Health News & Articles
A simple lower back pain?
Perhaps the most common health issue we encounter with clients is lower back pain (LBP). The complaints vary, from a feeling of ‘stiffness’ when getting out of bed in the morning, to a constant dull pain that never really goes away.
For some, there is a gradual warning that something is not quite right. For others, the pain can come suddenly, when bending over to pick something up, or twisting forward to reach into the car glove compartment.
Lower back pain can arise from many different conditions. As therapists and yoga teachers we are primarily concerned with mechanical LBP. There are some warnings and symptoms that suggest that the condition may be more serious and require medical attention.
According to Dr Deepa Krishnaswami’s article on lower back pain management, published in the British Medical Journal:
“…with back pain that persists for more than 4 to 6 weeks after a thorough clinical and medical examination and basic laboratory and radiological investigations, it is very important for the patient to undergo an MRI scan of the affected region and any other region (referred pain) as one might miss crucial conditions like nerve compression, radiculopathy, foraminal canal stenosis (…) chronic urinary tract infections, kidney infections, osteoporosis, and more importantly tumours of the spine”.
As a general guidance, here are some of the main red flags that signal urgent medical attention when suffering from lower back pain:
- Weakness in both legs that stops you from walking longer than 15 minutes
- Loss of sensation in legs, buttocks or feet that gets worse
- Back pain with disruption in bladder, bowel or sexual function
- Lower back pain accompanied by fever
- Failure to relieve pain by changing position
Other symptoms that signal a possible serious condition for which you should contact your doctor, are:
- Slow, relentless onset of pain
- Pain that is worse at night
- Pain shooting down the leg to the foot
Having said this, you’ll be relieved to hear that most lower back pain issues involve mechanical reasons and are not life-threatening. These issue can still cause debilitating pain, and do strongly affect the quality of life for millions of people. In fact, LBP is one of the largest, single causes of working days lost through illness in countries such as the UK.
Even when the origin is mechanical, not all LBPs are the same, and therefore need to be treated differently. You may be surprised to hear that a simple movement such as a forward bend of the spine (as when you move to touch your toes), can be used as part of the treatment for facet-joint dysfunction, but is not recommended and can be even dangerous if you suffer from a herniated lumbar disc.
Before you can decide which therapy to follow to treat your lower back pain, it is important to first seek the correct assessment from your doctor or specialist.
A medical diagnosis is ideal; unfortunately, most doctors simply apply the general rule of prescribing anti-inflammatory drugs and recommend rest. If the LBP persists, the doctor will most likely either send you to a physiotherapist, or after a few weeks of debilitating pain to an orthopedic consultant.
If you have ever suffered from LBP or are currently in this situation, you realise just how frustrating this can be.
A well-known Dutch study of patients suffering from herniated discs concluded that “early surgery achieved more rapid relief of sciatica than conservative care (physiotherapy), but outcomes were similar by one year and this did not change during the second year”.
So at the end of the first year, both groups, the one that had received surgery and the one that instead received physiotherapy–had the same results. The only difference was that patients in the first group benefited from faster pain relief, but they also risked the side effects and dangers of a complex procedure such as spinal surgery.
If you would rather avoid surgery, the best solution is to find a competent, careful therapist who can help you to recovery.
Many studies have shown that alternative ways of treating LBP have a positive effect on the patient: osteopathy, chiropractic adjustment, physiotherapy, shiatsu, and yoga therapy have all been shown to offer pain relief and improvement in the healing process.
It has now been accepted that total rest is not the solution for mechanical LBP. Small movements, walking, strengthening exercises and carefully selected stretches can not only help for a speedy recovery, but can also improve the state of mind of the patient, and therefore his or her quality of life.
THE PSYCHOLOGICAL COMPONENT
There is a psychological element involved in all forms of back pain. Pain itself has psychological effects, and chronic pain can often lead to depression. Some experts consider that back pain has more profound psychological effects than most other forms of pain.
At a superficial level, psychological tensions can cause muscles of the back to tighten. Such pain can be relieved by stretching and deep relaxation, and it is often significantly helped by yoga or relaxation classes.
At a deeper level, psychological tensions can predispose a person to mechanical disturbances of the spine through muscle spasms, interference with protective mechanisms, and reduction of blood circulation to the spine. It is difficult to disentangle the relative contributions of psychological and physical factors to the origination of LBP.
‘Psychological factors have been implicated in the development, exacerbation and continuation of low back pain. However, controversy still remains over whether psychological disturbance is a cause or a result of low back pain”
J.Costa et al-Spine-Sept 1992
Some lower back pain, such as herniated discs, can take at least 6 months to a year to heal, sometimes longer. During the later stages of recovery, all pain may have gone. However, the disc itself and the area around it remain weak and vulnerable to injury again.
It is therefore very important to resume activities slowly and with great care to avoid relapse and the risk that the issue might become chronic, leading to unavoidable surgery.
Lower back pain is not as simple as it sounds. There are many conditions that can cause it and just as many solutions.
Correct diagnosis, professional therapy, self-awareness and psychological well-being are the main factors that will help your body heal in its own time.
With warm thanks to the excellent Dr. Robin Monro, M.D.