I came across a startling statistic recently that surprised and also angered me a little bit, and I’m not easily angered. Only 7% of people who attend their GP with back pain will get referred to a physiotherapist. Now I always struggled a bit with maths but doesn’t that leave 93%? So what happens them? Some will be given the standard, pre written prescription of anti inflammatories and pain medication and hope it will settle. And many will. Some will be referred for further radiological investigation which is usually not warranted, contributes to rising healthcare costs and waiting lists and exposes them to unnecessary levels of radiation. Some are told to take bed rest, the worst thing you can do. But here’s the thing. A history of back pain is the biggest risk factor for future episodes of back pain. So would attending a physiotherapist to address what maybe caused the painful episode not make more sense than painting over the cracks with pain medication? And addressing the issue early means eliminating compensatory movement patterns that develop due to pain inhibition.
Here are my top 5 tips for back pain.
1. Keep moving
Easier said than done maybe but the benefits of continuing to remain mobile far outweigh the stone age method of taking to the bed. I recently saw a gentleman who had been prescribed medication and 2 weeks bed rest for an acute episode of low back pain. At this point he returned to his GP for review with limited movement and improvement who recommended he attend a physiotherapist. Cheers Doc! Two weeks to stiffen up then send him on. Inactivity will cause a pattern of stiffness, deconditioning and fear of movement – a bad pattern to get into, resulting in longer recovery and absence from work.
2. Hold off on the MRI scan
MRI should only be considered when symptoms are not resolving and invasive surgery is being considered. A detailed examination and assessment should give most of the information required to make a diagnosis. We may not be over joyed when we begin to see traces of grey hair and balding in our 30’s and 40’s but are we surprised? Then why should we be surprised to see similar age related changes in joints? Terminology like “degeneration”, “protrusion”, and “arthritic” will show up on many X-rays even with patients with no back pain at all. This information, if not of significance to their problem, can in fact do more harm than good creating further fear avoidance behaviour from certain movements. Degeneration means nothing unless it is related to your clinical findings and symptoms.
3. Limit Stress and address low mood
Both high stress levels and low mood have been linked with increased risk of back pain. It may be worthwhile making some necessary changes to manage both if this is the case. Limiting the contributing factors would be the first place to start. But then there’s that other magic solution that keeps cropping up as in previous blogs – exercise. Exercise reduces the incidence of low back pain as people that are overweight have an increased likelihood of having back pain. But exercise also creates good mood and positivity by releasing endorphins – my drug of choice!
4. Nothing is out of place!
Seriously. One of the most frustrating things I hear from patients is that they were told from another therapist before that something was “out of alignment” and they “put it back in” for them (and now I’m angry again…for the second time in this piece). It can be very hard to convince people otherwise once this idea has evolved in their mind. While someone may present with a postural deviation due to pain during an acute episode this does not mean a disc has popped out. It equally does not mean that manipulation can pop it back in. Manipulating a joint is useful in reducing pain by normalising muscle tone and spasm.
5. Seek the advice of a Chartered Physiotherapist
Everyone you meet on the street will have an opinion on what you need to do about your back pain. Because it is so prevalent most people will have experienced an acute episode at some stage of their life. Some will tell you the person you absolutely NEED to see about it, others will have you fearful that your only option is surgery. They all mean well but few have any idea what they are talking about. So talk to the professionals. Not only will a Chartered Physiotherapist assess and identify the cause of your pain but aim to prevent future episodes by prescribing exercises to address issues with mobility or stability. It may come as a surprise to many but physiotherapists do far more than massage and inflict pain on people. In my opinion one of the most important roles of a physiotherapist is to educate the patient about their problem, point them in the direction they need go, and give them the means to overcome that problem
For more information on any of the issues addressed throughout this article please contact Rob via email at firstname.lastname@example.org, Twitter @mccabephysio, Facebook at McCabe Physiotherapy or visit http://www.mccabephysiotherapy.com
Rob McCabe MISCP
MSc (pre reg) Physiotherapy, BSc Sport Science and Health, MSc Sports Physiotherapy, PG Dip Orthopaedic Medicine
Orchard House, Moorefield Rd, Newbridge, Co. Kildare
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