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Did you know that lower back pain is the 5th most common reason for people to visit their doctor! This always strikes me as weird as generally speaking your Physio is a better bet when you have musculoskeletal pain than your GP. Did you also know that lower back pain will affect around 70% of people throughout their lifetime. That a lot!
Low back pain is usually categorized into 3 categories: acute, sub-acute and chronic. Acute low back pain is an episode of back pain that is less than 6 weeks, sub-acute is between 6-12 weeks and chronic is anything more than 3 months. However it is often not so clear cut as this. Many episodes of lower back pain feel as though they might run together, or 'flare up' at different points throughout the year. Its important to understand your body - your back and what factors are contributing to your symptoms, in order to best prevent forte episodes.
The prognosis for anyone with an acute episode is fairly good, with most resolving in 8 weeks, with around 50% of people resolving spontaneously in the first two weeks.
The exact cause of low back pain is often very difficult to identify, in fact there are numerous possible causes of back pain from muscles, soft connective tissues, joints, ligaments, cartilage and even blood vessels. Depending on the circumstances chronic stress, depression and obesity has been linked with the onset of acute and even chronic back pain. However, just because it is difficult, doesn't mean it should be overlooked. It's important you work with your Physio / healthcare professional to ensure a clear picture of what is causing your back pain is established.
Managing back pain:
The best advice for the treatment of acute back pain is to continue to remain active as tolerated. Continuing everyday activities may sound counterintuitive but if we stay at home and cooped up in bed we tend to get more stiff. By being active we can promote blood flow and nutrients flowing to the area and reducing muscular tension. Here are some things we can do to manage an acute episode:
1. Stretches – There is no reason not to completely avoid stretches. All stretches if done correctly are good. However stretching should not cause more severe pain.
2. Heat or ice – Local application of heat or ice can reduce pain. Neither is better or worse for the situation, all dependent on your preference
3. Medication – Paracetemol or anti-inflammation drugs can be used to help ease the pain. These classification of drugs are known as analgesics which dampen the central nervous systems ability to pick up pain signals. These medications should be used only as prescribed by your doctors since some anti-inflammatory drugs can have some side effects.
4. Physical therapy – Physical therapy can give you great relief and advice on how to further manage your pain. A good physio will diagnose the pain generating structure. Possibly use some manual therapy early on to help relieve symptoms. They can cater a specific stretch and exercise program to help you get through it. They can also identify possible triggers and help devise a plan to prevent another episode from occurring.
If you or someone you know is suffering with lower back pain, encourage them to seek help. It doesn't have to be a debilitating injury and with the right advice it can be overcome!
Lower back pain can be very debilitating and the last thing you may want to do is move! However, movement is the key ingredient to expediting your recovery from and prevention of future bouts of lower back pain. Here’s 10 reasons why:
- Fear avoidance and guarding – lengthens healing process
- When we are in pain we want to avoid pain and discomfort. Seems natural. But in doing so, the muscles in our back guard up and prevent free flowing natural movement. The bigger, superficial muscles take over while the deeper, stabilising muscles turn off. If this is not corrected, the body will form maladaptive movement strategies which may lead to chronic lower back pain or other musculoskeletal injuries. Sound familiar?
- Physical Activity vs. Structured Exercise
- Unstructured physical activity includes activities of daily living such as walking, sitting and standing, cooking and other housework. This differs from exercise which is planned and repetitive. Getting back to physical activity early is essential in recovery from acute lower back pain in improving blood flow and promoting local healing. Normalising movement is also essential early on to prevent chronic issues.
- Blood flow
- Physical activity increases blood flow to the lumbar spine and surrounding structures which is essential for soft tissue healing. Not moving will restrict blood flow and weaken the supporting musculature, prolonging healing time.
- Release of hormones – endorphins
- As well as increasing blood flow and nutrients to the soft tissues in the back, exercise increases the release of endorphins in the brain (especially aerobic exercise), which bind to opiate receptors in the pain control system in your brain to decrease your perception of pain – like how morphine and codeine work. Movement and exercise is the natural drug!
- Postural muscles weaken – susceptible to future injury
- The bones in our vertebrae are not designed to withstand a lot of load for extended periods of time. This is the role of our deep ‘core’ muscles in our back and abdomen. The longer we restrict movement following a bout of back pain, the more these muscles weaken and forget how to be recruited in functional movement. This will lead to longer recovery and potentially recurring bouts of lower back pain.
- Changing positions to offload passive structures
- Vertebral bones, discs and ligaments are passive structures which need to be placed in positions of mechanical advantage. By adjusting postural positions appropriately, the load can be shared away from the injured structure.
- Improving your function
- Improving your function will improve your pain. Functional movement will recruit the appropriate muscles, improve blood flow and protect the spine from further damage. It will also allow your brain to maintain healthy movement patterns and avoid maladaptive strategies.
