(World Physiotherapy day-2024)HIGHLIGHT

Low back pain (LBP) is the leading cause of disability globally 619 million people
experienced LBP in 2020; that’s 1 in 13 people, representing a 60% increase from
1990. Cases of LBP are expected to rise to 843 million by 2050. This can be
experienced at any age, and almost everyone will experience it at some time.
Thankfully, it only becomes chronic (lasting more than three months) for a
minority.

What causes low back pain?

 90% of LBP is non-specific. This means no one specific structure (e.g., joint,
muscle, ligament, disc) can be found to cause it, and it is not due to a serious
or specific underlying disease.
 A combination of factors can often cause LBP, and even the best scans (like
an x-ray or an MRI) cannot identify a clear cause for most chronic LBP.
 Once your doctor or physiotherapist has examined you, they should be able
to identify the small number of people with LBP who need a scan.

When can you get help for your lower back pain ?
Many people with LBP recover with little or no treatment. However, you should
consult your physiotherapist or doctor after:
• 2-3 weeks if your pain is not reducing, or getting worse, or is stopping you from
doing your normal activities
• six weeks if your pain is staying the same, even if you can still carry on with your
normal activities

When could your lower back pain be serious?

These symptoms are very rare, but you should contact a doctor if you experience
any of them:
• bladder and/or bowel symptoms, e.g., difficulty passing urine
• impaired sexual function, such as loss of sensation during intercourse
• loss of sensation and power in your legs • feeling unwell with your back pain,
such as a fever
• you are over 50, have had a previous history of cancer, aren’t feeling well, and
have developed pain for no apparent reason. You should also seek medical advice
if you have had a traumatic injury like a fall or been involved in an accident.

What types of treatments help low back pain?

Physiotherapists are specialists in treating LBP, and can offer treatment tailored to
your needs. Your treatment may include a combination of:
• education to understand how to manage your pain • Lifestyle tips including
advice on physical activity, stress, and sleep
• physiotherapist- supervised exercise to improve strength and resume physical
activities
• simple painkillers, such as non-steroidal anti-inflammatory medicines

Why get help?

Chronic LBP can significantly impact your quality of life and is linked to other
health conditions. The longer you experience LBP, the more likely it is that you
will experience limitations in what you can do.
Getting help can help you manage your pain and return to your usual activities.
LBP is the health condition that could benefit most from rehabilitation.

Physiotherapy and low back pain

Rehabilitation is essential for all types and stages of low back pain (LBP). It can
reassure people, help them make sense of their pain, support recovery, return to
activities they enjoy, and maintain independence in daily life.

The role of physiotherapy in low back pain

Physiotherapists provide expert advice, guidance and treatment for LBP.
They will help to improve your overall health and well-being while reducing your
chances of future episodes.

LBP can be caused by a combination of physical and psychological factors, a

physiotherapist may be able to advise on these and how to adopt a healthier
lifestyle.

The biopsychosocial approach

Chronic LBP can be associated with feelings of depression, poor lifestyle habits,
and difficulties taking part in work and social activities.
Different healthcare professionals, including physiotherapists, work together to
help with these aspects of LBP. They can use what is known as a biopsychosocial
approach and will look at these three factors:
Biological: the physical aspects of your LBP
Psychological: the emotional and mental impact of your LBP, how you are coping
with it, your stress levels, and how you perceive your pain, eg if you are scared of
doing further damage
Social: this can include your family life, what support you have, the things you
have access to, eg places to exercise and/or walk safely, where you work and what
you do for a living

The role of self-management for low back pain

Self-management and exercise are the most recommended treatments for managing
LBP. Your physiotherapist will help you develop a self-management programme
that works for you.
This may include:
• a plan to put you in control of your pain and get you back to living well again
• provide you with confidence to trust your back again. Your spine is strong.
Although movements may be painful at first, they will get better as you gradually
regain mobility and get active again
• how to overcome a fear of movement and injury, or not getting better, eg with a
therapy such as cognitive behavioral therapy (CBT)
• understanding that most LBP is not serious • Understanding the importance of
sleep in tackling LBP
• how to manage stress and stressful situations that may be contributing to your
LBP • being physically active
• not smoking tobacco
• being engaged in social and work activities
• making ergonomic adjustments in the workplace, if required

Exercise and low back pain

Exercise has been shown to be the most helpful treatment for low back pain. One
type of exercise doesn’t appear to be better than any other – remaining active and
doing it regularly is the most important. Your physiotherapist will help you find an
exercise that’s right for you.

Exercise is helpful for low back pain.

