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Lower Back Pain – A Physio's Approach

posted Feb 12, 2015, 1:55 PM by Rebecca Smith

Lower back pain is one of the most common presentations to physiotherapists in private settings. It’s difficult for me to recall a day that I’ve avoided treating a back related injury. The typical sudden lower back related injury will involve somebody performing an activity that they are not used too or one that the human body is not designed to perform. A prime example of this is when somebody who has a sedentary lifestyle decides to paint their house all weekend or the older person who attempts to relive their youth by running full speed and sliding head first on a tarp covered in soap and water.

My approach as a physiotherapist is to firstly find out what movements provoked the injury, the time of injury and what position decreases the pain/discomfort levels. There are various patterns of movement that may cause injury to the spine. Increased stress is put through the back when combining movements such as reaching down and rotating. These awkward movements are common when painting, lifting a child from the ground or even picking up a box from the ground at work. To compound these problems, distraction and muscle fatigue is strongly linked with back-related injuries while performing manual tasks.

Treatment for lower back pain varies a lot. Education, exercise and soft tissue massage are my treatments of choice for initial appointments. Often an individual needs to be reassured about their back following assessment if there is no sinister pathology. This reassurance is to prevent or overcome what is known as fear avoidance. Fear avoidance is very common in back related conditions and occurs when an individual becomes rigid and overprotective of the injured area, which can be a barrier to recovery. In this case, empowering the individual to perform normal movements can often help them restore function and decrease anxiety associated with movement.

Lately the trend with many therapists is to prescribe static core stabilization exercises. The aim of these exercise is to strengthen the ‘core’ muscles, however this may be counterproductive in some lower back cases. I tend to avoid these static core exercises as they may encourage and increase the rigidity that the patient is experiencing and increase the over protectiveness and movement pattern disturbance.

Evidence-based risk factors for lower back pain:

-          Stress, anxiety and depression is associated with work-related lower back pain.

-          Back muscle endurance levels correlate with lower back pain.

-          Increased chance of lower back pain or herniated disc with occupations involving long periods of sitting or standing.

-          Physical labor including bending, twisting and heavy lifting have increased risk of injury

-          Smoking is heavily linked with sciatica and lower back pain

-           There is unclear evidence to suggest that obesity, height or leg length discrepancies are linked with back pain.

-          Increased risk in women over the age of 50 and those who’ve had more than one child.

-          Around 40% of back strains and sprains occur between 8 and 11am

As per most conditions and injuries, prevention is key. Single direction movements and positioning yourself appropriately prior to the movement or task is your best bet to prevent injury. So if you’re a female over the age of 50 who smokes and want to go on a slip n’ slide at 9am in the morning after a morning ab session at the gym to relieve stress, please reconsider.

If you have back pain or want to find out more about lower back pain and what you can do to prevent it, book yourself an appointment with me. One appointment now may save you several in the future.
Physiotherapist Narellan
Difference Physiotherapy Narellan & Camden