Low Back Pain

Physiotherapy For Back Pain

Along with neck pain, lower back pain is one of the most common musculoskeletal complaints that we see. Lower back pain is categorised into non-specific and specific pain. The pain is further categorised into acute, sub-acute and chronic pain. Acute pain is short lived and settles within 6 weeks. Sub-acute pain tends to last between 6 and 12 weeks. Chronic pain is anything lasting 12 weeks or longer.

Non-specific back pain

This the most common, accounting for approximately 90% of low back pain cases. Non-specific back pain means that there is no identifiable structure or pathology that can be attributed to the pain. It has been shown that it is not possible, nor necessary, to identify a specific structure, as this will not change how the condition is managed. Management is therefore based on pain, function (i.e any movement restrictions or weakness), and psychosocial factors (things like stress, worry, fear avoidance, catastrophising) that can contribute to the pain experience.

Non-specific back pain is often multi-factorial, meaning there is more than one factor that is likely affecting it.

For non-specific back pain, imaging (for example x-ray or MRI) is not necessary. This is because it is more likely to show false positives, as ‘abnormal findings’ are often shown on scans of people without pain. We know that what is shown on imaging does not always correlate well with pain, therefore having this imaging is unlikely to change the management of the condition.

Specific back pain

Specific lower back pain is when the pain can be attributed to a specific pathology or structure. It is rarer, accounting for only 10% of all back pain cases. Some specific causes of back pain are more urgent, and do require further investigation and imaging. Your physiotherapist will help to rule out specific, serious pathology by taking a thorough history and clinical examination. If specific pathology is thought to be present, your physiotherapist can direct you to your GP for onward referral, or to an appropriate specialist.

Specific back pain includes the following diagnoses:

• Osteoporosis
• Spondylolisthesis
• Metastatic cord compression (cancer)
• Cauda equina syndrome
• Scoliosis
• Ankylosing spondylosis
• Spinal stenosis
• Lumbar radiculopathy

Lumbar radiculopathy is a more common cause of specific back pain, in which nerve symptoms in the leg(s) are also present. Depending on the severity, this does not always require further investigation. It often settles with time and physiotherapy management and advice. In more severe
cases, further investigation may be warranted.

Physiotherapy for non-specific lower back pain, and some specific lower back pain for example lumbar radiculopathy, may include the following:

• Advice and education- Exercise management
• Postural and ergonomic advice
• Manual therapy – soft tissue massage, joint mobilization
• Pilates based exercise
• Acupuncture

If you have back pain and would like further advice, get in touch to book an appointment with one of our physiotherapists, who will be able to carry out a thorough assessment and guide you through a management plan. You can call us on 0191 285 8701 or email us at info@physiotherapymatters.co.uk.