ow back pain is a significant health issue that I see multiple times a day in clinical practice. The likelihood of experiencing back pain at some point in your lifetime is approximately 90%. Low back pain can occur due a number of different causes and determining an accurate diagnosis is essential to receiving appropriate treatment. In addition to receiving effective treatment management, you need to address what is causing the pain and why is it creating the pain to ensure you can prevent the problem from reoccurring in the future.
Low back pain is more than just a nuisance for those suffering from it, it is also a burden to our healthcare system and the economy. As previously mentioned 90% of the population may experience back pain at some point in their life. It is one of the most common injuries that people seek treatment for and unfortunately many people seek a type of care that is not necessarily the most effective option, costing taxpayers and delaying resolution of pain. Not only are we in the middle of a pandemic which has placed a lot of stress on our healthcare system but we have a rising disability epidemic of low back pain and a system that continues to lead people down the wrong pathway. So the question is what do we do?
A few years ago an article was released by the Lancet journal that aimed to get the facts straight on the best guidelines for low back pain care. The main concerns of this article included that low back pain is a global challenge, due to rising medical costs, increasing disability rates (including absenteeism from work) and expectation for medications, imaging, surgery and other services that are largely unnecessary.
The first step many people take when experiencing acute low back pain is a visit to the emergency room. In one study, less than 1% of ER visits related to back pain resulted in treatment for specific pathology in the back (infection, fracture, tumour etc). Most patients are sent home from the ER with no treatment, testing or imaging at all. This is not a problem with ER physicians, but rather a problem with an emergency room system that is ill equipped to manage acute back pain and effective education of the public about diagnostic and treatment options available that are more suitable for addressing low back pain. We live in a country that provides healthcare for all, but the system cannot handle the frequent ER visits related to low back pain. We cannot change our healthcare system overnight but we can educate and change our behaviours to make evidence based choices of where to seek appropriate care.
First line therapy should be non-pharmaceutical. National guidelines endorse the use of exercise, massage, acupuncture and spinal manipulation in the management of acute (new onset or sudden episode) low back pain. It is not necessary to get images (x-ray, CT, MRI), prescriptions or referrals for these services from your physician prior to seeing a physiotherapist, chiropractor or massage therapist. If you feel like you need to medicate, do not use opioids, instead guidelines recommend a non-steroidal anti-inflammatory (NSAID), with the minimal effective dose for the shortest amount of time.
Education should be a key component of low back pain treatment. Life throws us many variables that can complicate low back pain, such as workplace demands, family dynamics, stress, general health habits, etc. A good practitioner should always give advice to help navigate through these variables aiding you to make positive decisions to support your recovery. Simple things such as how to properly get up out of bed are extremely important in acute stages and although it may seem silly it is important to be educated to avoid further, long-term aggravation of pain.
Once an accurate assessment and diagnosis is achieved, the most important thing to include when dealing with low back pain is exercise. A progressive exercise approach that focuses on functional improvements is critical for both acute and chronic low back pain. Guidelines recommend exercise programs that are tailored and individualized to the patient incorporating their diagnosis, individual needs, preference and capabilities. An exercise program should not be a cookie cutter approach, when an exercise program is customized to the patient, it can be one of the most effective ways to manage chronic back pain and prevent future episodes. A progressive program should evolve over time, addressing weaknesses and limitations to improve the overall health of your back.
The best approach when dealing with low back pain is one that combines a diagnosis and progressive, individually tailored exercise with or without manual therapy, that accounts for individual needs and capabilities. In addition to exercise and manual therapy it is key to be educated on the injury, especially those who are struggling with low back pain and are stuck in a cycle of relying on medications.
Although low back pain injuries can be debilitating and sometimes difficult to overcome, you can take comfort in knowing that with a proper diagnosis and systematic approach to treating the injury, you can eliminate the pain sooner than later. If you have struggled with low back pain, feel free to reach out to our team of experienced healthcare providers to assess the problem and get you back on your road to a quick recovery!