Evening Echo article on August 8th 2018

Suffering from back pain?

Chartered physiotherapist Shane Hennessy explains how to best manage your back pain and reduce the risk of it returning

Back pain will affect over 80% of us in our lifetime and worryingly almost 40% of us will develop a recurrence of this pain within a year. It is the second most common cause of people taking time off work and costs the health service millions every year. Back pain can vary from a slight ache for a few days to a persistent pain that may require further treatment and even surgery in severe cases. It is very important to remember that the vast majority of back pain is not serious. In most cases the pain disappears within six weeks but may recur from time to time. Only around 1% of back injuries are serious and need further investigation or invasive treatment such as surgery.

The most common type of back pain is often referred to as nonspecific low back pain. This means that the pain is not due to any specific or underlying disease that can be found. It is thought in some cases to be due to an over-stretch or sprain of a ligament or muscle. In other cases the cause may be a minor problem with a disc or a minor problem with the small joints called facet joints between the two vertebrae.

Sciatica refers to nerve root pain and this occurs in less than 1 case in 20 of acute low back pain. Nerve root pain means the nerve coming of the spinal cord is irritated or pressed on, usually by a disc bulge in the back. Typically the pain is felt along the course of nerve spreading down the leg and often to the foot itself.

General practitioners and chartered physiotherapists are trained to assess your back to ensure no serious pathology exists. Seeking their advice is a good first port of call in managing your back pain.

One of the key components in managing a bout of back pain is to stay active and continue with normal activities as much as possible.This may not be possible at first if the pain is quite bad. However it is imperative to move around as soon as you are able and accept that there may be some discomfort in trying to keep active. Bed rest is not helpful for your back pain and is in fact associated with higher levels of pain and disability. An effective strategy in managing back pain involves manual therapy. There is good evidence that early intervention of this sort reduces the duration of the condition. Your physiotherapist will generally recommend a few sessions of soft tissue work, spinal mobilisation or taping techniques. These can provide good relief of pain and facilitate return to activity and exercise.

Medication has a role in relieving the initial pain. Medications prescribed usually include anti inflammatories, muscle relaxants and painkillers. Your general practitioner may recommend these in the early stages to allow you to remain active and benefit from rehabilitation programmes and exercises.

Exercise is key to your recovery however. A chartered physiotherapist is trained to assess for any movement or structural faults which may predispose to recurrent back pain and educate you on how to reduce your risk. Individualised exercise programmes can help you to recover more quickly and support your lower back. These programmes often include strengthening and core stabilisation exercises which have been shown to be very effective in reducing further episodes of back pain. Like any treatment, dosage is important and if the program is not followed consistently, just like a course of antibiotics for an infection then the treatment is often ineffective. With that considered, it is important to note that the best exercise is the one that gets done so a good starting point is with something you enjoy such as walking, cycling or even gardening.

You may be thinking, what about a scan? There has been a huge surge in recent years in the amount of people getting MRI scans on their lower back when in fact most of the findings reported on these scans should be considered normal. For example, some studies have shown that over 50% of people with no back pain have a bulging disc or that around 30% of people in their 20’s will have some degenerative changes in their spine.  The problem arises when people are told that these “abnormal findings” are the cause of their problem and this then leads to further fear, distress and avoidance of normal activities. An MRI scan can be useful in certain cases when the pathology is unclear for the treating clinician but by and large it will not change the treatment strategy.

So remember do not panic if you experience low back pain, it’s mostly not that serious. Seek help from your GP or Physiotherapist to manage the pain, and it’s crucial you stay active  and try to carry on with your normal activities during your spell of back pain.