10 surprising things re: low back pain

Everything humans know about successfully treating sore low backs

Regarding low back pain, you could probably stack paper to the ceiling (likely a few times over) considering the amount of research that’s been done. The Lancet published three significant papers discussing our current understanding of back pain, including its prevalence and treatment. 

What are the Lancet reviews? Think the biggest low back pain nerds researchers on the planet coming together to summarise everything humans know about successfully treating sore low backs. 

You can read these papers here: The Lancet – Low Back Pain Series.

Let’s summarise their findings!

1. Lower Back Pain (LBP) is extremely common: It affects millions, if not billions, of people worldwide. Almost everyone will experience some form of LBP during their lifetime, making it one of the most prevalent health issues globally.
   
2. LBP is often a normal part of life: Experiencing a brief episode of LBP doesn’t necessarily indicate a serious problem. Many cases are temporary and resolve on their own without requiring extensive treatment.
   
3. Persistent LBP is worsening despite healthcare advancements: Despite the progress in medical research and treatment options, the prevalence and impact of persistent LBP have not decreased. This indicates a need for better management strategies and a reassessment of current practices.
   
4. LBP is usually grossly mismanaged: One significant factor contributing to the high prevalence of LBP is the frequent use of low-value interventions. These are treatments that have little to no benefit for the patient and can sometimes cause more harm than good.
   
5. Prudent use of medication, imaging, and surgery: Treatments such as manipulations, acupuncture, dry needling, surgery, and injections are either not recommended or should be used very selectively. Over-reliance on these interventions can lead to unnecessary costs and potential complications.
   
6. Most episodes aren’t serious: While most LBP cases are not indicative of a severe medical condition, certain symptoms, such as numbness in the saddle area, bladder or bowel issues, loss of sexual function, gait disturbances, and severe pain that doesn’t improve, should be considered red flags and warrant immediate medical attention.
   
7. LBP is caused by myriad factors: Physical, environmental, psychological, and social factors all contribute to the development and persistence of LBP. This multifactorial nature of LBP means that a holistic approach is often necessary for effective management.
   
8. You are not your MRI: Imaging results, like MRIs, often show abnormalities that may not be the actual source of pain. LBP is influenced by more than just physical findings, so treatment should focus on the overall well-being of the patient.
   
9. Rest and time off work are almost always a terrible idea: Contrary to traditional advice, prolonged rest and time off work can exacerbate LBP. Instead, staying active and engaging in regular physical activity is crucial for recovery. Education that promotes self-management, reassurance, and a return to normal activities is essential.
   
10. Education (like what’s mentioned here) and exercise should be first-line treatments: Providing patients with education about their condition, encouraging regular exercise, and alleviating fear of movement are key components of effective LBP management. These strategies help patients take control of their condition and prevent chronic issues.

At the end of the day, most episodes of LBP get better regardless of what you do or don’t do!

Many LBP cases improve on their own with time. However, if you’re in pain and seeking a therapist who follows evidence-based practices, consider Abound Physiotherapy for professional help.

References:

Foster, N. E., Anema, J. R., Cherkin, D., Chou, R., Cohen, S. P., Gross, D. P., . . . Woolf, A. (2018). Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet. doi: 10.1016/S0140-6736(18)30489-6