The back is naturally a very strong structure that is made up of bones called vertebrae which are held together by a large network of ligaments and muscles. Acute low back pain refers to pain that has been present in the lower back for six weeks or less. Almost 80% of people experiencing an episode of lower back pain severe enough for them to seek help from a healthcare professional. It is a common ailment, and most people can expect to recover from acute low back pain fairly quickly. In fact, majority (85%) of these people fully recover after three months.
What Actually Causes Low Back Pain?
There are many structures within the back that have nociceptive (pain producing) nerve endings that register pain when they are stressed. The main sources of pain within the lower back are discs, facet joints, ligaments, tendons, and muscles. In this modern age, our lower backs are generally weaker than at any other time throughout the course of human history. This is because we spend more time sitting and less time being active. Therefore, it is probably safe to say that all of these structures are under more stress than they would have been for our ancestors.
Acute low back pain often occurs after heavy and unexpected lifting, bending, twisting, prolonged sitting, or after undertaking a new exercise regimen. Occasionally, it may occur for no identifiable reason. Careful examination by your physiotherapist can give a strong indication of the nature of the low back pain that you are experiencing. After which, your physio will direct you on the right course of treatment and further management.
When experiencing an episode of low back pain, it is common for people to feel like something has “shifted out of place”. This may be due to the surrounding muscles going into a spasm in order to protect the back. Whilst low back pain can be severe and alarming, it is reassuring to know that most people who experience lower back pain do not have any lasting structural damage within the back.
What to Do When You Have Lower Back Pain
While it may be tempting to stay in bed to allow your back to recover during the first few days following the onset of lower back pain, studies show that prolonged bed rest can lead to increased pain and a poorer recovery. Therefore, we only recommend bed rest when the pain is severe, and then for a maximum of two days only.
We would definitely recommend a visit to an experienced physiotherapist.
Your physio will take a detailed history of your condition, noting any previous injuries or courses of treatment. The physio will also note your work activity and the level and nature of exercise that you regularly undertake. They will assess your posture, your movement range, and the nature of any limitations. They may undertake a neurological examination, if indicated by referred hip or leg pain (sometimes called sciatica).
Your physio will discuss with you how you can best manage your individual case over the first few days and weeks. Physiotherapists treat with manual therapy (soft tissue massage and joint mobilisation) as appropriate. They will be able to assess whether specific exercises will be of benefit to you during your first few days. Some physios also use dry needling. The specific type of manual therapy that your physio administers is likely to change throughout your course of treatment.
Avoiding aggravating factors may help relieve pain initially. Becoming more active and gradually returning to your usual activities will promote recovery. A good night’s sleep can be very helpful in reducing pain and this should be prioritised during an episode of lower back pain. High stress, anxiety, and low moods may have a significant impact on pain levels, and managing this through relaxation activities may help reduce pain.
Acute Low Back Pain and Exercise
People who are experiencing low back pain may decide to avoid exercise, thinking that it could make their symptoms worse. However, the right type of exercise can actually reduce your pain. Good options would be walking, yoga, Pilates or gentle swimming. This type of exercise can help reduce muscular spasms and the overall sensitivity of your lower back.
As you progress with your treatment, your physiotherapist will prescribe exercises that will strengthen the key muscles of the back and trunk (abdominals, gluteals, paraspinal muscles). It has been shown through research that the muscles weaken quickly after a first episode of low back pain. This weakening can predispose to recurrence. Your physio will work with you on stretching and or range of motion exercises.
Your physiotherapist can also give you guidance on how to manage your work or home environment. They will also advise if you participate in gym or sport, how you can prepare for a return to sport. Sometimes, your physiotherapist may recommend Pilates or yoga and, if you have a personal trainer, we will discuss your treatment with them.
Do I Need a Scan?
Scans are rarely needed and are only necessary when a serious condition is suspected, which makes up less than 1% of all lower back pain cases worldwide. Physiotherapists should be able to identify signs that indicate a more serious condition. It is important to note that scans will almost always show something “unusual” in the back, which usually has nothing to do with the pain being experienced. For instance, disc bulges, disc degeneration, and facet joint degeneration are common findings in a MRI scan in people that do not experience lower back pain, and these findings can be considered a normal part of ageing (like getting wrinkles).
If you are suffering from lower back pain or have a concern about your back or any other musculoskeletal condition, we can help. Our physiotherapists at Excel Physiotherapy and Wellness have extensive experience in helping people reduce their pain and return to full function. Please call us on 1300 650 510 to schedule a consultation.