Should I Worry About My Lower Back Pain (LBP)?

Current evidence-based practice shows that most of the time the answer is no. For the majority of cases of lower back pain, having a better understanding of the causes and getting some expert guidance from your physio you can fully resolve the problem.

 

Biopsychosocial models: Factors that can influence lower back pain

We are often dealing with lower back PAIN and not lower back INJURY. Physiotherapists use an evidenced-based approach for the management of LBP by way of a biopsychosocial model. This means we need to consider the BIOLOGICAL tissues that are involved in the episode of LBP, the clients’ PSYCHOLOGICAL perceptions and emotions related to the episode of LBP and the SOCIAL context in which this episode of LBP relates to.

 

Taking this is biopsychosocial approach is vital as we know that in most episodes of LBP the physical factors alone are not the only causative influences and that there is significant influence from our body systems. In LBP the structural tissues involved need to be viewed as a source of input that potentially generate a response of pain. This input is open to interpretation and modification by our central nervous system that can either magnify or inhibit the potential pain according to how our body, physically and physiologically, and our mind, emotionally and psychologically, perceives the input as either dangerous or innocuous. This central nervous system process of interpretation and modification is directly influenced by:

  • sleep quality
  • emotional stress, moods
  • fatigue
  • nutrition
  • other health problems
  • physical activity levels
  • mental illness
  • context of symptoms e.g. home, work, sport
  • personality types eg. fearful, depressed, anxious

 

Simply put, when we are tired, run down or stressed our pain thresholds are often reduced. For these reasons the treatment of LBP needs to be dealt with regarding entire body systems including the hormonal, metabolic, psychological and immune systems and not just the involved structural tissues of the musculoskeletal system.

 

When we are tired, run down or stressed our pain thresholds are often reduced.

 

Are imaging scans and X-rays helpful in identifying the causes of lower back pain?

In some cases, getting scans and X-rays unnecessarily can actually increase the experience of pain

 

In most cases of LBP imaging in the form of scans and X-rays are not needed. In fact, getting scans and X-rays unnecessarily can actually increase the experience of pain in some clients! Did you know that half of all over 30 year old’s and two thirds of all over 40 will have degenerative changes in their lower back seen on imaging. If you’re over 60 it is uncommon to not have degenerative changes! When unnecessary scans or x-rays are performed the presence of degenerative changes are often misleadingly blamed for the cause of an episode of LBP when they have no influence whatsoever. The anxiety and fear created regarding the presence of these degenerative changes can sensitize our nervous system and we can increase our experience of LBP. This is unhelpful!

 

Reducing lower back pain by addressing the triggers

When addressing back pain, consider the triggers and how to address them, such as improving nutrition.

 

Let me explain further about addressing lower back pain by thinking about this comparison. When we experience a gradual onset head ACHE and feel some pain, we don’t call it a head INJURY and certainly we do not rush off to the doctor, receive some strong medications and get some scans of our brain. We generally think about what the triggers of that head ache are and try to address them. It may be drinking more water, getting more quality sleep, having improved nutrition, being less sedentary, taking some exercise or decreasing the stress in our lives.

 

Why then when we experience some gradual onset low back ache and feel some pain, we don’t call it a low back INJURY however some of us will rush to the doctor, receive some strong medications and get some scans or X-rays of our lower back. We generally will not think about what the triggers of that back ache are and try to address them. It may be drinking more water, getting more quality sleep, having improved nutrition, being less sedentary, taking some exercise or decreasing the stress in our lives.

 

LBP should be viewed similarly like tiredness, sadness, headaches, constipation or stomach upsets. They are not fun but very common experiences and predicaments of life that most of us experience from time to time.

 

So, try not to worry the next time you experience some gradual onset LBP. For the majority of cases having a better understanding of the causes and influences and getting some expert guidance from your physio you can fully resolve the problem.

 

Article by Michael Bushell, B.Sc. Physio (Aust); M. Manual Therapy (Aust); M.S.P.A. As an Australian Physiotherapy Association (APA) Titled Musculoskeletal Physiotherapist with over 24 years of clinical experience, Michael is a highly qualified physiotherapist with expert knowledge and skills in all areas of musculoskeletal and sports physiotherapy.

Improving your overhead shoulder control to reduce injuries

Overhead athletes such as tennis players, swimmers, cross fit athletes and volleyball athletes need to put their hands above their heads repeatedly for long period of times. Problems arise when the muscles that control the scapula get fatigued leading to injuries like shoulder instabilities, tendinopathies and impingements.

The predominant muscles that are involved in repetitive overhead motions such as required by a badminton player are the Serratus Anterior, Upper and Lower Trapezius.

A simple and great rehabilitative exercise with a kettlebell can be done to improve control and endurance in the Serratus Anterior and Upper Trapezius muscles.

  1. Start with a 6kgs Kettlebell and increase the weight as much as you need to be able to do three sets of 15-20 reps comfortably.
  2. Hold the kettlebell with a neutral wrist posture (no extension or flexion) with your thumb touching the chest.
  3. Press the kettlebell straight up and turn the arm out fully.
  4. At the top of the movement, actively reach the hand towards the ceiling as far as you can.
  5. Hold for a couple of seconds then slowly lower the weight back to the start position and repeat.

If you have any issues with your shoulder and are not sure what to do to resolve them then, we at In Touch Physiotherapy would be more than happy to look at it.

Happy lifting!

Imaging for back pain – is it always necessary ?

stock-photo-acute-pain-in-a-male-lower-back-monochrome-image-isolated-on-a-white-background-341735282Low back pain is very common. Most of us will experience some form of back pain in our lifetime.

So is it always necessary to have an imaging like Xray, CT or MRI to work out the cause of the back pain?

Here are some of the downsides associated with back imaging that should be considered:

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Jumper’s knee (patellar tendinopathy)

stock-photo-beach-volleyball-players-in-sunglasses-under-sunlight-dynamic-sport-action-outdoor-525074893The patellar tendon is a strong thick tendon that sits below your kneecap at the front of the knee and is responsible for transferring load between the quadriceps muscle to the shin. These loads are passed through in activities such as stairs, running, jumping and landing. In some cases, loads that are placed through the patellar tendon can be excessive and increased too quickly and the tendon can begin to fail. Inflammatory and degenerate processes then commence and can lead to pain and disrepair.

Patellar tendinopathy (aka Jumper’s knee) commonly affects people involved in jumping sports such as basketball and volleyball. it usually presents in scenarios where the load is increased too quickly or excessively. For example, a sudden change in volume/load, or in frequency of training, or potentially after a rest/ off-season period and return to sport too quickly.

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