Low Back Pain

Low back pain is very common with approximately 80% of Australian adults experiencing at
at least one episode of low back pain during their lifetime.    For most people low back pain is not caused by a serious problem and will resolve with some routine care and exercise.

Occasionally low back pain can be caused by serious disease or damage to the tissues of the back.  If you are experiencing any of the following symptoms, you should seek advice from a health care professional as soon as possible:

• occurs after a traumatic event, such as a car accident or a fall;
• If it wakes you during the night;
• If the pain does not reduce or change, no matter how you move or change position;
• If it accompanies numbness, tingling, or ‘pins and needles’ in your bottom, legs or feet; or
• If it accompanies changes to your bowel or bladder control.

How can we manage low back pain?
If you simply have low back pain without any other issues, then your pain is likely to be ‘uncomplicated low back pain’ that will improve.  You may find that a heat pack, certain posture positions, and perhaps surprisingly to some, staying as physically active as possible helps you to manage your low back pain.

How Should I Stay active?
Exercise is great medicine for lower back pain, with no specific type being found to be superior. Many people believe that core strengthening and pilates type exercises are the best, and while the research shows that these exercises are beneficial for low back pain, they have not proven to be better than other general forms of exercise.  
The takeaway message from this is: - stay as active as you can, with an exercise you enjoy and feel comfortable with, allowing for the restrictions in movement that may come with pain. 
Examples are:

• If you enjoy gardening, then staying active may mean pottering about in your garden, even if heavy jobs such as digging or pruning are too much for you.
• If you run marathons, staying active may mean continuing training but reducing the distances you run each week, or walking, depending on your level of discomfort.

If you don’t exercise regularly, an episode of low back pain may be your prompt to start! Walking, swimming and cycling allow people with low back pain to become active and stay active.  Some forms of dancing, yoga and tai chi are popular too.

The bonus of staying active is that it prevents loss of physical fitness, muscle strength and cardiorespiratory function or deconditioning. Staying active, even if at a reduced volume and intensity whilst you are experiencing low back pain, helps you ensure that other aspects of your health do not decline too.

After the initial phase of staying active,how can we progress to keeping pain free?
In the initial phase when you may have had severe low back pain, we use exercise to stay active and maintain mobility.  After the initial phase, and once pain has reduced the goal is to get you better and stay that way. 

As your low back pain reduces, you can increase your program of preferred exercise to include ‘graduated training’ and specific exercises that increase your range of spinal movement and strengthen the trunk and abdominal muscles. 
There is moderate evidence that undertaking exercise at this post-back pain stage can help prevent another episode of low back pain, and that is really important for quality of life.

Graduated training means a program that becomes increasingly more difficult.  An example is that if you were staying active by walking, to gain further health benefits you now need to walk further, or faster, up hills or carry weights.

Increasing and maintaining range of movement is also important to maintain movement in your back, and exercises like tai chi, yoga, and general stretching exercise at home can be included.

Strengthening exercises are also important, working the small muscles of the lower back, extending to larger muscles including upper and lower body exercises.  Again these need to be graduated, progressively increasing the difficulty and load.

We suggest seeking help from your Exercise Physiologist or Physio to help you plan and progress appropriate exercises for your return to full recovery and beyond.

Lisa Parkinson
Accredited Exercise Physiologist

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