Top 6 low back pain questions answered by Matthew Ash, an experienced Spinal Physiotherapist.
1. What has caused my back pain?
Sprains and strains of the muscles and tissues around the spine are the most common cause of low back pain. However, the truth is that we usually cannot pin point the exact structure or cause for low back pain. We do know the tissues in the lower back becomes inflamed, and the body responds with pain and muscle guarding as a protective response. This is normal, and is part of the response to look after the tissues and help them heal.
2. I didn’t actually do anything to cause it, so why does it hurt?
We are all designed with protective mechanisms to look after our body when there is danger to the tissues. If you hurt your back, it is normal to experience some pain and protective muscle guarding, which often changes our postures and how we move. In the first week or so after an injury, these protective responses are normal, however is some cases those protective postures and movement patterns can end up being a bit unhelpful, and can be a cause of pain even after the original injury has healed.
3. How long does it usually take to feel better?
Everyone is different, so recovery times are going to vary from person to person. At lot of minor low back sprains & strains will settle down over a few weeks; however, they can take up to 12 weeks to settle in some cases.
4. If it hurts to do things, then should I avoid them?
We know in most cases of back pain the spine itself is strong & sound, and does not need to be ‘protected’ further by avoiding movement and activity. It is widely accepted that complete rest is unhelpful when managing low back pain, whether that’s following an acute injury of with more persistent pain. In the first few days after an injury, it is better to reduce and modify your level of activity, however keep moving and stay as active as you feel comfortable. Normalising movement will in fact help to settle down pain. Think of this as ‘relative rest’. Yes you should avoid any strenuous activities that specifically aggravate your pain, but it is ok to move, even if it feels a bit uncomfortable.
5.Once I have hurt my back once, then will I likely do it again?
The short answer here is no. The body is extremely good at repairing itself, and as mentioned above things will usually settle down over a few weeks. However sometimes when in pain you can become a bit deconditioned, so it may be helpful to do some movement and conditioning exercises to make sure you get back to the things you want to do.
6. Should I have a scan to check my back to make sure that I haven’t damaged my back badly?
A recent systematic review from 2016 in the American Journal of Neuroradiology has shown that it is normal to experience changes in the lower back with age, just like getting some wrinkles or grey hairs on the outside. So in most cases suggestions of ‘disc degeneration’ or ‘disc bulge’ that show up on MRI or CT scan are likely due to normal changes with age but don’t necessarily provide any helpful information about why you may be in pain. Any scan results need to be consider in context with the overall clinical picture.
Scans can be helpful to exclude more serious pathology involving compression of spinal nerves or the spinal cord, or instability due to fracture, but these cases make up a very small percentage of low back pain.
Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations W. Brinjikji et al American Journal of Neuroradiology April 2015, 36 (4) 811-816
By Matthew Ash
myPhysioSA Spinal Physiotherapist
Mount Barker & International Spine Centre Wakefield Hospital Adelaide