 Staying as active as possible and returning to all usual activities gradually is
very important in your recovery.
 Start slowly and increase your activity as your confidence grows.
  Rest is not helpful but getting back to movement and usual activities is.
 Prolonged rest and avoiding activity can lead to an increase in your low
back pain, greater disability, a slower recovery, and being away from work
for longer.
 Exercise can significantly prevent the likelihood of your low back pain
returning.
 Moving with confidence and without fear is essential for low back pain.
 Many people start moving slowly and very carefully. This makes you tense
and puts more strain on your muscles.
 Exercising and moving in a relaxed manner is much better for your body.
 Feeling sore after exercise does not always mean damage to your body.
Muscles that haven’t been used a lot get sore more quickly.
 Feeling stiff and sore after exercise usually means your body is not yet used
to the activity, but is adapting to it. Exercising regularly is essential.
 The amount of exercise you do is probably more important than the type of
exercise. The greatest benefits are when an inactive person starts doing any
exercise.
 Getting at least 30 minutes per day is ideal.
 Exercise has many other health benefits. Exercise is very important in the
prevention and management of heart disease and stroke, certain types of
cancer, anxiety and depression.
 Exercises for core stability are not better than other forms of exercise. Core
exercises don’t offer any particular advantage to other types of active
exercise (eg walking) for low back pain.
 The best type of exercise is one you enjoy.
 Everyone is different - find an exercise that you like and is easy to fit into
your lifestyle. Walking, running, cycling, swimming, strength, and aerobic
exercise can all help your low back pain.

Physiotherapy and low back pain

Physiotherapists provide expert advice, guidance and treatment for low back pain.
They will:
• put strategies in place to help you manage your pain • help support your recovery
• get you back to doing the activities you enjoy

Exercise and low back pain

 Backs become healthier with movement and physical activity.
 Exercise can prevent low back pain returning and is one of the most helpful
treatments for low back pain.
 One type of exercise doesn't appear to be better than any other.
Low back pain: a global epidemic
Low back pain is the leading cause of disability worldwide In 2020 1 in 13 people
experienced low back pain

Physiotherapy can help your low back pain

Physiotherapists are specialists in the care of low back pain, and can offer
treatment tailored to your needs. They may:
• help you understand how to manage your pain
• offer lifestyle tips including advice on physical activity, stress and sleep
• give you an exercise programme to improve your strength and help you resume
physical activities
here is clear myth and facts which are essesntial to be known by patients.

MYTH FACTS
My back hurts a lot so I must have seriously Back pain can be scary, but it’s rarely dangerous
damaged it. or associated with serious tissue damage or life-
threatening disease - most people make a good
recovery.

I need a scan or x-ray to know what’s wrong with Scans rarely show the cause of low back pain.
my back. So-called ‘abnormal findings’ on scans like disc
bulges, disc degeneration and arthritis are
common and normal in most people without pain,
especially as they get older.

I’m going to wear out my back by bending and Backs do not wear out with everyday loading and
lifting. bending. Gradually increasing the strength of your
back should allow you to lift weights and loads in
different ways.

Strong pain killers will help my back feel better Painkillers will not speed up your recovery.
sooner. Simple pain killers, such as ibuprofen, should
only be used alongside other measures, such as
exercise, and even then only for a short amount of
time.
I need my back to be put ‘back in place’ Low back pain doesn’t mean something is out of
place and needs to be put back in – your back is
strong and won’t go ‘out of place’. It is
impossible to ‘slip a disc’.
I’m getting older, so I’m going to have low back Getting older is not a major cause of low back
pain. pain, but losing strength can be a cause.
I should rest and stay in bed to help my back Immediately following the injury, avoiding
recover. aggravating activities may help to relieve pain.
However, light exercise and gradual return to
usual activities is important for your recovery.
 It hurts when I do exercise and move, so I must be Backs become healthier with movement and
doing harm. physical activity. The spine is strong and capable
of safely moving and loading. Common warnings
to protect the spine are not necessary, and can
lead to fear and over protection.
I need to sit up straight as my bad posture is : There is no one perfect posture. Having a variety
causing my back pain. of postures throughout the day is good for the
back. They should feel comfortable and relaxed
for you. Differences in postures are a fact of life.

I need to do a lot of core exercises to avoid low Low back pain is not caused by a weak core.
back pain. Evidence shows that doing specific core exercises
do not offer extra benefit over general exercise, eg
walking, for pain and disability.

I need to have surgery or injections to cure my Surgery and injections are very rarely a cure.
back pain. Exercise and self-management techniques are
recommended, and have been shown to be as
beneficial, with less risk.

The more pain I have, the more my spine is More pain does not always mean more damage.
damaged. People with similar spine problems can feel very
different levels of pain.

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