Low back pain is the most common musculoskeletal complaint presenting to GPs in Australia. Research predicts it will affect between 1 in 7 and 1 in 4 Australians in their lifetime and between 10-40% of those will develop ongoing symptoms. It appears that back pain prevalence is more widespread in western and developed nations and the rate of people developing ongoing concerns is only increasing. Persistent low back pain can be one of the most frustrating presentations for clients to present with, it affects nearly every aspect of their daily lives, and reduces their ability to take part in the aspects of their life that they love.
Back pain can cause a range of functional difficulties going from difficulty sitting down for prolonged times, stiffness waking up in the morning, difficulty getting to sleep or even just staying asleep, to probably the most common difficulty bending down and picking things up. All of these things are integral parts of daily life. If someone has difficulty simply lifting things from the ground for a number of years that not only leads to physical effects but can also slowly erode someone’s confidence in their back.
I’ve personally never experienced back pain before but the stats say it is pretty likely that I will at some point in my life. While I haven’t experienced it first-hand, I have seen the effects that it can have on clients’ lives, taking someone from incredibly active one day to bedridden the next. In my experience as a physiotherapist, I have been able to treat many clients with back pain of an acute and chronic nature and improve their quality of life and maximise their outcomes.
The subjective component of the assessment is critical when assessing a case of lower back pain regardless of if it is acute or chronic in nature. A detailed history of how your symptoms began and how they have progressed since the onset is where we often begin. Gaining an understanding of the days or weeks leading up to the onset as well as what triggered the pain are our starting points. From there I like to know how the symptoms have changed and how they are affecting your day-to-day life and functional capacity, particularly what kind of activities make your pain worse.
If you have any neural symptoms such as pins and needles, tingling, numbness or altered sensation, or feelings of weakness this could be a potential sign of nervous system involvement. Gaining an understanding of where these symptoms are and what triggers them is incredibly helpful to me as a clinician.
If you have had a previous history of lower back pain before, whether that be one acute episode or four episodes per year I’d like to know what has set them off previously and how you have managed them. If you have undertaken physio and it has worked well that’s awesome, let me know what you feel worked best. If you’ve seen physios in the past and haven’t found it worked that’s awesome, let me know what didn’t work and we probably won’t look down that pathway again. With that also comes what you did, what was the exercise program and did you complete it? Rehabilitation is a team journey that we need to embark on together to get the best result.
Specific assessment and diagnosis of low back pain is both necessary and difficult. Determining a specific structure is nigh on impossible, instead, I tend to work more on aggravating movements, positions, and patterns with some specific structural tests dependent upon your subjective assessment findings.
Often the first thing I and almost all physios will assess is the movement of your lower back. For most clients bending forwards is the most aggravating movement but for some, it may be an extension or side bending movement. I like for clients to talk me through what they feel as they go, whether it be a tightness sensation or a pulling or grabbing sensation. All of these little details are important and I like to know how you are going with them.
Following that we will likely perform a functional assessment, this will be highly dependent upon how irritable your symptoms are, as well as what is functional for you. But often it will include looking at you walking, squatting, or bending to pick something up, or if you are under WorkCover we could be looking at work-specific movement patterns.
Specific assessments that we will perform to assist us in narrowing down our diagnosis to get as specific as possible will often potentially include an assessment of neural structures. This can be done in the form of a neurological assessment where we will assess your sensation, strength, and reflexes. The other way we may assess it is through neurodynamic tests. Essentially this is where we will assess the mobility of the neural system to look for any areas of restriction that may be causing neural referral. There may be other specific assessments such as testing for SIJ involvement, the inclusion of these is based on your subjective findings and whether we believe that this may be a potential cause of symptoms.
Palpation of the lumbar spine itself is often the last portion of the assessment. This includes both palpation of the muscles assessing for spasm and muscle tone, as well as assessment of the spinal levels assessing for both symptoms and for stiffness.
