Taking the Fear out of Acute Back Pain
I have been busy thinking of what new cutting edge physiotherapy treatment I could write about. Or what new fad exercise is out there to cure all your woes.
But in doing so I reflected on what I see most often in my patients, and what injuries seem to present most frequently.
It lead me to low back pain, or back pain in general, and the fear, worry and anxiety that unwantedly trudges through the door with the patient in pain.
The lifetime prevalence of back pain is approximately 80%, meaning that almost everyone will, at some stage in their life, experience a bout of back pain. The first incidence of back pain can be quite a traumatic experience. The significant pain, perhaps referring into the buttock or leg and an inability to get up from a chair let alone go to work is quite confronting and leaves the individual wondering just what to do.
I tend to work from 4 simple questions from the patients’ perspective in an effort to allay these justifiable fears:
What have I done?
How long will it last?
What can I do to help it?
What can my therapist do to help?
Covering these questions outlines the injury, gives an explanation for the pain or other symptoms and outlines a management plan that puts the individual in the driving seat of their rehab; they are not simply at the mercy of their physiotherapist or doctor, but have the power to improve their situation.
There is good evidence out there that shows the natural history of acute back pain is a relatively positive one in that the majority of cases recover completely in a matter of weeks to months. Even large disc bulges or protrusions have the ability to significantly reduce in size without surgery.
That said, it is still a good idea to see your GP and physiotherapist to rule out anything that needs further investigation, and get you moving faster.
You should always seek prompt medical attention if you have any of the following:
Radiating pain, numbness, pins and needles or muscle weakness in the lower limbs
Changes in bladder or bowel control associated with your back injury
Unexplained weight loss, decreased appetite or fever.
Severe pain not improving in a week
Indications for imaging (MRI, X-Ray etc) include those listed above and your GP or physiotherapist will know which type to request.
A core component of my initial treatment is education. As the title alludes to, fear of movement with the belief that damaged tissues need time to heal, or that pain is the result of further injury is a barrier to rehab. Increasing your understanding of the structure and function of your back is the first step in effectively managing back pain. Although an X-Ray, CT or MRI of your back seems a logical approach to help diagnose your injury, the evidence suggests that these types of investigations are unlikely to help your rehab in most cases. Most of us will have some kind of change on a scan and have no pain associated with it, so all of the ‘kisses of time’ found with these investigations can lead to confusion and unwarranted fear. If you have had scans, make sure your therapist takes the time to go through these with you to explain what it all means and if it is relevant to your condition.
Knowing what may or may not be good for your back while returning to normal activities over a couple of days to weeks is one of the most beneficial things you can do to improve your back pain. What I refer to as relative rest, (i.e., do no more than you need to and forget that job on the to-do list that’s been there the past 6 months), is advisable but I would recommend you carry this out for no more than 2-3 days initially depending on the severity of symptoms. Gentle stretches on the bed, walking and pool exercises can be a great way to initiate movement and can be progressed by your therapist as you improve, while heat packs and light massage can be a great plus on top of regular pain relief.
So remember ‘Motion is Lotion”, and you can get on top of back pain earlier and get back to what you love.