Low Back Pain Blog

Back pain is probably the most common complaint a physio receives. I have spent the last 7+ years looking into the research around this topic. Below is a bit of a summary to help you think through managing your pain.

1. Exercise for low back pain: It certainly helps, but it’s also complicated

• Exercise is generally beneficial for low back pain, but the specific type doesn’t seem to matter! Studies comparing different exercise types (like Pilates vs. general exercise, or high-load vs. low-load, weights vs stretching etc.) often show similar long-term results.
• The benefits of exercise may be more “central” than “local.” Improvements might come from psychological, cognitive, and neurophysiological changes (like reduced fear-avoidance or improved body awareness) rather than just increases in strength or flexibility.
• Dosage, relevance, and enjoyment are likely key factors in your success. What people do is more important than what they should do.

2. Your individual goals and the things physios usually measure don’t often align

• People with low back pain primarily have goals related to physical function and activities of daily living. These goals often aren’t reflected in traditional clinical measures like strength and range of motion.
• This is why we use a collaborative approach at Abound, focusing on your goals and preferences. Reducing pain is important to me because it’s important to you, but it also shouldn’t be the only measure of success.

3. The importance of information and sense-making

• In my experience people with low back pain crave information about their condition. They want to understand what’s happening, if it’s serious, and what they can do about it.
• We love to provide clear, reassuring information as a part of treatment. This can help reduce fear and anxiety (which we know can often amplify pain).

4. Rethinking “treatment”

• Education and assessment should be considered forms of treatment in themselves. They can provide significant pain relief and empower patients to self-manage.
• The therapist’s role seems to be shifting from “doing things to people” to “helping people understand and navigate their pain.” I will absolutely use my hands to provide pain relief. But I also want you to not need me moving forward! The best physios are the one’s that try to put themselves out of a job!

5. The value of staying active: For the love of God, please keep moving

• Advice to remain active during back pain is valuable, even if the evidence is not extremely robust. It promotes a positive message and encourages people to get on with their lives. (That sounds harsh but it comes from a place of love).
• Negative beliefs about back pain and activity are extremely common, so I may gently challenge you. Again, from a place of love!)
• Short-term attitudes and behaviours can impact long-term outcomes.

6. Discogenic back pain: More questions than answers

• While disc issues can contribute to back pain, their prevalence in people without any pain or symptoms can raise questions about their relevance.
• Diagnosing discogenic pain reliably remains a challenge.
• Even if discogenic pain is identified, it’s unclear how much this should change management strategies.

7. Deconditioning and physical deficits

• However, focusing on freedom of movement and variability may be beneficial.
• People with low back pain may exhibit increased trunk stiffness, reduced range of motion, and altered movement patterns. In my experience, this is mostly due to fear. The pain’s horrible, so naturally patient’s attempt to shut down all movement in the spine. But this seems quite unhelpful.