A Common Challenge: Non-Specific Lower Back Pain (NS LBP)

Speaking from personal experience, non-specific lower back pain can be horrible and debilitating (yes, physios are not immune from injury!!).  Along with treating myself, I’ve helped others to grapple with the challenge of non-specific lower back pain. In this article, we’ll embark on a journey through the world of non-specific lower back pain, intertwining personal experiences, exploring risk factors, and offering self-management wisdom. We’ll also unveil how physiotherapy can transform this chronic discomfort into a story of triumph.

Addressing the diagnostic elephant in the room: “Non-specific lower back pain”.   

This simply means that we are unable to determine the exact cause of the pain if it even has a precise bio-mechanical cause (lots of pain doesn’t). Medical testing protocols are just not sensitive enough.  Even a scan would not be able (in the vast majority of cases) to equate symptoms to a specific anatomical structure, which is why sometimes it can feel frustrating that no one is interested in offering an MRI scan when in fact their thinking is probably correct, it won’t necessarily show anything helpful or change the rehabilitation pathway.

What Is Non-Specific Lower Back Pain?

Non-specific lower back pain, a condition I’ve encountered not only professionally but also personally, is an all-too-common complaint. According to the World Health Organization, it’s estimated that 60-70% of people in industrialized countries experience non-specific lower back pain at some point in their lives.

It manifests as pain in the lumbar region of the back perhaps with radiating pain into one or both legs, but crucially without any clear identifiable injury or underlying medical condition. It’s the kind of pain that can stealthily seep into your life, affecting everything from work to sleep and, most notably, the simple act of trying to tie your shoelaces or stand from a chair.

Risk Factors: Personal and Professional Insights:

Drawing from my professional and personal journey, I’ve unearthed some risk factors associated with this elusive condition:

1. Age: As we age, the incidence of back pain increases.

2. Lack of Physical Activity: A sedentary lifestyle can lead to deconditioning.

3. Obesity: Excess weight not only places additional stress on the lower back but may also lead to increased systemic inflammation from poor choice of food.

4. Posture: Holding very upright postures, guarding, slouching, or sitting in unnatural positions for long periods without movement can lead to tired and painful musculature.

5. Psychological Factors: Stress, anxiety, and depression can exacerbate your back pain.

6. Smoking: Some studies suggest that smoking can impair blood flow to the spine, leading to increased rates of back pain in smokers.

Personal Self-Management Insights:

Personal and professional experience has also highlighted self-management strategies for dealing with non-specific lower back pain:

First, second and thirdly I recommend exercise and movement as the cornerstone of management:

My journey and those of my patients have affirmed that maintaining an active lifestyle, coupled with regular exercise (even when in pain), can be a reliable ally. The tricky bit is feeling comfortable and confident enough to exercise knowing that you are not going to make things worse.

The Role of Physiotherapy: A Personal and Professional Perspective:

1. Pain Alleviation: Professional hands-on techniques, such as soft tissue release techniques and spinal joint mobilizations, can provide pain relief which can, in turn, enable other exercise-based interventions to take place. This approach helped me.

2. Exercise as Therapy: As a physiotherapist and patient, I’ve harnessed the power of exercise programs to strengthen muscles, improve flexibility, and enhance overall physical fitness.

3. Lifelong Learning: My experience has highlighted the importance of continuous learning and educating my patients about their condition, reassuring that trying to commit and follow a progressive exercise programme is one of the best things we can do.

Indications for Further Investigation and Serious Pathologies:

Non-specific lower back pain can be worrying, particularly when accompanied by shooting, electrical neurological type pain to one or both legs, which often leads patients to want a scan.  However, it is typically benign, but it’s crucial to recognize when further investigation is needed. Indications for concern include:

1. Progressive Neurological Symptoms: Such as muscle weakness, numbness (particularly around genitals or anus), or bowel/bladder dysfunction.

2. Bi-lateral pain: Neurological type pain into both legs, accompanied by other signs may be an indication for further investigation.

3. Unremitting Pain: When the pain remains severe and unresponsive to treatment.

4. Pain at Rest: Pain that doesn’t improve with rest can be a red flag.

5. Trauma or History of Cancer: A significant trauma involving high forces, or a history of cancer may require further evaluation.

6. Systemic Symptoms: Fever, unexplained weight loss, and night sweats can indicate a more serious underlying condition.

MEDICAL EMERGENCY

If you have loss of bladder/bowel control/sexual dysfunction/numbness around your genitals/anus with lower back pain and/or bi-lateral leg pain, please go to A&E and discuss these symptoms.

We carry out a thorough assessment including talking about the background story of your back pain and asking about all your medical history to rule out anything of concern. If we have any doubts, we will let you know what we are thinking and if best for you, we will refer you to other medical professionals for their opinion.

In conclusion, non-specific lower back pain is an experience that unites many of us in the journey of pain and resilience. Whether you’re a healthcare professional or a fellow traveller on this path, the pursuit of effective self-management and the support of physiotherapy can turn this chapter of discomfort into a story of strength. Along the way, I’ve learned that while the pain is common, so too is the capacity for healing and transformation.

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