The dreaded and debilitating acute low back pain. Most people have had it or know of someone that has hurt their back, they were doing something trivial like bending forward to tie up their shoes or twisting to reach for something. The first episode usually happens between the ages of 20-40 years old and can cause moderate to severe pain(1) with a stabbing or pinching sensation on the slightest of movements. It can have a significant impact on daily activities which prompts high levels of stress and the desire to not leave your bed. So what should you do when this happens?
Your Osteopath will determine what the next couple of steps are. The first point of call is to consider a serious pathology. This is done by a thorough clinical history, musculoskeletal and neurological examination. Only around 1% of all acute low back pain is due to a serious pathology(2). In the vast majority of cases imaging is not immediately necessary. Imaging is a major expense for the healthcare system and considering that these back injuries have a relatively short duration it isn’t warranted(3). Once serious pathology has been considered and it is less likely to be the origin of pain your Osteopath will devise a treatment plan.
One of the most frustrating aspects of low back pain is the seemingly trivial way it started. There is generally two ways in which you hurt yourself. The big, massive trauma which is past what that body can physiologically handle, think something like a car crash. Or there is lots of little things building up over a period of time and then there is something small and innocuous that is the last straw on the camel’s back before it breaks, think something like sneezing (that’s my Achilles heel!). From there your body goes into a state of protection. Your body has two main first line defences. Pain. If the body makes something painful you’re less likely to continue doing it therefore less likely to hurt it further. Muscular spasm. The spasm makes the movement much more difficult and painful to achieve. What tends to happen is the response doesn’t match up to the injury thats occurred and the response is way to aggressive for the injury.
What’s the most important thing you can do from here? Stay active(3). Gone are the days where you are confined to bed rest taking pain killers to ease the pain. These days you should be trying to get back to daily activities as best and quickly as you can. This may involve modifying some of these daily activities. If returning to a desk job it may mean taking regular breaks and getting out of your work station every 30-45mins to promote movement and avoid those long periods of immobility. For a Tradie it may be avoiding certain tasks that put a particularly large strain/load on the back and substituting them for less stressful tasks. This combined with gentle mobility exercises that have been prescribed should be tried first. Medications can also be tried in the initial phase to help enable activity. Advice around medications should always be checked first with your pharmacist and GP.
Going forward there should be measures put in place to minimise the potential for another episode. Now this will vary from person to person depending on the predisposing factors. This is where your Osteopath can help. A big part of what our job is figuring out what the contributing factors are and adjusting them in a meaningful way. Some of the things we commonly look at are lifting technique, workplace desk setup, technique for sporting endeavours and minimising or altering any repetitive movement you may be performing. The solution is never just a recipe but is instead tailored to each persons lifestyle and demands.
Blog by Lachlan Cossens, Osteopath at McKinnon Osteopathy. Lachlan sprains a rib joint every Spring due to his hay fever and excessive sneezing.
To book an appointment with Lachlan Click here or call on 9578 2436
1. Casazza, B. A. (2012). Diagnosis and treatment of acute low back pain.
2. Henschke, N., Maher, C. G., Refshauge, K. M., Herbert, R. D., Cumming, R. G., Bleasel, J., … & McAuley, J. H. (2009). Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis & Rheumatology, 60(10), 3072-3080.
3. Www2.health.vic.gov.au. (2016). Management of acute non-specific low back pain. [online] Available at: https://www2.health.vic.gov.au/Api/downloadmedia/%7BE39CADF7-A680-450E-A675-311992CBE8BD%7D [Accessed 28 Apr. 2018].