According to the World Health Organisation, an estimated 619 million people live with lower back pain, making it the leading cause of disability worldwide. In about 90% of cases, back pain is classed as ‘non-specific’, meaning it can’t be attributed to an underlying condition like arthritis, or things like serious disc or other tissue damage, a fracture, nerve compression or a tumour.
Although it’s not possible to diagnose the exact cause of non-specific back pain, it can have a significant impact on overall wellbeing. “I have seen how back pain prevents my patients from fully engaging in their lives,” says spinal and orthopaedic surgeon Dr Ken Hansraj, author of Watch Your Back: Nine Proven Strategies to Reduce Your Neck and Back Pain Without Surgery (£19.30; Sounds True).
“The sense of restriction can be very demoralising. It can be difficult to focus on anything else but the pain, which only exacerbates the suffering. The emotional component of pain, especially relentless chronic pain, cannot be underestimated.”
So what can we do to ease this lower back pain and try to ensure it doesn’t keep recurring?
AVOID INACTIVITY: Although moving might be the last thing you feel like doing, over-resting your back won’t help. “On a physical level, prolonged inactivity increases back pain because the spine becomes stiff, weak and deconditioned,” says Dr Hansraj. “Physical movement and exercise stimulate the healing process for most back problems.
“Rather than bed rest and inactivity, controlled, incremental exercise often delivers the best long-term solution for healing your back, reducing pain and preventing future problems.
“Exercise will keep your back flexible and strong. At the same time, being active lifts your spirits by stimulating the production of endorphins, the feel-good chemicals produced by the central nervous system andthe pituitary gland, that relieve pain and reduce stress.”
It goes without saying, though, that you should always consult your healthcare provider before starting any exercise programme.
OVERCOME THE FEAR OF MOVEMENT: Many people with back pain develop kinesiophobia – the fear of physical movement and activity which might exacerbate their pain. “Some people are so afraid of making their condition worse that they come to regard their back problem as disabling,” says Dr Hansraj. “Their fear leads them to construct mental barriers to physical activity.
“They doubt they are capable of activity and worry that too much movement could injure their back further and intensify their suffering.”
A study by Australian researchers found that cognitive functional therapy helped back pain sufferers overcome their fear of movement, and they experienced less pain as a result.
The therapy is delivered by physiotherapists who can help patients understand that their pain is not a sign of serious damage, then to rebuild their confidence to move their back without over-protecting it.
RETRAIN YOUR BRAIN: New research has shown that pain reprocessing therapy – an emerging psychological treatment that aims to help patients shift their perspective on their chronic pain and to see it as less threatening – could be effective.
This therapy helps patients understand that the long-term pain they’re experiencing might be coming from altered brain networks associated with pain processing which haven’t been ‘switched off ’ since their back strain or injury happened – even though the original problem has healed.
In a randomised clinical trial published in JAMA Psychiatry, 66% of people who received four weeks of the therapy were pain-free or nearly pain-free afterwards. “For a long time we have thought that chronic pain is due primarily to problems in the body, and most treatments to date have targeted that,” said lead author Yoni Ashar, who conducted the study while at the University of Colorado, Boulder. “This treatment is based on the premise that the brain can generate pain in the absence of injury or after an injury has healed, and that people can unlearn that pain.
“The idea is that by thinking about the pain as safe rather than threatening, patients can alter the brain networks reinforcing the pain, and neutralise it.”
The treatment is fairly new, but there are physiotherapists, psychologists and osteopaths offering it in the UK so search out pain reprocessing therapy online.
TAKE A WALK: The pounding and jarring movements of some high-impact aerobic activities will likely aggravate back pain, but a simple walk can be great for your spine. A randomised controlled trial published in The Lancet shows that walking three to five times a week for an average 130 minutes helped reduce the recurrence of lower back pain in participants.
The researchers surmised this benefit could be due to the combination of the gentle movements of walking, the loading and strengthening of spinal structures and muscles, relaxation and stress relief, while the feel-good chemicals released during a leisurely stroll can help block pain signals between the body and brain.
Start with short walks, then gradually increase the distance and intensity as your fitness increases.
‘POOR’ POSTURE POO-POOED: We’ve been told for years that bad posture and slouching can lead to back pain. But now many physiotherapists and pain science experts are saying it might not be as significant of an issue as once thought.
An umbrella review of evidence published in the Journal of Biomechanics found no strong link between posture and back pain. Instead, the key to staying pain-free might actually lie in variety and regularity of movement – switching between different postures so that different muscles are worked and strained.
In other words, having a particular posture does not cause low back pain. However, staying in the same position for a long time might.
“Our spines are interconnected by two joints at each vertebral level allowing our spines to flex, extend, side-flex and rotate. Sitting for long periods and being static in one position causes stiffness in the joints, leading to back pain,” says Tim Allardyce, a chartered physiotherapist at Surrey Physio.
“Our spines are highly mobile and need to move, so I advise people to get up from sitting every 20 minutes and to move around for one to two minutes at a time. Changing position can help too, but getting up and moving is far better for our backs.”
GET IN THE SWIM: Aquatic exercise offers firm resistance without impact, can build core and other muscle strength and help restore stability to the back without placing unnecessary pressure on the spine.
A systematic review and meta-analysis of trials that examined the impact of aquatic exercise found it significantly reduced pain, plus improved disability and the quality of life of people with low back pain. Do some laps at the local pool or join a water aerobics class.
STOP SMOKING: “Nicotine restricts blood flow to the discs in your spine that cushion your vertebrae,” says Dr Hansraj. “The reduction of blood flow can promote spinal degeneration.”
It can be difficult to give up nicotine with willpower alone. Figures show your chances of quitting for good are massively boosted if you sign up to a local, free NHS stop smoking service. Ask your GP, pharmacist or health visitor to refer you.