Does it ever feel like your back has 'gone out'? You are not alone there. Low Back Pain is exceedingly common and affects up to 80% of Australians at some point in their lifetime. It's likely you will experience back pain at some point. But what to do?
Firstly, it's very important to understand that there are many myths about back pain. The language we use to describe back pain underlies these myths, and perpetuates the unmitigated disaster that is the management of back pain in Western Society. The fact of the matter is that the spine, which is the backbone of the body, is one of the strongest, most intricate structures in the body. Older notions of the back 'going out', or 'discs slipping' or the pelvis being 'out of alignment' have been replaced by more up to date concepts, such as the back being sensitized. A mechanical source as the cause of your pain is unlikely to be found.
Therefore, while your back might be very sore...in most cases it's structurally very sound. It will benefit from movement, even when it's very sore.
Do you need imaging? Probably not. While imaging can be useful in the minority of cases, in many cases imaging can actually show 'red herrings' that have nothing to do with your back pain. This can lead to worry, as well as further, more expensive testing and escalation of treatments, such as surgery.
The reality is that most back pain will pass on its own. It may be painful, but it is likely to be "self-limiting."
But what can you do about it now? The following recommendations are for acute and sub-acute low back pain. That is to say, these are recomendations for back pain that has come on suddenly and been present for less than 3 months.
- See a spine care expert. Some chiropractors, osteopaths, physios and GPs have a very up-to-date model of spine care. See one of them for a diagnosis to rule out any red flags, and for reassurance.
- Keep moving. While your instincts may tell you to stay in bed, the reality is that your back will improve with movement and time.
- Therapeutic exercise. Some exercises are very beneficial. But like medication, exercise needs to be appropriately calibrated and dosed.
- Spinal Manipulation. Most guidelines continue to find good evidence that spinal manipulation, or what some chiropractors refer to as an adjustment, can provide short term relief. Some people respond to this treatment, others do not. Therefore, it is important that your practitioner uses many modalities and is open to revising the treatment plan.
- Ice/heat application. Alternating ice and heat can provide relief. Do not apply the ice directly to the skin.
- Analgesia. It's important that you are comfortable, and short term use of acetaminophen, ibuprofen or opioids may be necessary. But believe it or not, the evidence for their usefulness is lacking. Opioids are currently being studied in a low back pain randomized clinical trial. Paracetamol may be recommended is low doses for short term relief, but the most up to date evidence suggests it is ineffective.
- Go back to work! Strange as this may sound, there is excellent evidence that an early return to work is beneficial. Long periods away from work, as well as seeking third party compensation are associated with very poor outcomes and are detrimental to your health, wallet and family life.