Lower Back Pain

How much of a problem is lower back pain?

On average, each person suffering with Lower Back pain took an estimated 18.7 days off work! This cost employers £315-£335 million in the UK. In Europe 24.7% of workers complain of backache. Half a million people sustain a back injury at work and up to 80% will experience a back problem during their working lives.

So quite a big problem then!

So what can cause lower back pain?

Well it sounds obvious but there is strong evidence that history of lower back pain (LBP) is a predictor of the onset of non-specific LBP (Janwantanakul et al, 2012)

Also:

65 - 80% of serious lumbar disc degeneration is inherited! But cumulative low back load is a significant risk factor for the development of lower back pain (Coenen et al 2012). There is a link between lower back pain, poor posture & poor abdominal muscular endurance (Mullhearn & George 1999) but although the link is there is it chicken or the egg?

So what are the main injuries that cause back pain?

In 80% of back pain, it is not possible to identify the exact structure causing the pain! This is even with MRI scans etc. and the reason for this is that just because the MRI shows or doesn't show an issue in the back doesn’t mean that the actual issue seen is causing the pain. For example Chronic regional pain syndrome causes pain but has no visible cause, which is very similar to phantom limb pain for a leg that has been amputated.

Facet joint injury: The role of the Facet joints is to limit excessive movement and provide stability for the spine & it accounts for between 15% to 45% of patients with chronic lower back pain. Lumbar facet injury most commonly refers pain to the buttock (42%) & least into the groin (3%) (Cleland & Koppenhaver 2005).

Disc Prolapse: This is when the disc between the vertebras bulges out and presses onto a nerve root. A positive straight leg raise test with leg pain between 30-75 degrees is 82% accurate at diagnosing a lumbar disc prolapse (Albeck et al 1996).  It is common in people who do a lot of sitting and sustained and repetitive bending activities.

Osteoarthritis: This is when the joints in the spine degenerate and wear over time:  Lumbar spondylosis or degenerative disc disease.

Stenosis: (Technically part of Osteoarthrits effects) Narrowing of the space where the nerve root comes out from the spine. If you are over 65, your back pain is relieved by sitting & is made worse with walking and standing then it's 89% likely you have stenosis (Cleleand & Koppenhaver 2005).

So what can help?

The National Institute of Clinical Excellence (NICE) guidelines for lower back pain say screening protocols to assess the problem correctly, patient education, manual therapy, exercise, acupuncture, psychological treatment and if the problem is not responding to these then invasive treatments such as injections or even surgery are needed.

Here is what some of the evidence says:

Pain relief and anti-inflammatories:

Non-steroidal anti-inflammatory drugs (NSAID’s) are slightly effective for short-term symptomatic relief in patients with low-back pain without sciatica (Roelofs et al 2011).

Manual therapy:

Spinal Manipulative Therapy appears to be as effective as other common therapies for chronic low-back pain (Rubinstein et al 2012).

Massage: Beneficial for patients with subacute & chronic low-back pain, especially combined with exercises & education (Furlan et al 2010).

Hypomobility (reduced movement) in the lumbar spine is 97% likely to benefit from lumbar spinal manipulation (Cleland & Koppenhaver 2005).

Acupuncture:

Chronic low back pain: Acupuncture & conventional therapies improves pain & function more than conventional therapies alone (Furlan et al 2010). 

Exercise:

An integrated back stability program significantly reduced pain & disability in the subject group studied (Norris & Matthews 2008).

Stability ball exercise was beneficial in increasing movement, reducing pain & increasing strength post back pain (Petrofsky et al 2008).

Post-treatment exercise programmes can prevent recurrences of back pain (Choi et al 2010).

Psychological treatments:

For Chronic lower back pain operant therapy was more effective than waiting list controls in the short-term (Henschke et al 2010).

Surgery:

Surgery is required for less than 4% of lower back pain but it is not usually done for pain relief.

Exercise programs 4 to 6 weeks post-surgery leads to a faster decrease in pain & disability after lumbar disc surgery (Ostelo et al 2010).

However limited evidence is now available to support some aspects of spinal surgery for degenerative lumbar spondylosis (Gibson & Waddell 2005).

Discectomy for carefully selected patients with sciatica that is caused by a disc prolapse achieves a faster relief of symptoms than conservative treatment(Gibson & Waddell 2007).

If you need more information on Lower back pain or need to book an appointment then call me on 01782 771861 or 07866195914

http://www.hawkesphysiotherapy.co.uk/