Back pain is very common
In fact, about 1/3 of the population will have back pain at some stage each year. The good news is most of these people recovery very well within a few weeks without need for invasive management options such as injections or surgery.
It is very rare for back pain to need urgent medical intervention or surgery
Most back pain is caused by soft tissue strain, joint restriction, nerve irritation or lack of movement. In some rare cases (less than 5%), back pain can come from serious problems such as organ pathology, cancer, fractures or compression of the end of the spinal cord (cauda equina). These conditions are indications for urgent medical assessment and treatment. Thankfully they are rarely seen.
Imaging in back pain is not usually needed
Imaging for back pain has been shown to be very unreliable and inconsistent. As you can see in the table below, even in people with no history of low back pain there are many findings on their scans.
Discs can’t slip and joints can’t pop out of place
Spines are very strong structures. Not only do they have the joints holding them together but also the discs, a lot of ligaments and some pretty big muscles. This means that the joints can’t just pop out of place and that the discs can’t slip out from between the bones. Our spine protects one of our most important structures, our spinal cord. It makes sense that it is so strong and robust.
Rest is not good for low back pain
Although it might feel good at the time, people who rest in bed or on the couch excessively will have worse back pain afterwards. The best thing to do with back pain is try to continue doing as much of what you usually do without causing too much pain.
Exercise is great for low back pain
The more we move with low back pain the better we feel. The last thing you want is for your joints to become stiff and restricted, or your muscles to shorten and lose their strength. Keeping active while managing your low back pain is important. This may not mean going and doing heavy squats, but doing some stretching and walking is ideal.
Beware strong pain medications
Although strong pain relief might be needed in some cases, it is best to avoid it where possible and restrict their use to the shortest time possible. This is recommended for several reasons. Firstly these medications can have significant side effects, are addictive and can limit your capacity to drive and work. Secondly, it has been shown that opioid pain medications, such as Endone and Codeine, actually increase the sensitivity of your nerves and brain, gradually making your pain worse and the medications harder to stop taking.
Pain does not equal damage
Pain is a complex sensory experience dictated by a lot of different factors. Most people expect that the amount of pain they feel is directly related to the amount of tissue damage that has occurred. This is not the case. An excellent example is when we get major muscular spasm. In this instance, there could be little to no actual tissue damage but the muscular spasm is significant which can cause a lot of pain and movement restriction. Also the amount of pain you have initially does not predict how long you will take to get better.
The spine is meant to lift, twist and bend
The spine is a strong and robust structure with many supporting ligaments and muscles. It is designed to be able to bend forwards, backwards and sideways as well as twist. Don’t be afraid to use it for these things. It is also designed to lift objects. Ideally we should keep a straight back to lift and push with our legs as well, but our back is strong enough to tolerate lifting loads. It is usually only with repeated lifting, lifting in awkward positions, or lifting with weak back muscles that causes problems.