Here’s some facts to establish
As a physiotherapist, personal trainer and someone who personally manages bouts of back pain, I deal with the topic of lower back pain (LBP) on a regular basis. It is quite obviously very common and according to a recent review, with an aging population, the prevalence of lower back pain is thought to increase even more over the coming decades. This is why I get quite angry when I hear misguided ill-informed information given to patients by some clinicians with language like “be careful”, “you’re too weak”, “you should take some time off work in bed until you feel ok”. Completely counterproductive. When you analyse the google searches for the term “lower back pain”, it has had almost a two fold increase since 2010.
People are getting worse and the medical community are struggling to help. In my own opinion, it is because we ourselves as health professionals are struggling to find the answer. This advice seems to have helped my clients in the past and may help you too.
Here are a few statements we hear quite regularly when it comes to the topic of lower back pain
I know I have awful posture at work so I probably need to keep an eye on that and sit up straight a lot more….
I have a very weak core so my back gives me trouble from time to time….
I need to be very careful with my back, I slipped a disc a few years ago and have always been afraid to bend or twist for fear of damaging it more
I hear these beliefs all of the time and unfortunately in spite of evidence refuting these claims, they just keep re surfacing.
The posture you are sitting or standing with right now, is not causing your lower back pain. There is no such thing as good or bad posture, only the length of time that posture persists for. The posture police will have you believe that you must sit up straight to avoid pain but this relationship has yet to be found in scientific literature. If this relationship was clear cut, people with scoliosis (curvature of the spine) would be destined for lower back pain and they’re not. People with perfectly aligned spines should be free of pain and they’re not. It’s just not that simple. The worst posture is the one held for too long. If you sit at your desk with the “straight as a arrow” posture for three hours, you are just as likely going to experience stiffness or pain than if you sat like Jabba the Hutt for those three hours. For more on the posture/pain debate check out Paul Ingraham’s extensive piece here.
The belief that weak core musculature can play a role in back pain is also quite prevalent. Eyal Lederman wrote an awesome piece on this myth recently. Weak trunk muscles and muscle imbalances, Eyal says, are simply another variation in human beings. Weak or “dysfunctional” muscles do not lead to back pain. Science has attempted to look at this and failed. From what I have seen and from looking at some of Prof Peter O’Sullivans work in Australia, tensing of the core to protect the back whilst carrying out movements can actually lead to detrimental results. Click on the link below to get an idea of how Peter helps his patients with some reassurance and removing these unhelpful beliefs.
It is understandable to avoid movements that would have been associated with pain in the past. In an acute setting, it may be beneficial to go through a period of unloading to allow tissues to heal if we are dealing with a very acute episode of pain in the lower back area. If however this episode is persisting past the two month mark with very little progress then protection and guarded behaviour can be, again, counterproductive. Our spines and body’s are resilient structures that love and adapt to movement. For proof of this, check out this hero. Restricting movement can cause your nervous system to believe that a danger is actually present and pain can persist to keep you out of said danger. This is easier said than done and can take a number of sessions to get comfortable with the idea but gentle, unguarded, worry free movement, no matter what it is (walking, pilates, swimming, yoga, running, prancercise (click that link for a giggle), etc.) can really help get you on the right track.
The general public are being bombarded with very mixed messages when it comes to lower back pain and persistent pain in general. For example this recent article from the Irish Times gives an extremely outdated and unhelpful message when it comes to the relationship between posture and lower back pain. “When sitting, try to sit as well as you can, in the best posture you can”. Like I said, we have lots of evidence that shows this is not the way to approach pain. Compare that to the great article from Dr. Mary O’Keefe in the Irish Independent which details how movement and exercise can greatly help lower back pain. Mary actually carries out research on the topic so can back her thoughts up with scientific studies. It is a great read and hopefully we see more of it.
So what is my advice for those looking to manage lower back pain?