Do you ever get lower back pain?

Scott Wood another of our team members is studying a Masters in Exercise Physiology and this is his article.

Did you know there are 3 types of lower back pain:

1. Specific spinal pathology (occurs in less than 1% of LBP cases) which is damage to the spine itself – such as spinal fracture and spinal infection
2. Radicular syndrome (occurs in 5-10% of LBP cases) – which is compressed or irritated nerve roots resulting in pain inside the spine, this includes conditions such as Spinal stenosis (narrowing of spinal canal) and Radiculopathy (commonly referred to as a ‘pinched nerve’ which is the damage to nerve roots in the area they leave the spine)
3. Non-specific LBP (occurs in 90-95% of LBP cases) – this is when the LBP doesn’t fall into the other categories as seen above (which are more sinister) and is normally diagnosed through tests in determine the pain the is not coming from the specific spinal pathology and radicular syndromes. There are also no specific tissues which have to be in pain to fall into this category

What people tend to think when they get back pain

• Rest
• Being careful with or avoiding dangerous activities 
• Strengthen muscle 
• Control posture 
• It’s a life sentence with no cure 

Interesting facts of lower back pain 

• Everyone has spinal degeneration with age, so when scanned it is highly likely to get diagnosed with a spinal condition
• Severe symptoms occur without pathology/diagnosis  
• Symptom severity doesn’t correlate with pathology/diagnosis  
• Positive outcomes despite pathology issue 
• 30% have persistent pain after surgery to fix the problem 
• Scanning for LBP results in worse outcomes    
• People think LBP caused by injury and damage 

What influences Lower back pain

• Psychological factors (stress, anxiety, depression)
• Poor sleep 
• Pain history (Have you had chronic pain in the past?)
• Beliefs/ values (do you have a positive outlook? Are you in panic?)
• Existing spinal pathology 
• Activity avoidance  
• Readiness to change  

How to treat it

• Body relaxation and awareness (e.g., don’t brace your core, RELAX it!)
• Build confidence (your back is a strong and flexible part of your body, which is made to be twisted and bent)
• Recent research has found that Pilates, aerobic (cardio) and resistance (weights) training are the most effective treatments for Non-specific back pain 
• Individualised training leads to the best success 
• Exercise training may also be more effective than hand-on therapist treatments 

My Top 5 Strength Exercises to treat LBP

• Front Plank
• Deadlift/Hip Hinge  
• 3-point row 
• Palof Press 
• Suitcase Carry 

Other good mentions

• Glute Bridge 
• Side plank

Key points

• Back pain does not equal damage 
• Back pain should not be disabling and stop you from doing the activities you enjoy 
• Exercise and movement are one of the best methods for treating LBP 

Core stability for lower back pain

• The belief that the spine is a delicate structure is not useful and strengthening the core is not a good approach to the issue 
• Bracing or tensing the spine is a current belief which is being disproved, this action is useful when lifting things heavy and certain tasks but doesn’t need to be done to combat LBP as it should be automatic 
• It isn’t about the tiny muscles; it is about the main trunk/back muscles which will engage in conjunction with the smaller deep muscles of the trunk.

Spinal flexion vs Extension 

• In most cases we spend our lives bending forward (spinal flexion) such as when doing housework, bending over to pick up things and sitting forward
• Spinal flexion can often be the movement which caused the LBP
• But ask your self how often do I bend backwards (spinal extension)? 
  • The body likes to be balanced like most things in life, so for every time you bend forward you should bend backwards to create a balance 
  • If you think you are someone who spends their life in spinal flexion introducing some spinal extension into your life can act as both a preventative and treating method of LBP 
  • Movements such as Bird-dog, Cobra pose and standing spinal extension can be good movements to relive symptoms to pain