Getting out of bed. Picking up a coffee mug. Waving at a friend. Bending down to pat a dog. Turning to flush the toilet.
Many who have experienced “doing their back in” have been baffled by the discrepancy between the mildness of the precipitating action and the severity of the resulting pain. How could such a small, innocent movement trigger such paralysing pain that lasts for weeks, months, years or, in some cases, decades?
The reason is that most cases of lower back pain are not the result of damage to muscles, tendons or bone. Most start with something as benign as a muscle spasm, which then sets the lower back on a pathway of nerve sensitisation and pain that is hard to treat.
The lack of serious underlying injury might be small comfort to the estimated 80% of the population who will suffer from lower back pain at some point in their lives. But the good news is that preventing lower back pain is a lot easier than treating it, and when it does occur, many cases resolve by themselves with time.
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‘Joints need to be moved’
The spine is essentially a pillar that protects the spinal cord and nerves and supports us to stand, but at the same time it allows us to bend and turn and twist, says Prof Manuela Ferreira, head of musculoskeletal health at the George Institute for Global Health in Sydney. This requires a lot of moving parts. “There are so many structures that could be involved in the process of back pain; so many joints, so many muscles – big muscles, small muscles – the disks,” Ferreira says.
And we don’t move those structures nearly enough. “Joints need to be moved,” she says. “We’re putting a lot of weight, a lot of load, on the especially the lumbar [lower] spine, without allowing it to adjust itself and move around.”
Don’t ignore the triggers of back pain
Back problems are the third-highest contributor to disease burden in Australia, and account for 2.2% of the national health budget. At any one time, one in six Australians is suffering from back problems.
The reason back pain is so common is because many people experience their first episode of back pain in adolescence and it has a high rate of recurrence: around one-third of people who have an episode of low back pain will have another one within a year.
But what triggers it in the first place? “We know there are genetic factors that predispose the back pain, we know that there are lifestyle factors, there are mental health factors,” says musculoskeletal therapist Prof Peter O’Sullivan from Curtin University in Perth.
Often, the most likely explanation for that first muscle spasm is we’re simply run down. “The current view is the majority – and this is like 95% of back pain – will often emerge at a time when you’re under stress, not sleeping, not as active, fatigued, and then you do something like just be bending over, picking something up, and then your back spasms,” O’Sullivan says. That acute pain then causes us to seize up, to move less, to protect the area, which in turn causes changes in the surrounding tissue and nerves so they become sensitised to even the slightest and most benign stimuli.
The pain is real
Anyone who’s experienced lower back pain might be surprised to learn that it’s rarely caused by serious injury. But studies using imaging technology such as X-ray, CT and MRI scans show that in the majority of causes, there is no obvious difference between people with pain and people without pain. “This old thinking of, ‘Oh, you’ve done your back’ is not supported with current evidence,” O’Sullivan says.
That doesn’t diminish the crippling effects of lower back pain. O’Sullivan likens it to a muscle cramp or severe headache: the pain is real, even if medical technology can’t pinpoint what’s causing it.
Adopt a healthy lifestyle
As with so many musculoskeletal issues, an ounce of prevention is worth a pound of painkillers. A recent Australian study showed just how important – finding that lifestyle changes such as sleeping better, quitting smoking, eating a healthier diet and getting more physical activity could save people thousands of dollars on healthcare for low back pain.
One participant in the study was a woman who had lived with chronic low back pain for more than 40 years, says PhD researcher Tiara Tian from the University of Sydney. “She went from being very impacted by back pain in her daily life, all the way to not being bothered by back pain for the last 12 months,” says Tian. All it took was a gradual increase in physical activity, from a 15-minute walk around the block every day to a Zoom-based exercise class.
‘Move the spine in all directions’
The solution to the majority of back pain is to just keep moving, experts say. “The best movement is the next movement,” O’Sullivan says. In terms of specific exercises for the spine, O’Sullivan says yoga can help. “We encourage people to move the spine in all directions … flex, extension, rotate and side-bend.”
Exercising with back pain doesn’t mean ignoring the pain, but doing as much as you can with it, Ferreira says. “You have to change how you move, but you have to keep moving – it’s almost like reminding your brain that it’s OK to move.”
