What is low back pain?
Low back pain (LBP) is a condition that causes a great deal of pain and suffering across the world. It also accounts for large costs to society due to healthcare spending and missed work (Cochrane 2014). LBP is very prevalent in the adult population affecting up to 80% of all adults sometime in their lifetimes. LBP is typically divided into acute (less than 12 weeks) or chronic (more than 12 weeks). In most acute cases, acute symptoms resolve within a few weeks to a few months. Your lower back (lumbar spine) is the region between your lowest ribs and the upper part of the buttocks.
Reasons for lower back pain
The most common reasons which contribute to feeling LBP are prolonged sitting at your desk and lack of exercise. Along with lifting items incorrectly and causing injuries. These can cause an additional mechanical load onto your lower back and cause a strain onto your muscles, ligaments and joints. Typically movements will make it worse and resting will help ease your tensions.
Why does my lower back hurt after sleeping?
It is normal for your LBP to feel worse first thing in the morning, this is a normal inflammatory picture. Inflammation is your body’s response to injury or insult and when you are sleeping the body sees this as a good opportunity to heal. Therefore you feel worse first thing in the morning as this process is still finishing but after you get up, have breakfast and a shower your symptoms should become a little easier. Typically as you head in the right direction the level of pain will reduce or you experience the symptoms for less time which is a good sign. Of course if there is no improvement with your symptoms then see your Osteopath or GP.
How do I know if my bed is causing back pain?
It is important to address your mattress and pillows as if this are old (more than 8 years old) and need changing this will not help. Typically we suggest a relatively firm pillow which keeps your head in the mid line (same line as your sternum) if you are lying onto your side. Ideally not a really thin pillow that you head is sidebending or a really big pillow/s that your head is sidebending the other way. As for mattresses we prefer pocket sprung mattresses which are relatively firm which support your spinal curves whilst you sleep. Ideally not really soft mattresses that your body sinks into the mattress and gives no support. If you are unsure then get in contact with us.
How do I know if my back pain is serious?
LBP can also be a result from other underlying conditions which refer to your lower back. These could be from your kidneys, digestive system and reproductive system to name a few. Typically you will experience constant pains and rest doesn’t necessarily help ease your tensions. In which case seek advise from your GP.
How is lower back pain diagnosed?
It’s not necessary to see your GP to gain a LBP diagnosis. Manual therapists (Osteopaths, physiotherapists or chiropractors) are able to diagnose low back pain more specifically. They will take a full case history and perform a physical examination with testing. Give you a diagnosis so you understand the cause of your pains and proceed with treatment.
What are the Treatment Options for lower back pain?
There are many treatment options available and it is up to the individual to make an informed choice as to which avenue they wish to pursue. The length of treatment depends on the cause of your LBP. It also depends on your body’s ability to heal and your adherence to the professional advice and exercises.
In some cases, where the pain is acute and not preventing you from performing your daily tasks, it is possible to self-manage their own symptoms. It would be beneficial to make positive lifestyle changes, reduce stress and have the right balance between resting and exercise. Have a well balanced diet with good hydration and nutrition and lose weight. Reduce alcohol consumption and stop smoking should all help with your recovery.
Acute lower back pain Manual therapy
The NICE low back pain guidelines (2016) suggest manual therapy for managing acute LBP within a treatment package, which includes exercise with or without psychological therapy.
Chronic LBP multidisciplinary treatment
Patients with chronic LBP receiving multidisciplinary treatments experience less pain and disability than those receiving usual care or physical treatment (Cochrane 2017). A combined physical and psychological programme which incorporated a cognitive behavioural approach for people with persistent LBP was beneficial. If an individual is feeling anxious or depressed this will amplify or increase a person perception of pain. Factors associated with chronic LBP are job dissatisfaction, depression and fear avoidance behaviour. So addressing how you think and feel about your back pain and introduce pain management strategies can help with symptom control.
If you choose to see an osteopath they will provide hands on treatment aimed to reduce pressure onto your lower back. The osteopath will address the whole posture to get other areas moving more freely (typically upper back and hips) to optimise the body’s natural healing processes. Our osteopaths will use a combination of muscular stretching, joint articulations and joint manipulations techniques (only when appropriate) to increase movement and reduce pain. You will be advised on how best to self manage your symptoms. Be given both muscular stretching and strengthening exercises and basic nutrition and hydration advice.
How long will it take to recovery?
From an osteopath perspective the prognosis for patients with acute low back pain is 3-6 weeks. Patients with chronic low back pain may take longer to recover depending on the individual. However, in both cases having a structured rehabilitation plan to enable you to take control of your own tensions would be worthwhile.
If you choose to see your GP they may prescribe medications to help reduce your pain. These can be oral non-steroidal anti-inflammatory drugs (NSAIDs) with or without gastroprotective medication. Weak opioids (with or without paracetamol) only if an NSAID is not suitable or has been previously ineffective (NICE 2016).
NICE (2016) guidelines suggest radiofrequency denervation for people with chronic low back pain could be considered if non-surgical treatment has not worked for them. NICE suggested not to use electrotherapies: ultrasound, electrical nerve simulation (PENS), transcutaneous electrical nerve simulation (TENS), interferential therapy, acupuncture or orthotics for managing low back pain.
Appropriate exercise taking into account people’s specific needs, preferences and capabilities is encouraged. Group exercise programmes for people with LBP were found to be beneficial within a clinical setting (NICE 2016).
Please see our best exercises for low back pain video
Cochrane Library (2014) Multidisciplinary treatment for LBP
Cochrane Library (2017) Multidisciplinary treatment at the early stages of LBP
Cochrane (2017) The impact of individual recovery expectations on pain, limitations in activities and return to work in LBP
NICE guideline NG59 (2016) LBP and sciatica in over 16s: assessment and management https://www.nice.org.uk/guidance/ng59/chapter/Recommendation