Lower Back Pain. A Pain in the Ass.
Where does it come from and what can we do about it?
One of the most common complaints I see most regularly in clinic is non specific lower back pain. As a society, it seems to plague us. It also seems like we've gotten to the point in some situations that we are expected to have it, and worse, are expected to live with it. But why are we so accepting of it?
Is it the fact that it's just so common and associated with any other ageing process like going grey?
According to the NHS, *back pain is the single biggest cause of disability in the UK, with lower back pain alone accounting for 11% of the total disability of the UK population.
So where does it come from?
It's true that any way we look at it our ageing bodies are likely to show some wear and tear. But how much of back pain cases are actually age related? I see younger and younger clients each year complaining of back pain, some involved in sports, some not. Non-specific lower back it seems, doesn't discriminate. We could put some cases down to our lifestyle and work. Many jobs involve long hours spent sitting either at a desk or in a vehicle, excessive manual labour or being on your feet for a double shift. Then there's our extracurricular activities, (yes you horse folk, I'm looking at you accusingly), many sports can increase the risk of back pain through injury, just ask the rugby lot. So if it's a combination of lifestyle & age, what the hell can we do about it?
Well, it seems to me we have a few options here:
Turning back the creeping hands of time to when we were younger
As far as the first option goes, it's a bit of a minefield. The truth of the situation is simple. We just don't fully understand how pain, and more specifically chronic pain, works. That's it.
The range of back pain complaints are vast, from mild to severe, with some being resolved via oral medications, some by various physical therapy and treatments like deep tissue massage, others by various targeted injections, the most extreme by surgical interventions. Then there's arthritis, disc problems, and heaven forbid, 'gluteal amnesia' (thanks for that little gem Dr McGill). I find it best not to look at the reasons why too closely, working towards a solution is time much better spent.
Mild to moderate pain can often be managed by over the counter NSAIDs, being an effective solution long term for some people. Others however, get little relief from such medications.
So for those of us who sit in the mild to moderate category (which is often case the non-specific category too), what can we do?
For a start, we can move more. The human body has evolved over millennia to move, and not just a stroll a day. According to the NHS, the guideline is *150mins of moderate intensity exercise a week or 75mins of vigorous activity a week. I've added the infographic below.
For those that choose not to rely upon NSAIDs, and who can't magickly turn back the hands of time, it seems as though exercise and movement are the best options to manage or even eliminate non specific lower back pain. But where to start? We're lucky enough to have various accessible movement practices available to us as a society, but I do think if you're going down that route you need to be honest with yourself about what you'll stick with. There's no point starting something that bores you before you even put some activewear on, you just won't stick at it or you'll find yourself making excuses to skip it. There's also no point starting something that you'd find torturous, the old saying of 'no pain, no gain' is absolute b******t, it falls into that same medical advice category as putting butter on a burn. You don't have to suffer in order to improve your health. I'll say it louder for the people in the back. A mild discomfort during exercise or treatment is fine, but you shouldn't be sweating with the pain, its just counter productive.
In my humble opinion the best thing to do is try several different things, after narrowing down what will fit in with your current lifestyle. Are you an early bird who'd enjoy getting up and out to exercise before your day starts? In which case some gyms open at stupid o'clock, as do most public swimming pools. Do you have a dog that may enjoy a run with you before breakfast? Or are you more likely to go to an evening class or work out at home (this requires much more discipline!), there are plenty of classes like Pilates , Yoga, HIIT, Body Balance, Boogie Bounce (mini trampolines), or even something more club focused like a martial art or hockey if you're so inclined. I suggest looking locally first and finding out what's available, it's much easier to attend a class that's only a stone's throw away. Then see if they do taster sessions so you can see if you like it. Having an exercise buddy works for some people as they can motivate each other (sounds like a nightmare to me but whatever works!).
The main thing really is that if you're motivated enough to really DO something about your pain, just get on with it. Throw the excuses in the bin and go have a bash at something new, you might just enjoy it, hell you might be blooming awesome at it. If it turns out you hate it, so what? Try something else, the likely-hood is you'll eventually find something you enjoy enough to WANT to go and do it rather than force yourself to go and spend the entire time watching the clock.
Go forth and move.
Until the next time, just keep on trotting on,
*NHS England-The National Backpain Pathway 2016-Charles Greenough.