- Improving and maintaining range of motion, not only in your lumbar spine but also in your hips and thoracic spine, will reduce load on your lumbar spine and reduce your recovery time. Not moving will further reduce flexibility, may cause imbalances in other parts of your body and lengthen recovery time.
- Psychosocial factors – pain is a function of the mind!
- The more we think movement will cause damage to our back, the more our brain will reinforce this belief by sending pain signals. Appropriate movement will not cause further damage to your back, especially in the acute stage. In fact, it’s essential that you move to show your brain that it is okay.
- Body of research to support movement in lower back pain recovery
- Don’t take my word for it. There are countless clinical trials and research articles to support the necessity of returning to normal activity rather than bed rest in recovering from lower back pain.
Can you use the Pilates reformer for lower back pain? The answer is an overwhelming YES! The Pilates reformer is one of the most well known and traditional pieces of equipment in the Pilates studio. Its' secret to success lies in its' adaptability and the plethora of Pilates exercises it allows you to perform. With its movable carriage, spring resistance and hand/feet loops, the Pilates reformer is one of my favourite pieces of equipment in the Pilates studio, especially when it comes to rehabilitating lower back pain!
Lower Back Pain
The difficulty with lower back is that no two lower back pains are the same. If your a regular reader of our blog, you will understand that every body is different and there are no two pains or injuries which are the same (learn more about this here). Many people, health and medical professionals alike, try to group patient symptoms into categories and then treat all people in the one category the same way. The truth is that each and every body's pain has differences, is driven from different places and thus needs to be treated individually. This is where the Pilates reformer comes into it's own! Because you can vary the spring resistance almost infinitesimally and change a persons set up from standing/sitting/lying on their back/lying on their front/lying on the side etc, the most appropriate position for rehabilitative movement can be achieved, what ever that might be for you and you lower back pain!
The thing many people don't realise when rehabilitating an injury is the power of our brain and our motor patterns (meaning the hard wiring our brain has created to perform certain movements without conscious thought, like being on auto pilot). These motor patterns are incredibly difficult to unwind, once you have been doing a particular movement pattern for a period of time (for many people with long standing back pain this is years or even decades!) this way of moving becomes like a highway for the brain and any attempt to use the side streets requires an incredible amount of conscious effort. This is where the Pilates reformer is a god-sent. It makes use of 'unfamiliar environments' to enable the body to learn new ways of moving without having the same software played out over and over again. Essential its like a 'control / alt / delete' for the brain and its motor patterns, an invaluable tool!
What do you mean by 'Unfamiliar Environments'?
The secret of training in an unfamiliar environment is akin to driving a car. When you are driving a route that you are very familiar with your brain switches over to autopilot to free up extra 'mental RAM' for you to use thinking about other more important issues. However, when you a driving a road for the first time, at night in a car that's not yours, you don't experience that same feeling of ease and thoughtless driving, in fact it's the total opposite. Your brain is concentrating on what lies ahead, where the peddle is, how the steering wheel turns with these new wheels and you are totally conscious about the process. The same principals apply to when your trying to change an old or faulty movement pattern. If you try to change it in your every day lifestyle, as you sit in your regular office chair or stand brushing your teeth at your bathroom sink, it is very difficult to persuade your conscious brain to stay focused on the task at hand and you inevitably slip back into your old faulty motor patterns which led to your lower back pain in the first place. However, if you can begin to train your postural muscles in a non familiar environment (eg the on the Pilates reformer) you have total access to your conscious brain as it tries to perceive how best to move in this new way and before you know it you have translated these movement patterns into real life and so too disappears your back pain.
How to get started?
At BPS we are proud to provide a comprehensive and unparalleled service to our clients (with and without back pain). With a variety of Pilates reformer classes, private sessions and rehabilitative services, we guarantee you will reach your movement goals. We are so confident you will love our services you can come to a free trial class by leaving your details here.
Lower back pain is one of the top 5 'most common symptoms' we treat at BPS. It's an incredibly common complaint and something we treat hundreds of times per month. Today's blog post aims at helping you determine what the true cause of your lower back pain is but more importantly how best to fix it and stop it from coming back!
Yes, your right, I said 'symptom' not 'diagnosis' when describing lower back pain ... because lower back pain is NOT a diagnosis in itself, it's only a symptom that you are experiencing. Painful stimuli can occur in many places in the body (learn more about how pain works here) but unfortunately with lower back pain, the pain generating structure (i.e. the thing that is painful) is often poorly diagnosed. So the first important question to answer is what is causing the painful stimuli which you are experiencing as lower back pain? Once you know the cause your half way there!