Following your objective assessment, we will have a diagnosis in mind that we can work towards specifically with treatment.
In most acute cases of low back pain, I find taping techniques can provide significant lasting effects to reduce the muscle spasm and tightness that occurs and often drives the symptom irritability. It’s important that you let me know if you have any history of taping reactions such as blistering, skin redness, or itchiness as this may mean that we may not utilise the same type of tape. I will always ask before putting the tape on, but if you do have any issues with a skin reaction, always remove the tape immediately.
What I don’t want you to take this as is to get in the gym and stay in the gym. Personally, I don’t really like the gym, so if someone gave me a gym program I wouldn’t be that enthused. I aim to work with you to find the type of exercise that you enjoy and want to do. We should be working to develop a lifelong habit rather than a two-month boot camp that you don’t enjoy. Specifically, with regards to back pain, there could be options such as Tai Chi, Yoga, or Pilates, there is a good enough base of evidence that these forms of exercise are effective at maintaining mobility and can be utilised in back pain management.
Our 3-week program was designed for clients who have suffered an acute injury and want to get out of pain ASAP. Low back pain is a great example of a presentation that responds well to this treatment style. An intensive 3-week treatment block can provide significant pain relief and assist in restoring functional capacity.
Our 3-week program is inclusive of the following:
Package price: $770
Our 6-week program is designed for clients who have more of an episodic history of symptoms, have had a longer time of symptoms, or have suffered a more significant injury. With specific regards to lower back pain, I would recommend this plan to clients who have neural symptoms down their legs, have had previous episodes of low back pain before and want to prevent further recurrences or those that have had symptoms for 1 or 2 months prior to getting treatment. Our 6-week treatment block work to reduce your symptoms and improve your functional capacity, but also specifically dive in and address causative factors such as muscle weaknesses or imbalances, areas of increased stiffness and tightness, as well as provide you with an ongoing comprehensive and individualised injury prevention program.
Our 6-week program is inclusive of the following:
Package price: $1050
Our 12-week program is designed for clients who have more of an episodic or persistent history of symptoms, have had a long period of symptoms, or have suffered a more significant injury. With specific regards to lower back pain, I would recommend this plan to clients who have neural symptoms down their legs, have had previous episodes of low back pain before and want to prevent further recurrences or those that have had symptoms for 3 or more months prior to getting treatment. Our 12-week treatment block work to reduce your symptoms and improve your functional capacity, but also specifically dive in and address causative factors such as muscle weaknesses or imbalances, areas of increased stiffness and tightness, as well as provide you with an ongoing comprehensive and individualised injury prevention program.
Our 12-week program is inclusive of the following:
Package price: $2050
The lumbar spine is strong, so what on earth could go wrong? We delve deep into the depths of low back pain to bring your the cold hard facts about it. This time we focus on the the benefits of keeping active, imaging, surgery, and the role of psychological factors.
The lumbar spine is strong, so what on earth could go wrong? We delve deep into the depths of low back pain to bring your the cold hard facts about it. This time we focus on the assessment and treatment of low back pain.
The lumbar spine is strong, so what on earth could go wrong? We delve deep into the depths of low back pain to bring your the cold hard facts about it.
Exercising with back pain is often one of the last things my clients want to do. But guess what, it helps you get better faster. Maintaining activity has been shown to help improve recovery rates. Do not feel you have to push too hard, a little bit of soreness can be ok, but if it is too painful its ok to take a step back. Check out my top 5 exercises for acute low back pain below!
Back pain incidence is increasing, there are some really simple stretches that you can do at home to help manage the early symptoms of acute low back pain. Check out our top 5 stretches for low back pain.
5 KEYS TO THE MANAGEMENT OF BACK PAIN Low back pain is unfortunately one of the most common complaints of musculoskeletal pain in Australia. Coupled with this, there is a trend towards an increase in the number of low back pain complaints which become chronic