Key Messages:
- Low back pain is a widespread issue, affecting people of all ages and socioeconomic backgrounds.
- In most cases, it is challenging to identify a specific cause for low back pain, leading to the term “non-specific low back pain.”
- Disabling low back pain is more common among individuals with physically demanding jobs, comorbidities, smokers, and obesity.
- Psychological distress, high pain intensity, and pain at multiple body sites increase the risk of persistent disabling low back pain.
- Low back pain is a multifactorial condition involving biophysical, psychological, social, and genetic factors.
- Early management and prevention strategies are essential to mitigate the burden of low back pain on individuals and society.
Introduction
Low back pain is an extremely prevalent symptom experienced by people of all ages worldwide. This interactive blog aims to shed light on low back pain, its common causes, neurological symptoms, and potential treatments. We will delve into the burden and global impact of this condition, emphasising the importance of addressing it as a pressing public health concern. Whether you’re currently suffering from low back pain or interested in preventing it, this blog will equip you with valuable knowledge to take charge of your back health.
What is low back pain and some of its characteristics
Low back pain is not a disease but a symptom that can result from various abnormalities or diseases. It is characterised by pain located between the lower rib margins and the buttock creases. Low back pain is prevalent in both men and women. It affects people across all age groups, peaking in mid-life. The burden of low back pain is higher in working populations, and it becomes more disabling with age.
Common causes of low back pain
Low back pain is typically labelled as “nonspecific” because specific nociceptive sources cannot be identified in most cases. Although some serious causes, such as vertebral fractures, malignancy (cancer), or infection, account for a small proportion of cases, they require targeted management.
Imaging findings are not always indicative of the pain source, leading to debates on their role in diagnosis.
However, neurological sources like radicular pain and lumbar spinal stenosis can cause leg pain in conjunction with low back pain.
Neurological symptoms associated with low back pain
Radicular pain, commonly known as sciatica, occurs when there is nerve-root involvement or irritation. It is characterised by leg pain worse than back pain, pain worsening during coughing or sneezing, and a positive straight leg raise test. Radiculopathy, on the other hand, involves weakness, loss of sensation, or reflexes associated with a particular nerve root, and can coexist with radicular pain. Lumbar spinal stenosis, caused by narrowing of the spinal canal or foramina, can result in neurogenic claudication.
Specific pathological causes of low back pain
Although most cases of low back pain are non-specific, some potential causes require specific treatment. These include vertebral fractures, inflammatory disorders (like axial spondyloarthritis), malignancy, infections, and intra-abdominal causes. Red flags, which are case history or clinical findings indicating a possible serious disease, are not highly specific and may lead to unnecessary referrals and imaging.
The natural history of low back pain and does it get better over time?
Low back pain is increasingly understood as a long-lasting condition with a variable course. About half of the people with low back pain have continuing or fluctuating pain of low-to-moderate intensity, while some recover, and others experience persistent severe pain.
Most episodes of low back pain improve substantially within 6 weeks, and by 12 months, average pain levels are low. However, recurrences are common, and approximately one-third of people will experience a recurrence within a year of recovering from a previous episode.
Multifactorial contributors to persistent disabling low back pain
Persistent disabling low back pain is not solely a result of nociceptive input; it involves multiple contributing factors. Biophysical impairments, psychological factors such as depression, anxiety, catastrophizing, and self-efficacy, as well as social and societal factors, all play a role. Understanding these factors and their interactions is crucial in managing and preventing chronic low back pain.
What can a Physiotherapist do for low back pain?
Physiotherapists play a vital role in managing low back pain. They can perform comprehensive assessments to identify contributing factors and design personalised treatment plans. Physiotherapy interventions may include targeted exercises, manual therapy, pain education, and addressing psychological factors like fear-avoidance behaviours. Physiotherapists also emphasise lifestyle modifications and ergonomic adjustments to prevent further episodes of low back pain.
What can you do for low back pain
If you are experiencing low back pain, here are some important actions to take:
- Seek professional evaluation: Consult a Physiotherapist to identify potential causes and develop a tailored treatment plan.
- Stay (relatively) active: It is safe to exercise and work with back pain – you may just have to modify what you do in the first few days
- Manage stress: Psychological distress can impact low back pain, so incorporate stress-reduction techniques like mindfulness or meditation.
Low back pain is a prevalent and complex condition that affects millions worldwide. By understanding its multifactorial nature and taking proactive steps, individuals can manage and prevent low back pain effectively. Remember to seek professional guidance, stay active, and adopt healthy habits to promote optimal back health and overall well-being. Together, we can address the global burden of low back pain and improve the quality of life for individuals everywhere.
If you’re not sure what you can do about your low back pain, contact us today to find out more!
Ref: Published Online March 21, 2018 http://dx.doi.org/10.1016/S0140-6736(18)30480-X
