A recent journal article in the Medical Journal of Australia* prompted this blog to encourage our clients to learn more about how they can take control of back pain. Low back pain gets 80% of us over our lifetime. It often resolves without treatment in the first week or two but recurs in up to 70% of cases. It is also common in adolescence (up to 50%). The assessment of back pain must consider the mechanics or movement relative to the muscles and spine itself however red flags and biopsychosocial factors are equally if not more important.
Red flags are indicators of medical conditions (rather than musculoskeletal cause of back pain) that need to be considered via assessment and sometimes GP referral. The diagnosis process sometimes involves investigations via Xray or MR scans which is important but comes with risks of opening a pandoras box of what may be causing the pain (e.g. knowing there may be a problem with our spine often adds to the psychological side of how pain can persist, when in fact we shouldn’t be worrying about most of the findings on scans). It is generally understood that in a small % of cases (usually <20%) a problem identified on investigations can be related to the cause of a person’s pain. In the rest of people with back pain the findings do not correlate with what is causing their pain.
For the 80% which is the majority, the word biopsychosocial is now generally applied to understanding the reason for a person’s back pain. Yes we still need to rule out the red flag problems and the persistent mechanical back pain coming from the musculoskeletal system. But the 80% of people with low back pain need to consider the many contributors that are often psychological, social and environmental / lifestyle factors. These must be considered in taking control of back pain. Getting a good opinion early on that considers all of these factors is essential but sadly is not common enough.
Good things to remember with low back pain:
- Getting active helps a lot of people take control of pain. The reason why can be complex but it works … you just have to find the exercise that suits you best.
- Stress is a big factor with persistent pain. Just considering this is a start towards managing the problem.
- Surgery is rarely the answer for low back pain.
* Atkinson & Zacest MJA 204 (8), p 299-300, 2 May 2016