LOWER BACK PAIN

Movement & mindset can help with pain.

Lower back pain has been identified as a ‘global epidemic’ by The Lancet medical journal. Over 84% of adults will experience lower back pain in their lifetime, with the burden on both the individual and the economy continuing to rise. Just as the causes of lower back pain are vastly varied, so too are the solutions. Many people in pain seek a ‘silver bullet’, which can unfortunately send people on a medical merry-go-round. So how can you regain control of your pain and your life?

WHAT IS HAPPENING IN LOWER BACK PAIN?

Lower back pain is a symptom, not a disease and it can come from many causes (both known and unknown). Fortunately, the vast majority of lower back pain is not sinister in nature and requires looking at the whole person, including mind, body and lifestyle.

Movement & mindset can be medicine.

Although it is common to be sent for medical imaging with back pain, it’s important to remember that many findings or ‘abnormalities’ identified in those with pain are also frequently found in people without any symptoms at all. This doesn’t mean that pain is not real or important, it is just helpful and interesting to note that imaging does not always explain the onset or predict the course of lower back pain. So, what can actually we do about it?

1. Keep moving

Did you know that paracetamol has been proven no better than a placebo tablet for an episode of lower back pain? While the typical advice for back pain used to include bed rest, this has now been shown to delay recovery and create further fear around movement.

The better you move, the better you are. Start with a gentle walk and some light stretching to reassure your body that it is safe to move, before building back up to previously enjoyed activities. There is certainly no one ‘best exercise’ for lower back pain – instead, people should choose something that they enjoy and will do regularly. This could include yoga, Pilates, strength training, cycling, swimming, sport… the release of feel-good hormones in the brain also act as painkillers!

2. Controlling the controllable

Research finds that certain factors can predict the likelihood of developing lower back pain, but the good news is that most of them can be modified!

• Body mass: being overweight is linked to long term lower back pain, but exercise also helps with weight and pain outcomes.

• Smoking: have you thought about cutting back?

• Physical inactivity: doing less than 150 minutes of moderate activity per week increases the risk of lower back pain, amongst many other health conditions.

• Catastrophising: beliefs that your back is ‘broken’ and never going to improve, can be a self-fulfilling prophecy.

• Fear-avoidance: the more you are worried about doing, the less activity you will end up doing, which is not helpful in the long term.

• Work satisfaction: studies have repeatedly found that being less satisfied with your job is linked with higher rates of lower back pain. Could it be time for a career change?

3. Mind your mindset

Modern pain science supports the observation of thought patterns which may be considered ‘helpful’ and ‘unhelpful’ to long term pain outcomes. The theory is that our thoughts and beliefs can either create ‘danger’ signals within us, or ‘safety’ signals. Consider the following beliefs about lower back pain:

• ‘My back is unstable’

• ‘I’ll never get better’

• ‘My back is out of alignment’.

If left unattended, these thought patterns can create more unease in the body and in turn, actually increase pain. Beliefs which can create ‘safety’ signals include:

• ‘I am strong and durable’

• ‘Even though I have a bit of pain, I’m going to go for that walk’

• ‘Motion is lotion for the body’.

It takes some time and effort to reframe beliefs, but in the long run, the work is worth it. Some people benefit from having a coach (family member, friend, trusted health professional) to remind them of these beliefs and habits when things get tough.

The take home message: Don’t wait until you’re absolutely pain free to get back to doing what you love. By gradually building up strength with exercise, most people find that the lower back pain becomes a whole lot more manageable and life gets much more enjoyable.

Jennifer Smallridge is an Accredited Exercise Physiologist at Upwell Health

Collective in Camberwell, Victoria; as well as an Academic Lecturer in the fields of Exercise Science and Functional Human Anatomy elopment.