Low Back Pain

Low back pain often occurs as a result of repetitive load injury rather than a single injury. Non-specific low back pain (LBP) refers to back pain with no diagnostic cause. LBP is common, the third most common condition patients see their GP about. In contrast, specific low back pain conditions are a rarity, approx. 5%. People with LBP often long for a diagnosis and of course a cure. However, expensive diagnostic imaging or too much rest may not improve LBP and over time, many incidences of low back pain resolve.

Why didn't the emergency department or GP order scans for my back pain?

Most x-rays or scans ordered by GPs and emergency departments don't show any defects with backs or only minor degeneration. Imaging of backs without pain show similar wear and tear changes so back pain doesn't appear to correlate with damage to lower backs. The National Health and Medical Research Council (NHMRC) don't recommend routine scans for acute low back pain unless specific pathology is suspected after examination, such as inflammatory disease or cancer. Radiation is accumulative and a CT of the lumbar spine delivers a radiation dose comparable to 165 chest x-rays and a lumbar spine x-ray series, the equivalent of 65 chest x-rays, states the NHMRC. Given the relatively high exposure rates, it is as well that GPs and emergency departments are cautious about ordering diagnostic scans without evidence of specific causes of back pain. Imaging of non-specific back pain doesn't confirm pain and is not predictive of improved patient results like improved pain, physical function or lower health care usage.

Chronic LBP is common. The ABS reports that 15% of the population have reported back problems and this increased to 24% in the 65-75 age groups but then decreased to 18% in the 75 and older age group. Back pain is the most common cause of limited daily activities in industrialised countries in people under 45 years. Although acute LBP is likely to resolve albeit with minor symptoms, chronic LBP has enormous implications for disability and the economy.

Activating the core

The deep stomach muscles called the transverse abdominus play an important role in the control of intervertebral movement in the lumbar spine leading to spinal stability. LBP can lead to weaker transverse abdominus muscles contributing to delayed pain improvement and physical recovery. Seeing a physiotherapist to guide the exercise program may improve the working of the deep abdominal muscles which has shown to reduce pain. Weak abdominal muscles may be contributors to LBP as well as LBP contributing to less active transverse abdominus muscles.

Most tissues heal within 6 to 12 weeks unless there is instability, malignancy or inflammatory processes at work in the back. Although disc protrusions are common causes of LBP, there is no clear relationship between the MRI or CT scan result and the symptoms. Most disc herniations will heal themselves regardless of the treatment. Lifestyle factors such a lot of sitting may predispose people to back pain. Muscular pain is the most common cause of low back pain and the pain receptors in the muscles are sensitive to mechanical load and can be exacerbated by muscle tension.

Bed rest is more of a curse than cure

The second Berlin Bed-Rest Study highlighted that the LBP can develop after only one week in bed. The multifidis muscle, a deep longitudinal muscle is important for the stability of each vertebra. In the lumbar region it is needed to support the lumbar vertebrae so if it is weakened by bed rest, then physical recovery may be delayed and contribute to further LBP.

For LBP, inactivity can lead to shortened muscles, joint stiffness, and reduced muscle strength. Fear of movement in patients with low back pain is associated with ongoing back pain but resuming daily activities, as much as possible, is the recommended course of action.

Heat wrap therapy

Using heat wrap therapy or a warm electric blanket may be as beneficial as paracetamol in reducing acute LBP and muscle stiffness in the first few days of acute LBP and is a relatively safe therapy. NSAIDs are less effective in reducing pain than heat wrap the

rapy in the first three to four days of acute low back pain and there is the possibility of serious adverse effects.

Patients will be guided in a range of conservative therapies for acute LBP. Improved knowledge and understanding of low back pain and its management enables individuals to choose the therapies they need at the right time in the right place and to understand the benefits of staying active.

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 "I have lived with chronic back pain since 2007. Early on I was in despair and constantly striving for a cure. Now I don't let pain stand in my way. I try to ensure I am as fit as possible (with the guidance of an exercise physiologist) and recognise that whilst I can't always control the pain, I can control how I respond to it."




The Australian Pain Management Association Ltd. (APMA) is a health promotion charity providing advocacy, information and practical support for people living with chronic (persistent) pain and their families. APMA is the consumer health organisation for all Australians who live with pain. APMA is your voice.


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