Back pain and specifically Low Back Pain (LBP) is a very common presentation at Lace Market Clinic. It can broadly be split into 3 categories, acute, chronic and re-occurring.
Acute Low Back Pain
Acute back pain can be exquisitely painful and is usually associated with a sudden onset with some sort of trauma like a fall, sports injury or when picking something up or moving awkwardly. Our first step is to rule out serious injury requiring further investigation and then secondly we will aim to reduce the client’s pain. This is usually achieved with a combination of soft tissue massage, joint mobilisation, stretching, muscle activation techniques and occasionally acupuncture. Acute pain is often very painful but is often unlikely to present a long term problem so a good dose of reassurance is often helpful!
Chronic low back pain is usually less sharp but more constant. This is pain that’s been going on for weeks, months or even years, it may be related to a specific previous trauma or often patients will believe it has a large postural element. In the recent past there’s been an unfortunate trend, with some health care professionals, to say chronic pain is all in the head. With pain that has been going on for a long time there is likely to be learnt behaviour in the form of movement patterns and emotional component maintaining the pain but it is also important to look at the bio-mechanics of how the person moves. Chronic pain is likely to be associated with muscular adaptation and deconditioning. Physical therapy can be useful to help the client can perform the exercise and deal with neuromusculoskeletal adaptation and deconditioning along with education to tackle any unhelpful beliefs or behaviours.
Reoccurring Back Pain
Patients with re-occuring back pain often describe symptoms that have been on/off for years or even decades. They will occasionally describe a previous trauma leading to biomechanical factors associated with their pain and express caution with certain movements, eg bending forwards or sitting for long periods. This cautionary behaviour can often become a significant factor in the person’s problem. For example, the belief that bending forward is likely to cause pain will lead to the patient avoiding forward flexion or adopting unnatural postures. This will lead to the body becoming less and less accustomed to the bending forwards, which means when they do bend forward, which is inevitable, they are likely to have a bad reaction. Or, in the example of the belief that sitting for long periods causes pain, the patient will adopt un-natural sitting postures and become tense. That tension itself becomes the source of the pain.
The key to permanent successful treatment is to use physical therapy to reduce the painful symptoms and progressive exercise to reintroduce the feared movement or activity in a safe and controlled way. This builds tolerance to the activity and eradicates compensatory movement patterns (conscious or sub-conscious) We always aim to get to a place where the patient is able forget they ever had a problem rather than a sticking plaster approach requiring the continuation of an unnatural adopted posture or movement pattern which helps them avoid aggravating the symptoms but leaves them vulnerable to other compensatory problems.