Getting to the bottom of lower back pain


COMMON COMPLAINT As many as four in every five of us will suffer back pain at some point.

Andrew O'Brien

Lower back pain. Those three words can strike fear into the bravest of people. Yet as a chartered physiotherapist, lower back pain is one of the most common complaints I deal with, and, despite the severity of the pain and the associated fear, it usually isn’t that big of a deal.
Part of the issue for the man on the street is the terminology and narrative around back pain. How often have you been warned not to do something for fear of ‘slipping’ a disc? Almost every workplace has manual-handling courses to educate staff as to the safest way to lift and carry at work, and everyone knows at least one person who is ‘crippled’ with their back.
According to the statistics, back pain is probably the most common ‘medical’ condition in the developed world, with 80 percent of people suffering back pain at some point. And what is the biggest predictor of back pain? It isn’t age, height, weight, back length, occupation, sporting background or even accident history. It’s having a history of back pain. In other words, almost everyone gets a sore back at least once, and plenty of people will have trouble more than once, regardless of what they do or don’t do.
What’s important to remember is that the majority of people who do experience back pain will see a full recovery within six weeks, regardless of the severity of their symptoms. It’s a message physiotherapists spend their days trying to get through to patients; don’t worry how bad the pain is, it will get better. I regularly see patients who on Monday are in agony and unable to bend to their knees, never mind the floor. Yet by Friday they are markedly better. As much as I’d like to claim it is my genius that fixes them, the reality is that such a recovery isn’t unusual.

Movement is key
The research around treatment of lower back pain (and pretty much any pain for that matter), shows that the most important thing to do is to get back to normal activity as quickly as possible. I know that could sound both difficult and counter-intuitive, but actually it makes good sense.
If you have ever experienced your back ‘going out’ and felt the sudden wave of pain, you will probably remember how hard it was to get moving afterwards, or first thing the next morning. But you probably also remember that once you got moving, things seemed to improve.
Some of the pain that you feel in these acute episodes is guarding; muscle spasm and sensitivity. It’s your brain saying ‘something hurts, so go easy’. The issue for many of us is that we have for a long time gone too easy and don’t move as much as we could or should. But once you break the cycle it gets easier.
The most common back complaint has the most boring label ever: non-specific low back pain. As the name suggests, it is due to no specific structure, but rather a bit of everything: aging of the discs, arthritic changes in the joints of the spine, muscular tightness or weakness, and hypersensitivity of the nerves in the area. Separate MRI scans taken just before and just after the onset of such pain would probably be the same.
What of the terrifying complaints, like the dreaded slipped disc? The reality is that a true disc injury is relatively rare, but disc changes on MRI are very common. I have written here before about how 40 year olds have a 50 percent chance of a disc protrusion on MRI, regardless of whether they have symptoms or not.
A ‘slipped disc’ really only becomes a problem if there are associated neurological signs such as pins and needles or muscle weakness. And even then, research suggests that conservative management may be just as good as surgery in the long term. Conservative treatment that consists of, you guessed it, getting back to normal activity as quickly as possible.
What then, is the best thing to do for a sore back? Get back to your normal activity. And the incredible thing with your back is that it doesn’t matter what activity. Pilates, yoga, swimming, tennis, walking, running, even weightlifting if that’s normal for you.
Most importantly, don’t be afraid. Remember 80 percent of people will have a similar problem at some point, and they’re mostly okay.

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