Is back pain bad?

Back pain and movement

For many years health professionals have been educating people to be careful about how they move especially with regard to their back. This has inferred that the back is weak and has a poor tolerance to activity. We now know that this advice is not necessarily correct. 

Your back is a very strong structure, and it is designed to move and be used. However, our lifestyles have tended to mean that many of us are generally weaker that we should be. This affects the ability to take load through all parts of our body, including our spine. Indeed it is the lack of moving, and the maintaining prolonged static positions that is more likely to result in problems.

How many people have back pain?

Research tells us that up to 80% of the adult population is likely to have an episode of back pain over their life. This usually settles quickly, like many other aches and pain do that we get from time to time. This is normal. However, in a small percentage of the population this becomes more chronic or repetitive in nature.

What should I believe?

Current thinking tells us that what we are told make a large difference to ongoing problems. When our back becomes sore we are told to look after it and not stress it. We have in the past been told that something is ‘out’ or we have slipped a disc. All these things lead to the belief that something is wrong, we need treatment, and we have to protect and look after it. However in the vast majority of circumstances there is no specific physical damage to the back. There are no torn ligaments or muscles, or joints out of place.

What has happened is that something has been overloaded and it has not coped, so it has reacted to the situation. This often creates muscle spasm, which can result in muscle pain. This is the bodies way of trying to protect itself. There may also be some inflammatory changes locally. All this results in the small nerves getting irritable and send messages to the brain, and we respond.

Our bodies response is strongly influenced by what we are told or understand. If we believe we need to protect ourselves the muscle stay tense for longer. The ongoing muscle tension may then lead to changes in how our body perceives the back. The nerves become more sensitive, resulting in small amounts of input creating excessive responses. Things like normal movement can then become painful. This all reinforces the process. The longer this happens, the harder it is for the cycle to be broken, and even when it is, it can leave behind memories which become active again next time something happens.

On the contrary, if we believe or are told that there is minimal damage and it will settle well, just like any other minor injury, and we keep moving, in a sensible way, our body keeps getting normal input and reacts accordingly. The muscle will relax and any inflammation settle, and we will feel better. This is not to say there will be no pain, but means the likelihood of everything winding up and getting over excited is much less likely to occur. This results in a much quicker recovery, and better long term results.

How can exercise help back pain?

So where does exercise fit in to the picture? For many years research had been telling us exercise is good not only to help prevent back pain but also in its recovery. Many studies have looked into what type of exercise works best. Unfortunately, the results of these studies are often conflicting. This is probable because a study looks at a group of people, where as individuals respond differently. However this also means if one type of exercise is not helpful a different style may be more beneficial.

As mentioned above much of the cause of back pain is due to the body being overloaded. General exercise resulting in improved strength and stamina is of great value here. With your body strong it is better able to cope with your daily demands, be it lifting machinery or sitting at a desk.

Once you have back pain, exercise also has a major role. Part of this role is to maintain your mobility and teach or remind your body it still can move and do things. This sends normal messages to the brain which help turn off the protective spasm. This helps stop the region from creating over excitable messages which wind up pain and create memories of pain and dysfunction, helping limit chronic pain and further back problems.

Though there is some disagreement in what exercises work we do know from research that you need to do them for them to work. This may sound obvious, but compliance is often an issue when any exercises are given. We also know that the best long term results are when people keep doing some exercise. Reoccurrence rates drop, and significantly fewer sick days due to back pain are taken with those who keep exercising. This is most likely because you are maintaining your bodies ability to cope with the demands you place on it over the day.

In summary then, my key messages are:  

Key messages

  1. Back pain is common but in most cases not harmful
  2. Exercise has been shown to help prevent back pain
  3. Exercise is an important part of helping resolve back pain
  4. Continuing to exercise is important in stopping reoccurrence of episodes
  5. Poor education on back function can make your episodes of back pain worse and increase the likelihood of chronicity
  6. You back is supposed to move. Static and repetitive postures are more likely to cause problems

 

If you have back pain – what are the first steps to helping?

  1. See a Physiotherapist to help you with setting up a plan to help you manage and improve your pain and symptoms.
  2. Progress to structured exercise as soon as practicable.  Find an Accredited Exercise Physiologist, or experienced Personal Trainer with experience in rehabilitation to help you do this.
  3. Keep going with the exercises even if you do have pain! It works as prevention as well as a cure!

 

Hamish Ashton, Author is a Senior Physiotherapist at Vector Health and Performance with more than 25 years of clinical physiotherapy experience in a wide range of settings.  Vector Health and Performance can help you with back pain or injury with physiotherapy, exercise physiology, strength and conditioning.  To make an appointment please call 4927 8190 or email reception@vectorhealth.com.au

 

 

 

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