Low back and neck pain is common, especially in office workers.
Low back pain is very common
- Around 80% of people get low back pain, and will have a significant episode
- Whist majority of acute episodes settle down and may resolve within a few months, ongoing symptoms and recurrences are extremely common
- Many people experience pain back pain and pain into the leg, known as sciatica
- Many people fail to get better despite a variety of commonly used treatments as they are not educated about what they can do to self-manage and prevent a return of pain
Why is low back pain so common?
- The simple answer is our lifestyle!
- Majority of people have sitting jobs, and spend long periods of the day in sustained flexed postures
- Those that do not sit for work usually have a bending job, so they are also performing repeatedly bending (flexion) all day (eg. Plumbers, Nurses, Mum’s looking after children)
- Our spine is designed to move, and too much movement in the one direction often creates a problem
What are the common causes of back pain and sciatica?
- The most common cause of low back pain is disc problems, especially in those aged 20-55.
- When the disc bulges far enough to compress the nerve behind it pain is often felt in the leg
- Typically, if the disc is the source of back pain symptoms are aggravated by periods of sitting and bending, and relieved by walking or lying down
- Over the age of 55, people may develop symptoms in the leg caused by bony degenerative changes around the nerve, called canal stenosis. These people experience pain in the leg with walking, and it is usually eased by sitting.
Should I get an MRI or another kind of scan for my back?
- For the vast majority of people, the answer is No!
- Imaging should be reserved for those where there is a suspicion of fracture or cancer, and in these instance x-ray is often the first line choice
- Imaging will often not change management, and is one of the reasons that the clinical guidelines all around the world for low back pain do not routinely recommend imaging even in the presence of leg pain (2010 Koes et al, Clinical guidelines for low back pain)
- The other reason not to get a scan early is that a huge percentage of asymptomatic people (those that have no back or leg pain) have disc bulges, disc degeneration, facet joint changes etc. In our 20’s these findings show up in around 20% of people without pain, and over the age of 50 these findings increase to show up in around 50% of those without any pain (Brinjikji et al 2015, Systematic review on spinal imaging)
What can I do to relieve my own back pain?
- The McKenzie Method, or Mechanical Diagnosis and Therapy (MDT) is a very effective evidence based, reliable form of assessment to determine which specific movements/exercises you can do to get relief of your pain
- An MDT assessment involves your testing repeated movements and or sustained positions with your back, to determine if there is a direction of movement that will give relief and restore your flexibility rapidly
- This direction preference can be found in over 70% of patients with low back pain, regardless of if the pain has been present for days or years
(2011 Werneke et al, Association between direction preference and Centralisation in low back pain)
- Regularly perform your direction specific exercise for relief, especially after prolonged periods of sitting or bending
- Get up and move often, ideally every 45 mins
- Sit with appropriate lumbar support like a McKenzie lumbar roll
- Consider the use of a stand-stand desk if this is available to you to vary your working position regularly
- Keep active, as research clearly shows that regular activity to maintain fitness has a protective effect on the spine
How do I know if I will benefit from an MDT assessment at Absolute Health and Performance?
- Around 70% of people will be able to find a specific exercise that will rapidly relieve pain and restore movement
- “Responders” are rapidly identified, usually within the first 1-2 sessions (most in the first session) so you will not waste time and money and can quickly determine if you can successfully learn to self-treat
- Even those with difficult problems who have had pain for years and failed to get better despite seeing a number of different practitioners rapidly respond, with research showing even in chronic pain patients around 50% Centralise and get rapid relief of their sciatica
- If you are not in the 70% that need direction specific exercises, this can be quickly identified within a few sessions and can help determine which type of specific pathway you need to go down to get a resolution of your problem.
Written by Physiotherapist Joel Laing | Absolute Health & Performance- Physiotherapy Services Melbourne CBD.
References:
Brinjikji, W. et al. “Systematic Literature Review Of Imaging Features Of Spinal Degeneration In Asymptomatic Populations”. American Journal of Neuroradiology 36.4 (2014): 811-816. Web.
Koes, B., van Tulder, M., Lin, C., Macedo, L., McAuley, J. and Maher, C. (2010). An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. European Spine Journal, 19(12), pp.2075-2094.
Werneke, M., Hart, D., Cutrone, G., Oliver, D., McGill, M., Weinberg, J., Grigsby, D., Oswald, W. and Ward, J. (2011). Association Between Directional Preference and Centralization in Patients With Low Back Pain. J Orthop
