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The twinge of terror


Do you over-react to back pain?

Andrew O'Brien

How lucky were you over the Christmas period? Did Santa come and deliver everything that you had asked for? I was speaking to a friend over Christmas who told me of how lucky he had been a few days earlier, ironically enough while visiting Santa last month.
As the story went, my friend and his wife had taken the kids to a Santa experience afternoon out. You know the deal; train rides, hot chocolates and a photo with Santa to finish. This particular event was spread over a big area and there was a lot of walking to be done. Not such a big deal for most of us, but the kids were tired and cold and before he knew it, daddy was piggy-backing one, then another.
As one of the kids jumped on, he felt the dreaded twinge. A dart somewhere in the lower back that could surely mean only one thing: his back was ‘gone’ and he’d need to see his GP for painkillers and probably an MRI. How was he going to get that organised only a couple of days before Christmas?
Incredibly (or not, if you read to the end), although his back was a bit stiff the next morning, he was able to get up, and as the day went on, his back seemed to improve. By the third day he was barely aware that there had been a problem. ‘How could that be?’, he wondered. Maybe the damage hadn’t been as bad as he first thought.
But here’s the thing, back pain is rarely about damage. I’ve written here before about the fact that by the age of 30, over half of the population show signs of degenerative changes in their lumbar spine, even if they have never had back pain. In fact, medical guidelines now advise against referring patients for MRI unless they have significant neurological signs. The reasoning behind such advice being that telling otherwise healthy people that they have a ‘bulging disc’ creates unnecessary fear.
I often use the analogy of a paper cut when discussing pain. When you get a paper cut, it hurts and there is at least a little bit of damage – but not enough to drop everything and race to the hospital for a tetanus shot and stitches. Take that a step further, and slice through the end of your finger with a carving knife. Most people would just bandage it up and tell everyone not to make a fuss. And wouldn’t you know it, the pain goes away pretty quickly.
So why do we always panic when we get a sore back? Or, why are we surprised when it stops hurting two days later? The simple answer is education, or lack thereof; not in the formal sense, but education about back pain.
Sadly, my friend’s mum has a long-term back problem that is complicated by other significant health issues, so his experience of back pain is informed by hers. It’s a recurring theme; how many of us know someone who is ‘crippled’ with back pain? And yet, how many of those people are truly crippled? Unfortunately, the health care community are at least partly to blame, with overuse of medication, unnecessary imaging and outdated advice all still a problem.
According to research, the best treatment for acute lower back pain remains education, exercise and advice to return to normal activity as soon as possible. In some cases medication might be needed in the short term, but there is little evidence for strong-opiate based medication.
Interestingly, when it comes to exercise, it appears that no one form is better than any other. Rather, the best exercise is the one that you will actually do. Most people who come to the clinic with back pain end up with the same three back-specific exercises and advice to go for regular short walks, purely because the exercises are easily done either in bed or on the floor and anyone can manage a five-minute walk. That way the exercises get done and the fear of movement is removed.
So how lucky was my friend? No more than anyone else. The vast majority of acute episodes of low back pain will resolve within six weeks, regardless of what you do, but by continuing as normal you give yourself the best chance.

Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200 or at