Lower Back Pain, Physiotherapy and You (Part 2)

In our first post about Lower Back Pain (LBP), our Musculoskeletal Physiotherapist Guojie shared valuable insight into myths that surround the relationship between exercise, back pain and injury. Here, he continues with other myths on LBP and how physiotherapy is one of the means of addressing them:

 
My posture is the cause of my persistent back problem.

If you do a Google search for “posture and pain,” you get 4 million hits. This is the most common myth on LBP you will ever read about in the internet. Does bad posture cause LBP?

It is well known nowadays that there is no ‘perfect’ posture.

 

Any position, be it straight like a soldier at attention (left) or slouched like a snail (right) gives rise to discomfort when adopted for a prolonged period of time. Hence, what should we to do to reduce our lower back pain instead of worrying about posture?

  • Ensure that you take adequate breaks from prolonged/sustained inactivity like deskbound work, painting, squatting or repetitive tasks like bending and lifting. Here, you prevent the problem from occurring instead of treating the problem after it has happened.
  • Adopting an ‘ideal’ sitting posture is usually my recommendation. Sitting should not be one where you need to arch your back and hold your tummy in. You should be sitting relaxed against the backrest with a ‘neutral’ spine (below).

Posture is only one of the many factors that might cause lower back pain. Persistent LBP is usually multi-factorial and it is important to take other factors such as occupational types, family stress and sleep into consideration. Physiotherapy intervention that accounts for all of these factors has been proven to be more effective. 

 

I should not see a physiotherapist when I have an episode of severe back pain.

When you first sprain your ankle, it can be very painful. The first thing that comes to mind is to wrap it tight, apply ice for pain relief and rest it. This rule applies to a sprained back too. What you require is definitely not a protocol of leg lifts, crunches and jogging, but an assessment to diagnose your pain, followed by relative rest and pain relief.

For acute (first 1 to 2 weeks) onset of LBP, physiotherapists employ appropriate pain relief treatment to manage the pain. Modalities like electrical stimulation and heat therapy are effective in pain management. As individuals who develop severe back pain tend to fear for the worse (very common), early intervention can help to provide the right diagnosis, reassurance and self-care strategies that are crucial to preventing LBP from becoming persistent. Early intervention also helps in identifying cases when early medical intervention is required. In this way, early physiotherapy assessment and intervention can also be an unexpected cost-effective solution.

 

You will require a scan before you start physiotherapy.

Diagnostic tests in general are indicated if the test will help guide specific treatment strategies, improving treatment outcomes. Tests that are performed without clear indication, however, can lead to unnecessary interventions, increased patient anxiety and costs.   A scan will only be needed if we need to exclude the possibilities of cancer, infection or fractures.

 

Physiotherapy cannot resolve the cause of my pain; it can only reduce it.

True, but that’s simply because no treatment can ever guarantee you complete pain relief, not even spinal surgery! The nature of LBP conditions is that recurrences are bound to occur, affecting up to 40 – 50% of individuals within six months and 70% within 12 months. This is not related to treatment efficacy.

Besides, pain (in this instance, LBP) serves as a good warning system to inform us of impending or further tissue injury. If you are in a situation that may potentially cause injury (e.g. sitting non-stop for 4 hours), pain and backaches are the best way your body can warn you to readjust or stop. Let’s put it this way,

“It is important to first understand the role of pain in the human body then the cause of your pain, and finally determine whether it is possible to resolve it.”

Physiotherapy is a form of conservative treatment that seeks to treat underlying physical impairments that are linked to the development of your pain. One of the fundamental intervention techniques that physiotherapists use to rehabilitate individuals with pain and dysfunction is exercise therapy. Furthermore, research suggests that exercise therapy reduces the recurrence rates of LBP and is the only modality that has been proven to work! If your physiotherapy treatment did not include a sensible exercise programme, it is unlikely to solve your pain issues in the long run.

 

Spinal manipulations are done to adjust posture, realign discs and joints.

Specialised physiotherapists are trained to deliver safe spinal manual therapy (or manipulations). The purpose of manipulations is to ease restriction from stiff joints and tight muscles. A skillful manipulation can deliver instant reduction in pain and improvements in movement. You may find that you can move better as a result of manipulation. However, there is no available evidence to show that x-ray scans can identify mal-aligned joints, or that your discs/joints can be realigned by spinal manipulation.

While manipulation may be effective for acute low back pain management, it is not sufficient in reducing the rate of recurrence. It should be effectively integrated with exercise in the overall therapeutic plan and tailored to each individual’s needs.

 

Once I hurt my back, I will NEVER be able to _________ again.

Most are unsure about how active they can get after recovering from a back injury. Although LBP can be very painful initially, majority often recover well and fast within the first few weeks. Most individuals with LBP experience no major change to their quality of life, although it is common for small periods of back discomfort to occur occasionally. That means that in spite of the injury, individuals can gradually return to the activities that they once enjoy.

 

Finally, having a peace of mind before you start your rehabilitation plan is extremely important. We hope that this article has been useful in addressing common myths, questions and other queries about lower back pain. If ever in doubt, do consult your trusted physiotherapist for the advice you need.