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Non Specific Low Back Pain

6th October 2020

What is it?

The term Non-Specific Low Back Pain is a generic way of identifying low back pain. Mainly this is because there are a number of different tissues that can be a source of pain within the low back, including muscles, discs, joints and ligaments. When examining a person with back pain, clinical tests will engage across the range of tissues in the back, making it almost impossible to single out one tissue over another. Though it means we aren’t able to specify the cause, fortunately we have good evidence to show this can still be managed successfully. Mostly this is by reviewing the individuals’ circumstances around the onset of the pain, and making the necessary modifications to help the pain recover.

This post is intended to provide some advice for people with pain located only around the low back area. If pain is moving into the leg, or pins and needles and numbness are present, then this is something that should be reviewed in greater detail before seeking advice (if you’d like to know how to seek further advice see our Remote Consultation service).

Should I be Active With Back Pain?

Generally people who maintain a regular source of exercise or activity are less likely to suffer low back pain [2], and can see a quicker recovery when back pain occurs [3]. When you have back pain, being active often helps speed up the recovery, but it is essential to make sure you can perform the activity without any pain occurring. This may mean you need to modify the exercise by reducing the intensity or the duration to keep things in a manageable place. One of the biggest mistakes I hear in clinic is people working through or into pain in the belief it will benefit them in the long run. More often pain will increase in this scenario rather than improve. In some cases you may find you still have pain in the exercise, despite making changes to it, and when this occurs you’re better to seek an alternative activity altogether. I find in clinic, identifying the activity that can be performed successfully is a huge help is speeding up the recovery.

How does it occur?

The cause can vary greatly from each individual, but in clinic we find a common causes can include a recent change in lifestyle. When people see a sudden change in the day-to-day activities it can sometimes cause the tissues in the back to become irritated and begin to become painful. In clinic the most frequent change I hear of is an increase in sitting or desk bound work [4]. The reduced movement in the persons daily routine can led to a cause of stiffness that then develops into pain or aching within the low back. This can be described as a creeping or building type of stiffness over a number of weeks or even months. Other lifestyle changes can also have an impact on back pain, and reflecting on any recent changes to your day-to-day actions in the last few months can be very important. This is because it helps identify things to modify or counter to improve the pain picture. The final consideration is that, when sitting, ergonomic set-ups play a key role as well. When you sit in a poor position, or work at a desk with a poor set up, you can create more irritation to the tissues within your low back that can lead to pain or stiffness.  

How can I prevent Low Back Pain?

The key is to make sure you maintain a good balance of activity within your lifestyle to help maintain good mobility. Reviewing the duration of sitting or sedentary nature in you day-to-day living, and then adding brief but frequent breaks to that sedentary activity. As a guide, moving for 2-3 minutes every 20-30 minutes of sitting is often helpful, though you may modify this to suit your daily needs. Everything should be based around what you feel helps in reducing the back pain you may be suffering. This still applies even if you’ve improved your ergonomic positions, but making sure you have a good desk set up is a big help (for information on how to set up your desk position click here). Finally, engaging with some simple movement exercises a several points over the day can prove very effective. This may be in the form a basic Pilates or Yoga routines (if you’re well versed with these disciplines), or a selection of simple low back movement exercises (see our Self Help section of our YouTube channel). Something as simple as performing a few minutes reapplied at several points in the day can be especially useful as part of your management picture.

Should I get a scan or MRI?

In a majority of back pain cases an MRI is often not helpful or needed. As studies have investigated pain free low back scans, they’ve found that people will often show findings such as disc injury or joint wear and tear even though they remain pain free. As an example, 50% of the general population of 40 year olds will show some kind of disc injury, even though they may not have any pain [1]. This means when you have an MRI result it’s still very difficult to identify if the finding is actually part of the pain picture. As in, it may be a coincidence that it found a disc bulge and doesn’t have any actually role within the pain. Also, because of the way we manage low back pain, the information doesn’t change the strategy for improving it. This is because we manage this based on how the person functions, by controlling the things and movements they report are more painful. 

References

[1] Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations; Brinjikji et al.; American Journal of Neuroradiology 36.4 (2014): 811-816

[2] Is occupational or leisure physical activity associated with low back pain? Insights from a cross sectional study 1059 participants; A. B. Amorim et al.; Brazilian Journal of Physical Therapy 23.3 (2019): 257-265

[3] Best Evidence Rehabilitation for Chronic Pain Part 3: Low Back Pain; A. Malfliet et al.; Journal of Clinical Medicine 8.7 (2019) 1063

[4] Association of Exposures to Seated Postures With Immediate Increases in Back Pain: A Systematic Review of Studies With Objectively Measured Sitting Time; D. E. DeCarvalho et al.; Journal of Manipulative and Physiological Therapeutics.(2020) https://doi.org/10.1016/j.jmpt.2019.10.001