A Move to Improve - 5: Independent Back Management
Back pain is a very common complaint across Australia with 1 in 6 Australians suffering back pain at any one time and up to 90% will have back pain at some time in their life; making back pain the 3rd leading cause of disease burden in Australia (AIHW. 2017).
As with conditions there are a number of factors that can increase your risk of suffering back pain, slow its recovery and promote re-injury. Some of these include:
- Occupation (those with repetitive bending and twisting with load or prolonged sitting)
- Insufficient physical activity
- Joint trauma or injuries
- Exposure to whole body vibrations
- Repetitive uneven loading of spine
Back pain also has a strong link to other health conditions with 2/3 Australians suffering back pain also dealing with at least one of the following:
- Cardiovascular disease
- Mental health
- Chronic Obstructive Pulmonary Disease (COPD)
The best thing you can do for your back health is to live a healthy lifestyle - following the WHO guidelines for activity and eating. As well as being aware of prolonged or stressful postures.
This all seems straight forward and obvious to most people. The interesting thing about backs is you may have a badly degenerated spine with protruding discs that look terrible on the X-Ray but you have no pain. A systematic review showed 30% of 20 year old subjects had a disc bulge, while 60% of 50 year old subjects had a disc bulge, the prevalence went up to 84% for 80 year old participants(Brinjikji et al. 2014) . For this reason scans only give some of the information. You may have had the disc bulge for decades and not shown any symptoms. It is better to treat the symptoms and functional limitations
The muscles and connective tissue in your back and around your pelvis and stomach do a great job of supporting your spine even if it is damaged. It is for this reason that Physiotherapists play a key role in back pain management - we can: strengthen/loosen and co-ordinate the your muscles to perform their role.
The key with any acute back injury is to be patient. You can have all the massages and do all the stretches you want but it will not make the tissues heal faster and in the early stages it is very easy to re-aggravate your initial injury. In most cases enough healing should have taken place after 6 weeks for you to start returning back to normal.
In the meantime you can prevent complications such as weakening of muscles by light pain-free exercise such as yoga and thai-chi. The import part here is pain-free you might feel tightness - this is fine but you want avoid pain. So, if every time you arch your back it hurts - don't go so far - stop short of the pain.
We know from the literature is: a moving back is a healthy back. Small movements like rocking your knees from side to side in lying or bringing your knee to your chest creates safe movement of your back and promotes muscle relaxation, relieving some tension and pain in your back. This should be seen as a snowball effect - do not start big, start small and grow the size of the movement over time.
Similarly, it is important to keep walking. The small amount of rotation in the pelvis and co-ordination of core muscles needed for walking helps keep the smaller joints moving and prevent spasms.
Using this advice of little and light movements that increase over time your back should start to improve: you should go further with your bending before it hurts, be able to sit/stand for longer, sleep through the night, carrier heavier load. This is the important time: this is when many people over do it and regress. Stick to the plan of slow progress.
After 6 weeks your tissues should be healed enough to reach full range with no pain. If you want to, this is when you can start adding load. It is recommended to complete some strength based exercise 2-3 time a week however, this does not mean you mush go to the gym to lift up heavy stuff and put it down again. Controlling your own body weight in different positions through it's full range (like yoga or tai-chi) is enough.
It is this strength and control of your body movements that supports your back and helps prevent a re-occurrence down the track.
The most import advice is: DON'T BE AFRAID TO MOVE.
Life is too short to be worried about pain.