‘Snake oil’ for Lower Back Pain? Think again. (Part 1)

 If we should not buy ‘snake oil’ from the street peddler, then what should we do to alleviate and reduce lower back pain?

Low back pain (LBP) is the most common musculoskeletal problem worldwide, with up to 85 percent of all individuals experiencing LBP at least once during their lifetime. It is the most common musculoskeletal problem that people seek medical help for. I’m sure most of us would be familiar with how disabling and troublesome low back pain is, especially when it is persistent and affects activities that we need to do or enjoy on a regular basis. I am not ashamed to admit that even I had to take medical leave once due to LBP!

Being a musculoskeletal physiotherapist, I was able to diagnose the condition myself and understand how to manage it effectively. However, many may not be equipped with the necessary skills and knowledge to do so. These days, it is common for our generation to rely on mass media for information or to seek advice from family and friends. Such information is convenient and we trust them to be safe and reliable.

However, we’ve often been told before to never quote information from unreliable sources, ever since our days in school. This is because information derived from unreliable sources run the risk of being inaccurate. This is as how we do not buy ‘snake oil’ from a street peddler because of the three big unknowns:

  • Effectiveness
  • Contents and potential risks of adverse reactions
  • Manufacture origin

Based on my years of work and personal experience as a physiotherapist, I have found that the best approach towards managing LBP often contrast with the wider beliefs of the general public. This is alarming as it means that the large majority with LBP are treating their pain with unproven and unreliable methods!

In this and the following blog post is a compilation of common myths that we, physiotherapists, often hear from our clients about Low Back Pain. We will try our best to explain as to why they might not exactly be true:

 

I should not exercise if I have back pain.

False! Exercise has physiological benefits to the spine and exercise-based therapy is an important component of LBP treatment in physiotherapy. What we observe is that while most spinal disorders occur in patients with the lowest and highest amount of physical activity, moderate physical loading of the spine, by contrast, has a protective effect. Exercise facilitates nutrients to our spinal discs, resulting in a slower degeneration rate. Below are some additional facts on what exercise therapy can do for LBP:

  • Exercise therapy has modest benefits in patients with sub-acute (4 to 12 weeks) and chronic (>12 weeks) LBP. In addition, the improvements associated with exercise therapy are long lasting (≥1-3 years).
  • In both sub-acute and chronic LBP, exercise therapy is particularly beneficial when the approach includes aerobic activity (e.g. brisk walk, swim, bike, jog),  biopsychosocial-based methods (such as a cognitive-behavioural approach to change beliefs about LBP) and a graded exercise regime (i.e. gradually increasing exercise intensity).

In summary, the best outcome for exercise therapy is one that incorporates all of the following:

lbp-exercisetherapygraph

My pain has improved since I hurt my back about 5 months ago. However, I still feel some aches with certain movements. My spine is still not completely recovered.

Experiencing mild aches and pain months after injury is very common. However, this does not necessarily mean that the spine has not recovered. In general, most injuries often require a basic recovery phase of 8 – 12 weeks (varying slightly between individuals). What we do know is that injuries also result in changes to the body’s nervous system.

The nervous system comprises the (1) peripheral nerves, (2) spinal cord and (3) brain. The nervous system adapts in relation to the amount of injury sustained (see image below). If we have a minor injury, the pain we feel is usually mild and less time is taken to recover. However, when our injury is more significant, our nervous system changes to produce a greater intensity of pain. Tissues take longer to recover and similarly so for the pain to resolve.

Nervous system's reaction to pain

An analogy would be that of a volume knob. After serious injury, volume knobs within different parts of the nervous system are turned from ‘4’ (normal sensitivity) to ‘10’ (higher sensitivity). The body hence requires more time for the volume dial to switch back to ‘4’ (Note: For certain individuals, the knob may remain at ‘6-7’ for an indefinite period of time. This phenomenon is better explained as chronic pain.)

Volume knob

In our next post, we will continue with other common myths about causes of Low Back Pain, its symptoms as well as where physiotherapy lies in the spectrum.