Possible Pain Generating Structures around the Lower Back Pain
- Long Sacro Dorsal ligament inflammation
- Facet Joint
- Nerve Root
- Muscles (eg Quadratus Lumborum, Erector Spinae, Psoas, Gluten Max)
- Period Pain or Menstrual Pain
- Visceral Pain
So the important thing when looking for ways to improve and ultimately eliminate your lower back pain is to get the correct diagnosis first! Once you know what is causing your lower back pain, you are half way there to fixing it! All too often we treat clients in the BPS studio who have had lower back pain for years and years and the only reason their symptoms have lasted so long (despite them doing everything they have been told by their health care professional) is because they have never got an accurate diagnosis! Imagine that, trying to fix a problem when you don't have the foggiest of where to start or what is causing the pain in the first place! Madness ...
Now, there is no substitute for getting a thorough diagnosis by a BPS professional in clinic, but I know that many of you reading this blog don't live in Sydney and can't get to either our Caringbah or Ashbury practices. So to help you out I want to start by clarifying where about your lower back pain is, this often tells us a lot about what the cause of the injury may be.
Lower Back Pain Locations
The first place to start when figuring out the cause of your lower back pain is to start with its location. We have created the following infographic to help you decipher what the pain generating structure might be in or around your lower back. Check out more helpful diagnostic tool on our Instagram page below! You may have a few of these areas involved it doesn't have to be isolated to just one in particular.
Does Movement affect your Lower Back Pain?
Once you know the particular area thats involved, the next thing to understand is if movement makes your pain better, worse or has no real impact. We created the following flow chart to help you narrow down what movements may be aggravating your back pain and make the path to deciphering the cause one step closer.
We hope that from the information above, you have a better understanding of what may be causing your lower back pain as well as what movements may be aggravating and elevating it. At this point you have two choices, we always recommend that you seek out a health professional close to you to help you with your diagnosis. If you live in the Sutherland Shire or Inner West why not book an appointment online with one of our BPS Physios and allow them to help you with your treatment plan.
If your not a Sydney local, the following tips will help you on your way to elevate your lower back pain...
Treatment for Lower Back Pain
Disc pain is a tricky one (and not as common as you might think). It is very much dependant on the direction of the pressure which is causing the disc pain, for example is the disc being pressed forwards or backwards or maybe to the side. If you have had an MRI and you are aware of the direction of your disc pressure/protrusion you best bet for reliving your symptoms is to position your body in a way which unloads the disc. For example if you disc is bulging forward (most common) then you will probably find that gentle back bending will alleviate your symptoms where as if your disc is bulging backwards maybe forward bending will be alleviating. The below videos shows you some examples of how to flex and extend your spine depending on which direction feels good for you!
Facet Joint Pain
Facet joint pain is pain caused by compression or irritation of the facet joints in your spine. Facet joints lie at the back of your spine and are generally more irritated when you bend backwards. Thus the best way to alleviate your symptoms is by bending forward. The below video shows you some examples of how to bend forward and unload your facet joints.
- Standing Roll Down for lower back pain
Nerve pain, now this is a 'scary one'. Not really, unfortunately many people have an exaggerate understanding of what nerve pain is and how to get rid of it. Like all of these pain generating structure, its important to know where and what level the nerve pain is coming from, once you know this you can move your body into positions which unload the nerve. We often do rotational exercises with our patients to help them unload the nerve root and take the pressure is pain caused by compression or irritation of the facet joints in your spine.
SIJ pain stands for Sacro Illiac Joint pain, it is pain that is caused from your SIJ not so much from your lower back (although these areas are very close to one another). The most common pain generating structure in the SIJ is a ligament called the long scare dorsal ligament. The easiest way to unload this ligament and alleviate your symptoms is with a release of piriformis. The following video shows you how to release this your self!
- Piriformis Release for lower back pain
Muscle pain often called DOMS (delayed Onset Muscle Soreness) often occurs after a muscle has been worked to a load it is not used to and for the next 48hrs the lactic acid circulating in that muscle can feel tender. There are many ways to help alleviate DOMS but mostly it comes down to time and waiting for your body to break down the lactic acid and repair the muscle. Gentle stretching and heat can help, so can epsom salt baths. Check out the following videos for some ideas on how to stretch the following lower back muscles.
This one often gets poorly diagnosed for musculoskeletal lower back pain, the biggest give away is the time of the month it occurs in! There are a variety of pharmaceutical products (ponstan, neurone etc) which will help alleviate these symptoms, I often find that a good hip flexor and adductor stretch does the trick too!
- Good Stretches for Period Pain lower back pain
Serious Lower Back Pain
In the medical world there are things we term 'red flags' meaning they are serious and could be potentially highly danger if not seen to appropriately. It is important you see you medical professional if you experience lower back pain in conjunction with one of the following symptoms;
- A fever (high temperature)
- Redness or swelling on your back
- Pain down your legs and below your knees
- Numbness or weakness in one or both legs or around your buttocks
- Loss of bladder or bowel control (incontinence)
- Constant pain, particularly at night
- Pain that's worsening and spreading up your spine