Let's look at that Back Pain...... again!
- rosskernow
- Jan 10
- 5 min read
Updated: Feb 11
Do you suffer from ongoing back problems or sciatica which mean you are struggling to reclaim your life?
Maybe you’ve tried some of these treatment options:
your usual physio, chiropractor or osteopath
hands-on therapies: adjustment, mobilisation or massage
hands-off therapies: exercise, Pilates or dry needling
different medications
injections
rhizolysis
surgery
Perhaps you’ve even made an impulse purchase that promised the world but delivered little.
You’ve probably tried all the ‘miracle’ exercises and stretches on YouTube too.
You might feel like you are on an endless treadmill from investigation to medication, specialist, therapist and back to the start again.
So what’s next? What do you do when the ‘usual’ therapies fail?
It can be hard to see a way out, but there is hope!
Recent research is pointing towards different, innovative back pain treatments that challenge the ‘standard’ back pain physiotherapy treatment.
This article will give you a taste for these modern ideas by presenting the current best practices for low back pain relief.
If you are wanting to address you low back pain, no matter how long you have had it for, we at Turra Physio are here to help you.
Here is a summary of the steps:
QUICK SUMMARY
HOW TO HELP YOUR PERSISTENT LOW BACK PAIN
Rule out ‘red flag’ conditions: this may have been done by your GP or physio but it’s an important step not to miss
Assess if the back pain acts mechanically: even when pain has been present for months and years, there can still be a mechanical element to address
Learn about your pain: finding out that your back pain isn’t just about your back can be challenging but ultimately can be the game-changer
Innovative brain exercises: help improve the ‘map’ in your brain, the way that your brain ‘sees’ your back
Pace yourself: have a plan of physical activity (and even social activity) that uses the principles of graded exposure to ‘get under the radar’ of the pain system
Exercise: cover the three areas – general exercise, strengthening exercise and movement
Reduce systemic inflammation: there are steps you can take involving regular exercise, good sleep habits and a health diet to help you hurt less
Get a fresh perspective: if you are stuck in a rut, it might be good to get a fresh set of eyes on the problem if things are not changing or getting worse.
RULE OUT 'RED FLAG' CONDITIONS
Before you go any further, have you had ‘red flags’ ruled out?
‘Red flags’ are clues from either your description or the physical examination that could indicate something serious or sinister.
These things are usually rare, but they do happen.
If your GP is suspicious about your signs or symptoms, they will send you for an investigation like an MRI or a CT, and perhaps blood tests.
It is widely recognised that these investigations are overused for low back pain and often not needed. However, one situation where imaging is definitely worthwhile is investigating suspected red flags.
Since most back pain presentations don’t need imaging, don’t be disappointed if your GP doesn’t send you for an MRI. It is not best practice to get imaging for everyone with lower back pain.
They have been shown to be more harmful than helpful when they aren’t required.
If your physio has any concerns about one of these conditions, they will typically suggest that you visit your GP for their opinion or further investigations.
Once you have had red flags ruled out, the next step is really important …
MRI and other investigations have a role when they are used to investigate for serious conditions. By the way, they don't show up red ever!
ASSESS IF THE BACK PAIN ACTS MECHANICALLY
Regardless of the duration of the back pain episode, a systematic assessment process is needed to establish if there is a mechanical cause for back pain.
A mechanical cause simply means a cause that is related to a low back structure that is going to respond to some kind of direct treatment.
A system like the McKenzie Method can help quickly and accurately determine if this is a back pain that can be changed rapidly.
The McKenzie assessment works to categorise a problem into one of four categories. The first category is when a directional preference is found, meaning a direction of movement that rapidly changes things and remains that way ie it’s not just the first moment when you hop off the bed, but for example you can bend better with less pain and it remains.
If a directional preference is found, this needs to be explored and treated thoroughly, but it doesn’t detract from the next very important element …
LEARN ABOUT YOUR PAIN
One of the most important elements of successful physiotherapy treatment of persistent back pain is to learn more about your pain and how it works.
This might seem like a weird way of treating back pain!
However the research shows that this can be absolutely pivotal in helping persistent pain problems. We have found that to be the case in our experience as well.
Books we recommend
Explain Pain – David Butler and Lorimer Moseley
Protectometer: The Explain Pain Handbook – David Butler and Lorimer Moseley
Painful Yarns – Lorimer Moseley
Pain and Perception: A Closer Look At Why We Hurt – Dan Harvie and Lorimer Moseley
Why Does It Still Hurt – Paul Beigler
Why is learning about pain science helpful if you have persistent back pain?
You might think ‘I know all about my pain – I live with it every day’.
That is true, but we also know that learning about the biology of how pain works allows you to look at your experiences through a new lens.
This in itself can be very liberating.
Two of the key concepts are these:
Pain and injury are not the same thing – you can have one without the other.
The longer you experience back pain, the less reliable and the less accurate the information it provides about your back.
Therefore, the pain becomes less ‘helpful’.
It starts to behave under the theme that it is ‘better safe than sorry’.
It is like your body errs on the side of caution.
As a result, your pain can continue long after an injury is fully healed.
This image from the book 'Explain Pain' shows two different experiences of pain - one where pain reduces more proportionately to healing and one where the central nervous system plays more of a role as pain persists.
Understanding some pain neuroscience will help you to know:
When you should pay attention to your pain
When it is OK to have pain and how much is OK
When resting won’t help
When you can safely do more
How to reduce your pain through movement and activity
In short, it will help to give you the confidence to move.
This can be a game changer!
Patients get the best results when they read about it, or watch a good explainer video, and talk it through with an informed health professional.
Most people hit some learning snags along the way, when something doesn’t quite make sense. Dealing with these snags when they happen makes it easier to keep learning.
A good back pain physio with the right knowledge and experience can make all the difference.
It is impossible to overstate how important this step is.
A working knowledge of pain science powers everything to come …
Understand why you hurt and you will hurt less
David Butler
