeconomic status, or ethnicity. Low back pain affects everybody, it does not discriminate. Whilst this all may sound scary, low back pain is just a symptom, it is not a disease or diagnosis, and it should certainly not define who you are. In this article we are going to outline the most recent evidence regarding some of the causes of low back pain, as well as what you can do to help treat it.
So, what are the causes of low back pain? There are some specific causes that are important to identify, but these only account for a small proportion of cases. These include malignancy, vertebral fracture, infection, or inflammatory conditions. A study completed in Australia found that only 0.9% of people presenting to primary care had a specific cause for their low back pain. Most of the time a specific cause for someone’s low back pain can not be identified. There are some structure’s in the back that can produce pain (intervertebral disc, facet joint, end plate changes…), but rarely as a result of acute damage. Your pain may simply be a result of overloading these structures or moving the wrong way and causing an irritation. It is important that you seek help from your physiotherapist to help determine where your pain is coming from and what to do about it.
A physiotherapy assessment is more then just seeking how to provide relief from pain or to diagnose the injury of a structure. Physiotherapists are trained to listen out for “red flag signs”; indicators that the problem you have come in with today is actually a problem in our field to treat. They are trained to understand some things fall outside their scope of practice and when it is important to refer on.
In regards to treatment, best available evidence and guidelines now support the use of exercise and self-management strategies as best practice in the management of low back pain. There is now greater emphasis been placed on active treatments that focus on improvement in function, and less emphasis on pharmacological and surgical interventions that have no superior benefit and more side-affects. Physiotherapists are extremely well positioned to practice in this evidence-based model of care. Your physiotherapist will be able to help you determine and correct any deficits in your function and identify any abusive loads that may be contributing to your pain. They will then help you understand why your pain first started and establish a progressive exercise program for your own self-management. If you have any questions or concerns make sure you discuss them with your physiotherapist.