Low back pain is is one of the most common conditions that patients seek healthcare services for.
Causes of low back pain
Low back pain can be caused and exacerbated by a multitude of factors, including muscle dysfunction, pinched nerves, inactivity, repetitive motion, herniated discs, spinal stenosis, osteoarthritis, etc.
What happens in a consult?
We take a comprehensive history and perform a thorough examination, to establish:
- Are the symptoms mechanical, traumatic (falls and accidents which necessitate investigations) or visceral (arising from organs or causes that necessitate a medical referral)?
- If mechanical, what are likely structures that cause the pain, and the directional tendencies for ease and irritation, and plan for therapy (e.g. manual therapy to relieve pain and facilitate movement)?
- Prognosis and discharge planning – symptoms that are not overly irritable, without neurological involvement, and ability and confidence to restore self-initiated movement, tend to produce a favourable outcome.
Acute vs. chronic
Most cases of low back pain even if it feels severe initially, will subside within a few weeks. However, low back pain is known to be recurrent. Some predictors of recurrent low back back includes core muscle dysfunction, poor fitness, and job dissatisfaction.
Treatment options
As low back pain is caused and affected by many factors. No one treatment techniques address all of them. An individualised and evidence-based approach is needed taking into account current symptoms, irritability, existing wear-and-tear, job or activity requirements, etc. Some of the treatment options include:
Manual therapy
Spinal manipulation has been shown to be effective for acute mechanical low back pain. Our physiotherapists and chiropractors are skilled practitioners of spinal manipulation.
Acupuncture
We use acupuncture as an primary or adjunct therapy to help relieve acute muscle guarding and prepare for other techniques such as spinal manipulation. All physiotherapists and chiropractors are certified and experienced in either acupuncture or dry needling.
Therapeutic exercises
Therapeutic exercises can be broadly divided into two categories: Specific exercises to help address dysfunctions, e.g. McKenzie exercises to treat discogenic pain or core exercises to optimise motor control; or general exercises to improve or maintain cardiorespiratory fitness and minimise disuse deconditioning. Exercise prescription is both a science and art – it takes experience to utilise scientific knowledge to reduce symptoms and improve function based on the patient’s individual needs and circumstances.
Self-care
For many people with acute low back pain, self-care measures such as temporary rest, over-the-counter pain medications, and gentle stretching and activity can be effective in relieving symptoms. It is also essential to address lifestyle factors and practices that contribute to low back pain, such as physical inactivity.
Prevent low back pain, not just react to it
Here are some of the measures to minimise the impact of low back pain:
Physical exercise: Regular physical activity can significantly reduce the risk of low back pain, with a 25-40% lower risk observed in individuals who exercise regularly. We understand that you are busy, and can design exercise programs incorporating aerobic, core muscle activation and weight bearing components to suit your lifestyle.
Postural awareness: There is not one good sitting posture, standing posture or lifting posture. Much of the prior assumptions on “perfect” lifting, sitting and standing work postures have been debunked. It is more important to move regularly especially if you have a desk job, and being mindful when you need to lift – injuries tends to occur in unguarded moments. We use a range of tools such as diagnostic ultrasound and pressure biofeedback to help you improve awareness and activation of your core muscles.
Weight control: Being overweight or obese is a significant risk factor for low back pain, with a 16-25% higher risk observed in individuals with a BMI of 25 or higher.
Regular breaks: We recommend taking breaks at least every 30 minutes of sitting. Movement helps reactivate core and trunk muscles and restore blood flow, and also redistribute load and forces in the back and trunk.
