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Low Back Pain: What We Know



You bent down to tie your shoes or you tried to perform a crazy Instagram-inspired exercise in the gym and you were suddenly struck down with a pain in your low back. If this is your first time meeting the low back pain monster, you are scared. You panic and have no idea what to do. Did you break something? Are you about to become paralyzed?


Let me clarify things for you, based on the absolute latest guidelines in low back pain management. It is my duty, along with clinicians worldwide to help change the way we look at low back pain, for a very important reason. Low back pain is the number one cause of disability in THE WORLD, and a big part of this is due to lack of proper education (for doctor and patient). Everyday, health care systems around the world spend valuable health care dollars in low back pain management without scientific justification.


Low back pain really does not refer to a condition, rather a symptom of pain somewhere between the ribcage and the top portions of the buttocks. This pain can sometimes be accompanied by pain in one or both legs and potentially changes to sensation or muscle strength in the leg(s). It is almost always accompanied by some form(s) of activity limitation in the first days, like being unable to sit, bend or even walk normally.


We STILL do not know exactly what tissues are to blame for majority of low back pain situations (over 99% of them!). Could be the joints in the spine, could be the discs, we can’t say for certain!

What we DO know with confidence is taking an X-ray of the back will not show us anything special to help you on your way (for vast majority of cases). In fact, sending off for further investigation can actually hinder recovery and increase risk for pain becoming chronic! Most times, low back pain is short-lasting but recurrences are common throughout a lifetime and very few end up with persistent, disabling pain.

What causes low back pain to be so chronically debilitating? Lots of things play into this (we call this the biopsychosocial model). Physical factors (strength or activity of specific muscles), psychological factors (how prone we are to anxiety and worry), genetic factors, other health issues (diabetes, asthma, for example), etc. [Take a peek at my two-part PAIN post a while back to get a better understanding of what causes a pain issue to become chronic]


There are known risk factors that can predict who is more prone to experience disabling low back pain. Depressive disorders, obesity, smoking, low levels of physical activity, laborious job demands, prolonged awkward work postures, among others.


[DISCLAIMER: This is not unique advice for your situation, always consult with a trusted health professional on your specific circumstance.]


Stay calm. Don’t panic. It is highly unlikely anything serious has happened. Know you are going to be okay. Your body has all the right tools to take care of what ever tissues are inflamed or pain-causing. Avoid aggravating positions in the beginning and seek out some positions of relief, where you can take a break from the pain (they can be different for different types of back pain). Minds can wander to the worst things, so contact a health professional if you need some more REASSURANCE and guidance.

It is unlikely an emergency room visit is necessary and is actually shown in the latest guidelines to be a wasted resource (less than 1% of reported low back pain is related to a more serious issue). The key is to KEEP MOVING, try to avoid bed rest after the first 24 hours. The stats show, the faster you get back to doing your thing (even going to work), the quicker you’ll recover and the less likely you are to go on to have more chronic issues.


The latest guidelines recommend not to go for the pills as a first-step due to lack of effectiveness. If managing things on your own is not enough, the next line of recommendations emphasize physical and psychological therapies (including a visit to your friendly neighbourhood chiro ;) ) with the most prominent, effective therapy being EXERCISE as well as adjusting (SMT), massage and acupuncture.

EDUCATION on the right way to manage your brush with low back pain will be a game-changer. Talk to an expert.


Your bout of low back pain is over, congratulations, you made it through! Now what? If you were paying attention 😉, I mentioned one of the greatest predictors of low back pain is history of low back pain. So, I'm sorry to say folks, you aren't quite out of the woods.


You may not be able to alter the genetic components that predispose you to low back pain but you bet your butt you can have an impact on the more important aspects.


The physical piece of the pie, to me, is comprised of two aspects: creating resiliency and minimizing threat. Creating RESILIENCY means getting that core in shape and not in the Zac Efron washboard abs kinda way. I'm talking about core activation and your ability to control your torso through several different positions and loads. Minimizing THREAT is about back education and understanding what positions and prolonged postures put us at greater risk as well as what positions are safe and protective. 


The psychological aspect, in my opinion, trumps. Learn how pain works, what it means, when it can be deceptive. Cliché level 1000: "We always fear what we don't understand." Don't fear pain, understand it. 

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Foundation Physiotherapy & Wellness

123 Edward Street, Suite 100

Toronto, ON

M5G 1E2

p. 416.979.3022

f. 416.979.3023

ryan@foundationphysio.com

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PHOTOGRAPHY: MISHELLE RABKIN      ©2018 BY DR. RYAN ALBERT