Treating and managing back pain
Treating and managing back pain
Back pain can be super debilitating and disruptive to your lifestyle, preventing you from doing the things you love or performing at your best at work. Lower back pain is a common occurrence and affects a large number of adults and adolescents at some point in their lives. This may be due to an acute incident, repetitive strain or exposure to prolonged and unfamiliar postures.
Back pain is one of those things that many of our patients will tolerate over a period of time before coming to see us. They’ve been ‘dealing’ with pain and ignoring it, until it’s now got to a point that it’s affecting their work, their sleep, their activity and their productivity. We’ve found that early detection and consideration of the contributing factors help in the long-term management of back pain.
Treating acute pain is one thing, but actually creating a strong body to prevent reinjury, improve posture and reeducate movement is another. Here’s more on our approach to treating a body, not just an injury.
We look back, to understand the best way forward
Most often, our patients have a history of back pain with recurring flare ups. This may be because when their original injury occurred they received hands-on therapy but didn’t get a full rehabilitation programme to help build up resilience and help prevent those re-occurrences from happening.
That’s why our first step in treatment is to get a very thorough understanding of history and lifestyle to understand what components are impacting on an injury, or causing aggravation or discomfort. This assessment considers things like work and home stressors, physical activity related stressors, and patterns of activity. Sudden ‘boom-and-bust’ changes in activity can also lead to injury - which is something we saw a lot of following recent lockdown restrictions. Some of us went from being very active to nothing at all, while others launched into physical activity that their body wasn’t quite prepared for!
Often, injuries are down to what’s called cumulative strain. That means the way we’re repeatedly moving our body starts to compound an issue over time, but it could be one (sometimes insignificant) action that will actually trigger the pain - such as picking up your child, twisting or bending to put on your shoe. Therefore understanding the bigger picture of your history and activity is necessary to understanding why this acute injury may have occurred.
When we understand what’s contributing to pain or discomfort, our approach to treatment is then able to shift from just immediate pain management to creating a plan that supports your body’s recovery long term. This plan includes hands-on treatment, but also education, exercise recommendations and advice around lifestyle changes.
We calm things down, then build back up
While initially there may be certain activities that you need to do less frequently or reduce in the short-term, ACC’s Lower Back Pain Guidelines advise that the number one thing you can do for back pain is to keep moving as much as you can tolerate. While this might seem counterintuitive to someone who is in pain, early movement has been shown to correlate with better recovery rates and pain levels.
Here’s what we tend to recommend:
Despite its complexity, your spine is a strong structure, so don’t fear movement. Aerobic exercise helps get blood flow moving around your body to manage inflammation. Walking on flat surfaces, keeping your legs moving and swinging your arms can help to loosen muscles in the lower back. In the acute stage of an injury, particular or certain movement may further aggravate an injury, so this is why advice from your physio on what’s best for you is so important.
Following your session with your physio to desensitise your injury, you’ll be given 1-3 exercises specific to your injury or concern that will help to maintain those changes. It’s important that you integrate these exercises into your routine every day while continuing to focus on regular movement. As each case is unique, prescribed exercises are tailored to your injury and stage of recovery, but overall, glute strength, quad strength and core strength are all going to be important in reinforcing a strong and resilient back.
We’ll help you find ways to adapt the movements that may be causing you pain or aggravating an injury. For example, if your job requires repetitive movements, how can you modify or support these? Likewise, if your injury is from physical activity, we’ll work with you in the gym to assess your movement and provide modifications for your technique and alternative exercises that can best support your goals.
Avoid staying sedentary for more than 30-40 minutes at a time during your episode of back pain. You can undo the benefits of exercises by then remaining stationary for long periods in postures that aren’t helpful to your recovery.
Many workplaces will provide ergonomic assessments which are generally very helpful. However, if your injury is exacerbated by your working environment, a more personalised assessment may be necessary. Ask a colleague to take a photo of you sitting at your desk, and bring in with you to your physio appointment to discuss potential modifications with your practitioner.
We can provide referrals for scans and other specialists if needed. If you need advice around pain medication, you’ll need to chat to your GP. We find that over-the-counter pain medication and anti-inflammatories can help in the acute stage of an injury.
Our belief when it comes to back pain is that if you can move better you can heal better. And if you can heal better, you can get back to doing the things you enjoy, sooner. There’s no need to fear movement - but it needs to be the right movement, and that’s where we can help. If you’re struggling with on-going back pain or an injury, make an appointment to come in and see us; a good diagnosis through a thorough assessment is your first step to living pain-free.
Disclaimer:
An individualised assessment is considered best practice when dealing with lower back pain and a medical history is often necessary to consider. The lower back has many structures and not all back pain is the same. It is important to consider the below symptoms when considering seeking care. If you experience any combination of these symptoms or are progressively worsening, contact your GP or visit your local A&E with urgency.
References:
Accident Compensation Cooperation & National Health Committee. (2011). New Zealand Acute Low Back Pain Guide. Retrieved October 15, 2020 from https://www.healthnavigator.org.nz/media/1006/nz-acute-low-back-pain-guide-acc.pdf
Zigenfus, G. C., Yin, J., Giang, G. M., & Fogarty, W. T. (2000). Effectiveness of early physical therapy in the treatment of acute low back musculoskeletal disorders. Journal of occupational and environmental medicine, 42(1), 35.
