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