A Quick Snapshot:
Low back pain (LBP) is the leading cause of disability in over 160 countries right now and more than 84% of the population will experience it at some point during their lives. Less than 5% of back pain cases are due to serious medical issues yet chronic LBP affects roughly 38% of the population. Something doesn’t add up! We need to do a better job at managing LBP – This article is going to outline the 6-step process of “Gold Standard” back pain care based on The Clinical Care Standard guidelines that were produced by the Australian Commission on Quality in Health Care in 2022.
What is LBP costing Australians right now?
It’s costing our health:
It affects 4 million Australians (most likely between the ages of 35-54):
- 2.4x more likely to report worse overall health, 2.5x more likely to have extreme psychological stress and 2.6x more likely to experience severe levels of pain.
- It’s currently responsible for losing 10-13.5 years of health life (DALYs). That means that back pain is currently cutting health short by over a decade.
It’s costing our wealth:
~$3.4 billion was spent on back pain care in the healthcare system last year:
- $2.1 billion was spent on hospitals.
- $724 million was spent on primary care (90% on GP’s and pain medications).
- $566 million on referred services (85% on scans or imaging).
- ~264 million work days are lost every year due to back pain.
It’s costing our relationships:
Ask anybody who’s experience chronic pain issues how it affects their mental state, which affects their interactions with friends, partners, family and coworkers:
- Poor sleep, crappy mood, high levels of stress and greater mental health risk.
- Social isolation. No longer participating in hobbies or sports (constantly missing out).
- Lack of understanding. Friends, family, partners, coworkers not truly understanding the extent of impact it’s having.
- Significant impact on physical intimacy and physical activity.
- General fear and anxiety or the uncertain nature of back pain.
The 6-Step Process To Beating Low Back Pain
This 66-page document that your GP, Allied Health Professional etc should be aware of came to a general consensus of the best way to manage LBP episodes. Now why is this important? Because it’s been shown that people getting the wrong kind of care early on, increases the chance that this will become a stubborn, ongoing issue down the road.
I’ve broken down the guidelines into six distinct phases:
- GET MOVING
- PAIN RELIEF
- MONITOR & REVIEW
Step 1: Assessment
This involves having an appointment with a health pro, where they’ll be asking you a series of questions and putting you through a variety of physical assessments. Believe it or not, most cases of back pain can be diagnosed during the history-taking (asking questions) alone. The physical assessments such as reflexes, neurological exams, movement screening and strength tests just help confirm what we expect to see.
If we know that <1% of cases are medically serious and <5% of cases actually impact the nerves (true sciatica), then the most important part of Step 1 is to rule out the serious stuff.
If there’s any suspicion, you’ll get referred for some imaging. We’ll talk about this more later.
Step 2: Reassurance
Your spine is very resilient. Your back can not, and does not, go in and out of alignment when you do simple things like “sleep wrong”. There are lots of different factors that can influence our back pain such as: overall health, sleep, stress levels, nutrition, exercise levels, general mood etc. If it were that simple for your spine to get “out of alignment” and you believe that your chiro is putting it back into place, imagine the sort of damage that would be done to AFL or AFLW players every single game.
Some of the biggest reasons back pain episodes turn into ongoing, chronic and debilitating problems are because of fear, activity-avoidance and unhelpful pain beliefs. Now it’s important to understand that all pain is real, it’s not “made up” or just “inside your head”. But it’s the job of the health pro to help this all make sense, answer any questions, give you the reassurance you need that nothing sinister is happening (despite it being painful as hell right now) and give you the confidence you need that you’re going to be ok!
86% of all back pain cases will be completely gone in 3 weeks. The odds are in your favour.
Step 3: Get Moving
The faster you can get back to normal activities the faster you’ll recover. I know that sounds like I’m talking in reverse there, but the mental advantage of being able to continue on with life as normal as possible is the superpower of recovery.
It might look slightly different. You might need to temporarily stop some activities, modify others, do slightly less or have more rests and breaks. But the overwhelming fact is that the longer you spend in “Bed Rest” the longer your recovery typically takes.
Based on your original physical assessment, your Health Pro will be able to help you get started in a safe and manageable way. If you’re looking for the cheapest, most accessible and often the most beneficial way to reduce back pain: regular, short bouts of walking can be a great option.
It’s important to keep up physical activity even after your back pain has gone away because that’s a crucial step in preventing future episodes (not to mention all the other obvious health benefits regular exercise has). If you’re not a great exerciser, it can be a good idea to work with a clinician or coach who has a good understanding of back pain.
Step 4: Self-Manage
I talk about this point often, but one of the things we lose when we get injured is a sense of control over our own lives. This is incredibly disempowering and can actually feel quite depressing. That’s why a good Health Pro helps you take back control of what you can.
Things you can do for yourself that can influence your pain levels are more likely to help than passive treatments that are done to you. For example, physical activity, social connection, healthy sleep habits and using heat packs make you feel more in control and therefore give you a greater sense of power than continuing passive things like pain killers, massage and bed rest.
