Low Back Pain

Non Specific Low Back Pain (NSLBP) is probably one of the most unhelpful terms.

It does not mean that there is no cause or that it’s all in your head.

It simply means that no specific cause can be identified and therefore some of the more sinister causes have been ruled out. However, it is presumed to be of musculoskeletal origin.

Okay so what are some things that we do know about it?

Pathology and Epidemiology

• It accounts for 90% of all low back pain cases
• 50-80% of people will experience NSLBP over their lifetime
• About 8-20% of the population will suffer with it within a year
• 88% of people get better in 6 weeks or less!

So the good news is you are not alone and in most cases you should start to feel better in a relatively short amount of time.

I’ve heard NSLBP compared to the common cold: most people will get it, there is no exact ‘cure’ for it, but you will naturally start to feel better over time – in fact many people will start to feel better within 2 weeks.

It is, however, important to check other red flags:

• Motor weakness in the legs, i.e. with knee extension, or foot dorsiflexion
• Recent-onset urinary or faecal incontinence
• A major trauma such as a road traffic collision or fall from height
• A localised point of tenderness along the spine
• Severe unremitting pain that prevents or disturbs sleep (and no improvement after 4-6 weeks)
• Unexplained weight loss
• Fever

Do seek medical advice if you have any of the red flags above or your symptoms are not improving.

Treatment

Exercise is the best form of treatment, however, massage can be useful for pain modulation and therefore support with getting you moving again.

According to the research pilates is the best form of exercise for both pain and function (Hayden, et al, 2021).

And a high dose of exercise is better than a low dose (Hayden, et al, 2021).

But if pilates doesn’t appeal to you, then the best kind of exercise is the exercise that is best matched to your interests and needs (Cashin, et al, 2021).

Early Rehab

When the pain is high, you want to lower the intensity of the exercise.

The video below provides a few movements where the focus is on finding mobility in the low back to keep things moving at this early stage of rehab.

Rest is certainly not best when it comes to low back pain.

Rest should be limited to the first 24-72 hours and then early activity is the key.

Mid-Stage Rehab

In this stage, the pain should be decreasing so we want to start to increase the intensity of the exercise.

In the following video we focus on bringing in some more movement through the spine with flexion as well as strengthening through the spine by keeping the spine straight.

We also start to bring in some loading with some additional weight. A kettlebell is a great piece of equipment for working with the spine, however, you can also create your own weighted bag to use!

Late Stage Rehab

In this stage you should be pretty much back to normal, so you might be tempted to stop all rehab, however, this is probably the most important stage of rehab!

We want to focus on increasing load and strengthening the back with a variety of stimulus so that the recurrence of low back pain is reduced.

In this video we are focusing on higher impact and velocity movements.

Kettlebell swings are a great exercise at this stage.

References

Cashin, A. G., Booth, J., McAuley, J. H., Jones, M. D., Hübscher, M., Traeger, A. C., Fried, K. and Moseley, G. L. (2021) ‘Making exercise count: considerations for the role of exercise in back pain treatment.’ Musculoskeletal Care, 20(2):259-70. DOI: 10.1002/msc.1597

Hayden, J. A., Ellis, J., Ogilvie, R., Stewart, S. A., Bagg, M. K., Stanojevic, S., Yamato, T. P. and Saragiotto, B. T. (2021) ‘Some types of exercise are more effective than others in people with chronic low back pain: a network meta-analysis.’ Journal of Physiotherapy, 67(4):252-62. DOI: 10.1016/j.jphys.2021.09.004