Lower

Back
Pain
Will There

Ever be a cure ?

In most modernised countries lower back pain (LBP) will affect

between 50% - 75% of the population and about 40% will
experience it at some stage each year . Apparently , only 10% 20% will never have it .
Most sufferers would have short duration pain and only a few
would develop a chronic ( long term ) problem . It is thought that
80% - 90% will recover in approximately 6 weeks regardless of the
type of treatment used , or indeed , the lack of. Musculoskeletal
disorders tend to be the most common of chronic ineffectiveness
and LBP makes up a large proportion of these . Most chronic pain is
of low intensity with few people having a persistence of high
intensity pain .

The amount of different treatments available is staggering but

there is no conclusive evidence as to which is the most effective .
The treatment is more likely to be down to who you see rather than
what your presenting problem is . A person living in the U.S. A. is 5
times more likely to be a candidate for surgical intervention than a
person living elsewhere back surgeries increase at the same rate
as surgeons that appear in that location which indicates that it may
be the presence of of more surgeons that dictate the intervention

and not necessarily the presenting problem .

In the world of physical therapy, there is also a lack of a clear
direction in the most effective protocols to use in the treatment of
back pain. Studies indicate that treatments vary from heat
therapies, to electrotherapy, to massage, to exercise, to
mobilization, to manipulation, all depending on who you see as
opposed to what is wrong with you. The use of manual therapy
combined with exercise seems to be the least favoured in many
quarters.
In general terms the evidence seems to show that passive
treatments do not work, yet these passive treatments are common
place in attempting to combat back pain with traditional
physiotherapy.
Underuse
Many people spend all day sat behind a desk then go home and
spend the evening on the settee this causes the muscles at the
front of the body to become short and tight and the muscles on the
back of the body to be over-stretched . In both cases they also
become weak because they are simply not being used . This leaves
the spine with very little support ( see the article ' Injury
Prevention the Importance of Keeping Opposite Muscles
Balanced ' ) .
Overuse
Many jobs entail doing the same thing all day , every day . If you
are constantly bending down and standing up ( especially with poor
posture ) the muscles become strained and no longer function
properly leaving the spine with little support . You can get a sudden
injury by lifting too much weight ( living whilst twisting is the
biggest culprit ) .
The human body cannot cope with the lazy modern life nor
with constant repetition it needs variety .
For us to combat back pain we must face some home truths as
therapists and as patients.
1) Passive treatments are limited and not evidence based.
2) Persuading the injured party to accept some responsibility in

managing their pain in very important and worthwhile.

3) Bed rest often makes the problem worse, while correctly
prescribed exercise enhances recovery.
4) Back pain presents its self by means of episodes, flare ups,
recurrences, often becoming chronic and it is therefore important
to aim at long term management as opposed to symptom treating.
Education of the injured person as to the reality of their needed
management interventions is essential to them being able to adapt
their behaviour to enhance pain free activities.
The cure is prevention i.e. don't do the things that cause back
pain !
For Manual Workers
People who lift for a living tend to get problems in the bones of
the spine to avoid this the No.1 thing that you must not do is to
bend very far forward for at least 1 hour after getting out of bed
this is because the discs in your spine are at a high pressure and
you can damage them .

We have always been told to lift items off the floor using this
technique ;
This is nonsense unless the item is small or thin it's impossible
to do this. The trick is to do 3 things ;
Keep the curve in the lower back
Keep the object as close to the body as possible
Use your legs to pump your body upright

Top picture is wrong - bottom is right

If you are lifting a box , try this ;

If you want to pick up something small off the floor try the golfers
lift ;

For Sedentary Workers

People who sit for a living tend to get problems in the spinal discs
to avoid this we have always been told to sit upright in a chair
this is also nonsense .If you sit in any one position for more than
10 minutes the muscles begin to tire try changing your position
frequently ;

Every 20 minutes or so , stand up and slowly stretch for 20 secs;

The ideal working day is an equal mixture of manual and office

work . Until industry accepts this and makes the necessary changes
LBP will always be a part of working life .
In General
There is no better general exercise for the lower back than
walking but not mall walking you must walk fast enough to get
your arms swinging . This engages all the back muscles .
To effectively treat back pain, the therapist must educate the
injured person on their responsibility in managing the injury . This
will involve their active participation in modifying behaviour that
may have previously aggravated the injury. The therapist must
have a clear understanding of the correct and timely use of
exercise in achieving long term improvement, rather than using
techniques to treat symptoms .
The therapist and injured person must accept that not all back
pain will be curable and may require life long strategies . It must
be noted that passive treatments show little if any evidence of
aiding back pain while manipulation and exercise do . Exercises
need to be selected carefully and should favour endurance rather
than strengthening or mobility . Exercise for rehabilitation is not
the same as exercise for healthy individuals.

Warning
Not all LBP is muscular in origin it can be due to a number of
other causes such as urinary tract infection or spinal cancer . If you
have any reason to believe that this may be so , for instance if you
have any swelling or pain at night , then see your GP immediately .

Val O'Halloran
Massage Therapist