This doesn’t mean that you can’t employ some of those passive options. These can be a great way to get started and make you feel comfortable. However, they open the window to recovery, they are not the recovery process. The sooner you can get yourself involved the faster and more successful your recovery will be.
Step 5: Pain Relief
If it’s recommended, typically the lowest-possible effective dose of anti-inflammatories (ibuprofen, Voltaren, Celebrex etc) for the shortest amount of time is the first point of call. Evidence shows that stronger options such as anticonvulsants like gabapentin or antidepressants like benzodiazepines (duloxetine, amitriptyline) have no or limited effectiveness in reducing back pain and have significant risks attached to them.
Also, opioid analgesics (codeine, morphine) have limited short-term effectiveness. They also have a high risk of dependence, and have been shown to prolong recovery. I’m not saying medications should never be used, I always say they exist for a reason. However, they should be reserved, and used sparingly, for acute and severe cases, most likely in the emergency department.
It’s important to remember also that pain killers and pain medications exist to “enable physical activity, not to eliminate pain”. They’re a gateway drug to the real good stuff: exercise.
This seems like a good time to also highlight the benefits of other treatment options you’re familiar with like: massage, cupping, needling, manipulations, cracking etc. They can be very useful tools to enable physical activity. Any effect they have on pain is typically very short term. They are not designed to eliminate pain, they are also designed to allow activity.
Step 6: Monitor & Review
Another reminder that the odds are in your favour:
- 50% recover within 5 days.
- 70% recover within 1 week.
- 86% recover within 3 weeks.
Back pain will typically get better on its own (even without any kind of intervention or treatment) but it’s important to have an ongoing line of communication with your coach or clinician so you can keep them notified if something gets worse, new symptoms show up or you need to keep progressing your activity levels so you can keep getting better.
It’s a consistent cycle of helping you feel more capable, confident and in control of your body whilst continuing to monitor if any signs of serious medical issues start to develop.
Where Are We Going Wrong..?
Now that you’ve read the global consensus on how to treat back pain, go back up to see how many people back pain is affecting and where we’re spending all our money right now.
If you’ve ever experienced back pain, what are you usually told?
- Get a scan
- Go see a surgeon
We’re spending most of our money on GP’s, pain medications and scan referrals.
Do You Actually Need A Scan?
We spend over $500 million on scans every single year, despite it only being recommended in 1-5% of cases. This means 95% of cases should not be referred for imaging (x-ray, MRI, CT etc). And you should absolutely not be getting routine scans from your local health practitioner for things like “alignment checks”. To be blunt: they aren’t very good at telling us what’s wrong, they’re only useful in the 1-5% to rule out something serious. Again, most Health Pros can rule out these serious conditions simply by asking you questions and performing a simple physical exam. Let’s look at why scans shouldn’t be done.
The following graph is showing scan results from people with absolutely zero pain.
At age 20, ~37% of people without pain will have degeneration. By age 50, 80% will show degeneration and more than half will have disc bulges (again, with zero pain or symptoms). If this many people have scan results that sound scary but have absolutely no pain, then what good are they?
It’s been shown that people who get unnecessary scans often have worse outcomes, and we can see why. Being told you have disc bulges or spinal degeneration can have an incredibly negative and harmful effect on people. It can make them feel fragile and broken and often it scares them away from the very thing that will help them recover – getting back into physical activity!
Remember: 80% of people by age 50 would have what is often called “degenerative disc disease”. Imagine if we started calling other common age-related findings like this? Every wrinkle: degenerative skin disease. Every grey hair: degenerative hair disease.
Our 4 Action Steps To Take Right Now.
If you’re experiencing back pain here are out three steps we recommend you take right now to get on top of it and stop letting in control your life:
- Get it assessed by a Qualified Health Professional. Make sure the 1-5% of medically serious conditions are ruled out. This will give you peace of mind and immediately reduce the amount of stress, fear and worry.
- Find ways to be more active. It doesn’t matter what kind of movement, it can be anything that reduces the amount of time you’re staying still. It can be frustrating to not be able to do your usual routines, but whatever you can do – you should. Regular, short bursts of 5-10 mins can actually be more beneficial than longer sessions.
- It’s easy to focus on all of the things you can’t do or cause pain right now. Make a big list of all the things you can do that involve moving your body that don’t make your pain significantly worse. Some mild discomfort is expected, but don’t let it get more than a 4-5/10 while you’re exercising. Anything over a 5/10 probably means you’re just not quite ready for it yet!
- Don’t stop there. One of the most powerful ways you can protect yourself against future bouts of back pain is to continue to improve your overall health. It doesn’t take much, but if you can dedicate 20mins per day to boosting your health you can make drastic changes.
Need Help With Back Pain?
Hopefully this guide has given you the framework to get yourself started on your recovery! If you’d rather have us go through this process with you, we suggest booking a quick call with one of our Health Pro’s with a specialist interest in back pain recovery.
You can click HERE, fill out a quick form and book a free call.