Back Pain: Common myths and what to do when it strikes
October 1, 2020
What is Low Back Pain
Back pain is a very common condition with more than 80% of people worldwide experiencing some pain in their working life, but it is rarely serious with only 1% of back pain disorders related to cancer, infection, fracture or an inflammatory process and only 5% of back pain associated with nerve compression. In fact, 90–95% of low back pain cases are caused by a simple sprains and strains, have no diagnosis based on scans and usually recover quickly without the need for treatment.
Although symptoms are primarily felt in the lower back, other symptoms can include
- Mid and upper back pain
- Hip and groin pain
- Coccyx pain,
- Leg pain, and
- Pins and needles or numbness.
What should I look out for?
While lower back pain in rarely due to anything serious, you should attend A&E urgently if you experience any of the following symptoms:
- Difficulty passing urine
- Loss of control of your bladder or bowel
- Numbness around the genitals or groin area
- Severe weakness in your legs
- Numbness or pins and needles in BOTH your legs.
Myth: I need a scan to show me the cause of my back pain.
Fact: Based on a person’s medical history and symptoms your GP or physiotherapist will be able to identify if a scan is required, however, as stated above, the majority of back pain is caused by simple strains and sprains which don’t show on any scan, and what might show up could be a red herring! Research has shown that people who don’t have back pain actually do have disc bulges (30% of 20-year-olds increasing to 96% of 80-year-olds), disc protrusions (29% of 20-year-olds increasing to 43% of those 80 years of age) and arthritis (4% of 20 -year- olds increasing to 83% of 80-year-olds). These are normal findings that increase with age and show us that results of scans correlate poorly with pain and disability levels. Therefore, according to the latest scientific research scans are only needed when a serious condition is suspected (cancer, fracture, broken bone, infection).
Myth: Exercise will make my pain worse
Fact: There is very strong evidence that gradually increasing and returning to activities, work and hobbies are very important in helping you recover, and exercise is the best approach for helping and reducing back pain. The back, like all body parts is designed for movement. Walking, running, cycling, swimming, yoga and Pilates are all very good for back pain, but ultimately the best exercise is the one you like doing and will stick to over time.
Myth: Pain means damage
Fact: Pain isn’t necessarily an indication of injury or damage, and the level of pain you feel rarely correlates with a certain amount of damage or injury. Recent scientific evidence now shows that the ‘volume switch’ for back pain can be turned up by multiple factors such as past experiences of pain, health (low energy, feeling tired) and lifestyle (overweight, sedentary lifestyle, poor sleep patterns), as well as psychological (low mood, stress, depression), physical (avoiding normal movements), and social factors (eg scaremongering friends, family or colleagues).
Myth: Back pain can’t be cured.
Fact: It can be common to be told ‘your pain cannot be changed you just have to live with it’, but like any other injury of the body such as an ankle sprain, it does get better with time and gradual movement. Just as avoiding movement would not help your ankle, the same goes for back pain or injury. As discussed, pain including back pain can be influenced by many factors such as poor sleep, stress and low mood and everyone’s experience is unique to each individual, therefore setting personal goals to address these issues can be very important for improving pain and aiding recovery.
What Causes Back Pain?
Back pain can occur following physical trauma (such as a road traffic collision), however, the likelihood of developing symptoms and the severity of symptoms depends on a combination of factors including
- Repeated or excessive stresses beyond your current fitness levels
- Individual factors – being female, increasing age and pregnancy all increase the likelihood of developing pain, particularly in combination with physical and psychological wellbeing factors.
- Physical wellbeing factors – smoking, obesity and poor general fitness all increase the likelihood of developing pain and the length of time it takes to recover.
- Psychological wellbeing factors – stress, depression and anxiety all increase the likelihood of developing pain and even increase the severity of pain and the length of time it takes to recover.
The body is resilient, so back pain rarely develops because of one factor. For example, older age does not guarantee pain, nor does obesity or being female. However, the more of the above factors you have, the more likely you are to develop pain. So you may not be able to reduce your age, but you can stop smoking, lose weight and get fitter.
How can I help myself when it strikes?
With the correct management, low back pain will usually settle on their own within the week, regardless of the severity. If not, the majority of low back pain cases can be treated conservatively with physiotherapy treatment and advice, however, your attitude and the actions you take are the most important factors in preventing long-term problems. Here are a few tips for a speedy recovery…
Medication. Pain relief (eg paracetamol) or anti-inflammatories (eg ibuprofen) may help to reduce pain, help with sleep and allow you to move more freely. Ensure you check with you GP/pharmacist or read the label prior to using medication.
Heat: Hot water bottles or wheat bags can help with pain relief and reduce muscular tension. you could also ask your pharmacist about heat patches as a more practical option.
Relaxation: Stress and anxiety can increase muscular tension as well as increasing pain severity and spread. Relaxation, mindfulness and other strategies can help to reduce muscular tension. (see our ‘Benefits of Mindfulness’ blog for more information on mindfulness)
Be positive: On a similar note to above, one of the most powerful drivers of pain can be negative emotions such as worry and fear. Our emotions can not only affect how we move (causing more pain or preventing recovery) but can also lower our pain threshold causing out pain to be more severe and widespread. You will be glad to hear however, that being positive can do the opposite!
Movement: Try to avoid prolonged postures or positions. Try to move regularly and limit the time you sit as your desk, use electronic devices, drive or watch TV. Get more active by doing some exercise such as walking, swimming, Pilates/yoga or going to the gym. If you have a manual job, try to find a way you can continue to work. Some pain is to be expected when at work, but ultimately it will help you get better faster. Once your pain has improved, don’t stop moving, continue to stay active (outside of work) to prevent future episodes.
Postures: No posture is good for any period of time, so the best advice would be to minimise any prolonged posture by regularly varying your posture. In particular, however, when in sitting you should avoid slouching or looking down. Consider your workstation, is your screen too low and making you look down? Is your keyboard so far forward that your shoulders are outstretched? Do you spend time with the telephone on your shoulder? And outside of work, do you spend a lot of time on a laptop, or looking down at your phone?
Consider what factors may be contributing to your pain: Pain rarely develops due to a single factor. In fact, pain usually develops due to a combination of factors. Some factors that can predispose you to neck pain are smoking, prolonged poor postures, sleeping with two pillows, general lack of activity and fitness, and poor mental wellbeing. Try to remove or change some of these factors will not only improve your pain but prevent any further occurrences of pain. (See our ‘Mental Health Self Care’ blog for more tips on looking after your mental wellbeing)
How can physiotherapy help?
If your pain is not improving after 5-7 days, contact a physiotherapist for a full assessment. Your physiotherapist will be able to help you start the recovery process by
- Helping you understand your condition
- Helping identify the factors that may be have caused or be aggravating your symptoms and providing advice on how to minimise these
- Developing symptom management strategies so you always feel in control
- Providing ergonomic or manual handling advice.
- Providing a progressive, individualised exercise program to improve mobility and strength in order to address symptoms, but also to prevent future episodes.
Dependent on the condition they may also provide additional manual therapies that may help ease symptoms, such as
- Taping to provide postural support
- Soft tissue massage to reduce any muscular tension in the surrounding muscles
- Mobilisation of the lower back to reduce stiffness
- Acupuncture to reduce pain
If you need some help managing your back pain, call us on 0333 2200 238 to organise a remote or face to face appointment with one of our physiotherapists.