What is the best treatment for low back pain? Well, it turns out it’s not drugs, injections or surgery – so what is it?
Low back pain. Most of us will suffer from it in our lifetime.
It can affect anyone at any age – and, according to a recent Guardian article, since the pandemic, the welfare bill for back pain alone has increased by 25%.
What causes low back pain?
Three papers on low back pain recently published in the Lancet medical journal highlighted that there is rarely a single distinguishable cause of low back pain.
For the vast majority of people, low back pain is experienced as a result of a multitude of factors, including our environment, lifestyle and physical and mental well-being.
Often referred to as non-specific low back pain, this is what most of us are suffering from – and yes, that also includes me.
My own low back pain
My own low back pain started in my late teens when I was a weekend function waiter at my local hotel.
Holding a large silver platter of meats and trimmings on one arm and serving dozens of guests from each platter, was sometimes unbearable.
In between courses, I’d find a bit of wall in the kitchen and lean my back against it trying to give myself some relief.
Into my twenties and thirties I had numerous diagnoses: scoliosis, herniated discs, sciatica, piriformis syndrome.
I had X-rays, MRI scans, and at one point even had a purple dye injected into my spinal canal. The intention of this procedure, known as a radiculogram, was to show-up any abnormalities.
After the procedure I spent 24 hours lying flat in my hospital bed to prevent any side effects – but 24 hours after that I was extremely unwell, with headaches, vomiting and dizziness.
Funnily enough the NHS don’t do radiculograms anymore.
Our body is the greatest healer
Talking of the NHS, here’s a take-home from their back pain advice article. I think we low back sufferers can feel reassured by this: “In most cases the pain is not caused by anything serious and will usually get better over time.”
“In most cases the pain is not caused by anything serious and will usually get better over time.”
NHS website - Back Pain
The body is incredible at healing itself. Most pain conditions are quickly resolved by the body. This even includes herniated (slipped, bulging) discs.
In fact, according to Martin Underwood, co-author of the Lancet series, a GP and a professor at Warwick Medical School – “For most people, it’s a short-term episode that will resolve over a period of days or weeks, without the need for any specific treatment.”
“For most people, it’s a short-term episode that will resolve over a period of days or weeks, without the need for any specific treatment."
So here’s the thing. If our GP has ruled out anything serious (see the box below) and we know our own body sorts out the likes of a herniated discs itself within a few weeks – and we are still in pain – then why is that?
This is the thing about non-specific pain. Our body and mind holds on – trying to protect us.
When to see the GP
- You have pain down both legs.
- The pain is constantly there - day and night.
- You have recently had a fall or accident.
- You have had a fever.
- You have had a diagnosis for cancer.
- You have unexplained or unintentional weight loss.
- You use intravenous drugs.
- You have had bladder or bowel incontinence.
The move away from surgery, injections and opioids
What is becoming more evident is that our healthcare systems are shifting away from costly and often unnecessary interventions.
The best treatment for low back pain is no longer considered to be surgery, spinal injections or dangerous drugs such as opioids.
Instead they are moving towards cheaper interventions which have high success rates.
This means us taking charge – particularly with chronic non-specific pain conditions such as low back pain.
“Promote the concept of living well with low back pain: person-centred care focusing on self-management and healthy lifestyles.”
Low Back Pain series, The Lancet
Known as self-care or self-management – this is the way our NHS and healthcare services globally are heading.
Here’s the Lancet series’ call to action to healthcare practitioners: “Promote the concept of living well with low back pain: person-centred care focusing on self-management and healthy lifestyles.”
Dr Chatterjee is a GP turned lifestyle guru, urging both the medical profession and general public to move towards what he calls “progressive medicine.”
“I want to share what I’ve learned, so that you can take back control of your own health.”
Dr Rangan Chatterjee
So what is the best treatment for low back pain?
So if we know the body has already healed anything significant – we now need to assure our mind and our soft tissue, that all is well.
The best way to do that is simply to move.
I particularly remember one time my back “went” just before I was meant to be on a narrowboat holiday with a group of friends.
Trying to get out of the car after a two hour drive, I was bent double. It wasn’t just painful. I was literally unable to straighten my back.
It was quite a walk along the canal path to our boat and I thought I was going to have to be carried.
However, the more I got one foot in front of the other, the more my back warmed up, the more it relaxed. By the time we got to the boat, I was completely upright.
Just keep walking
If, like me, you are a long term sufferer of low back pain, you’ll recognise that pattern of the muscles all around the affected area joining in.
This is our body protecting itself. The challenge we have is that these muscles will stay in this “locked” state if we don’t start walking.
With each step we take, we are warming the muscles and allowing them to stretch and contract.
We’re also telling our brain that it’s safe.
Keep walking until you are upright and the pain has eased.
I get that this may not be the solution you were hoping for. However, this really is the current thinking – and in my own experience – the best treatment for low back pain.
Once you have walked, and this is key, don’t just sit on the sofa. So far, we’ve warmed up and used the muscles.
We’ve also assured the brain that we’re still ok.
Now we need to do a bit of self-massage, some stretching and some strengthening.
For the key exercises I recommend, download my low back pain self-care card.
Free Download: Non-Specific Low Back Pain
Non-specific low back pain is rarely serious and is usually simple to relieve with some easy-to-follow strategies. This fact sheet explains the nature of non-specific low back pain and gives some helpful tips on how to relieve pain and gain mobility.
Remember, don’t sit down until you’ve done these exercises. Then also do the exercises after each time you’ve been sitting.
In most cases, this is going to make a difference. However, sometimes we may need some extra help if the some of the deeper muscles are being a bit stubborn.
In which case, of course seek out a suitably trained soft tissue therapist such as a Jing Method advanced clinical massage therapist.
Steven Murdoch is a locally based therapist. This article has been reproduced from this website with permission and follows recent press reports of "back and neck pains driving a major UK health crisis" and advice to "ditch the chair and get active".