What is LBP?
LBP can be defined as either acute or chronic.
Acute LBP is defined as low back pain that is pain, muscle tension, or stiffness, localised below the costal margin (below ribs) and above the inferior gluteal folds, with or without referred or radicular (nerve) leg pain. Acute low back pain is defined as pain that persists for less than 12 weeks. (Kripa, Kadiresan et al 2024). Patients with a new episode of acute low back pain have a favourable prognosis, with 75% to 90% recovering in terms of pain and disability (Coste 2004; Grotle 2005), or returning to work within 3 to 6 weeks. Most soft tissue injuries will heal by 3 months. (Grotle et al 2005).
Chronic LBP is defined as “pain, muscle tension, or stiffness lasting longer than 12 weeks or recurrent low back pain defined as two episodes in a year, lasting more than 24 hours, with more than 30 days pain‐free between.” (Hayden et al 2021).
Management
Seeing a Physiotherapist early can help ensure a better prognosis. Education and a clear management plan is a key piece in helping LBP.
Acute Low Back Pain Tips
- Bed rest may be useful for the first 24-48 hours but it’s important to avoid complete bed rest. The spine loves movement i.e. motion is lotion for joints.
- Heat packs/ hot water bottle over region of pain/tightness can be helpful. Be sure to have a layer of cloth between the heat and your skin. 20minutes is an ideal time to use heat and can be applied every 2 hours during the day.
- Manual therapy is shown to be effective in low back pain, it encourages joint mobility and can help inflammation around the affected area and reduce pain. (George et al., 2021).
- Movement of the lower back is encouraged as much as pain allows. For instance, move in directions that you find comfortable e.g if you like leaning back/extension, move into direction i.e. go for a walk, or stand more. Typically, any gentle relatively pain free movement can be helpful.
- Discuss the appropriate medication with your GP/Pharmacist.
- Use of a TENS machine on the lower back can also help reduce pain. (George et al., 2021).
Physiotherapy in Acute LBP
Exercise and good movement patterns are crucial for long-term recovery. Engaging in early gentle exercise and strengthening routines can help you:
- Reduce pain and discomfort
- Improve mobility
- Reduce the risk of future injuries
- Strengthen muscles that support the spine
Physiotherapy can be extremely beneficial in guiding you through specific exercises tailored to your condition/diagnosis. A physiotherapist can help you develop a personalised plan that addresses your pain, improve posture, and educates you on how to protect and strengthen your back during daily activities.
Common Myths About LBP
- I need a scan of my back: Whilst imaging is helpful in some serious low back conditions (largely neurological conditions where there is leg pain or progressive weakness or sensory changes) it is normally not required and in most cases, it does not change the outcome of treatment. Remember imaging does not show pain! Infact, imaging the lumbar spine often has poor clinical correlation. For example, your scan can be normal whereas your pain is real. Or you may have no pain and there’s pathology on your spinal scan.
- I Slipped a disc: Discs do not slip in the lumbar spine they normally bulge. Disc bulges are common and are a part of the normal aging process of the lumbar spine and the spine in general. Evidence shows that >50% of people over 40 have disc bulges and have no pain!! (Brinjikji et al., 2015)
- I’ve had a flare up and hurt my back again: Most flare ups are not caused by actual tissue injury and damage. They are more likely caused by other extrinsic triggers such as poor sleep, stress, poor mood and fatigue which can then cause increased sensitivity of the pain system.
- Bed rest is best: Complete rest should be avoided! This causes increased sensitisation to movement and can cause fear avoidance behaviours and develop into a more chronic and painful experience.
References
- Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., Halabi, S., Turner, J. A., Avins, A. L., James, K., Wald, J. T., Kallmes, D. F., & Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811–816. https://doi.org/10.3174/ajnr.A4173
- Coste, J., Lefrançois, G., Guillemin, F., & Pouchot, J. (2004). Prognosis and quality of life in patients with acute low back pain: Insights from a comprehensive inception cohort study. Arthritis & Rheumatism, 51(2), 168–176. https://doi.org/10.1002/art.20235
- George, S. Z., Fritz, J. M., Silfies, S. P., Schneider, M. J., Beneciuk, J. M., Lentz, T. A., Gilliam, J. R., Hendren, S., & Norman, K. S. (2021). Interventions for the management of acute and chronic low back pain: Revision 2021. Journal of Orthopaedic & Sports Physical Therapy, 51(11), CPG1–CPG60. https://doi.org/10.2519/jospt.2021.0304
- Grotle, M., Brox, J. I., Veierød, M. B., Glomsrød, B., Lønn, J. H., & Vøllestad, N. K. (2005). Clinical course and prognostic factors in acute low back pain: Patients consulting primary care for the first time. Spine, 30(8), 976–982. https://doi.org/10.1097/01.brs.0000158957.96130.0e
- Hayden, J. A., Ellis, J., Ogilvie, R., Malmivaara, A., & van Tulder, M. W. (2021). Exercise therapy for chronic low back pain. Cochrane Database of Systematic Reviews, 2021(9), CD009790. https://doi.org/10.1002/14651858.CD009790.pub2
- Kongsted, A., Risa, I., Kjaer, P., & Hartvigsen, J. (2021). Self-management at the core of back pain care: 10 key points for clinicians. British Journal of Sports Medicine, 55(20), 1125–1129. https://doi.org/10.1136/bjsports-2020-103081
- Kripa, S., & Kadiresan, M. (2024). Low back pain myths: A narrative review. Journal of Musculoskeletal Research and Practice, 12(1), 35–42.
- O’Sullivan, P. B., Caneiro, J. P., O’Sullivan, K., Lin, I., Bunzli, S., Wernli, K., & O’Keeffe, M. (2020). Back to basics: 10 facts every person should know about back pain. British Journal of Sports Medicine, 54(12), 698–699. https://doi.org/10.1136/bjsports-2019-101611