Back pain has always interested me simply because it is so common and yet even today, with all of our advances in technology and anatomical understanding, we really don't understand back pain as a whole. We have come a long way in just the last 10 years and in the next 10 years and beyond, I hope we will go a lot further.
Perhaps the most challenging thing we come across in low back pain however is the practitioner, and the fact that the old ways, are not necessarily the best...
In a word, no. In fact, most of you will experience spinal pain at some point during your life time. Research estimates that up to 90% of you will get low back pain (LBP), and 70% will get neck pain. To put that into context, the last census recorded in 2011 showed a UK population of just under 63 million. This means that around 56 million of you will get back pain and around 44 million will get neck pain. That’s a lot of people!
In fact low back is the most common reason that you will visit your GP if we remove both headaches and tiredness from the equation. When we put it like that, you may look at the problem of spinal pain and its burden on you and the economy (£10,668 million per year) in a new light. Unfortunately it is not a very exclusive club to belong to although I often say to patients that its better to be boring and common in medicine, rather than rare and interesting!
For a vast majority of you, yes, in fact most ‘simple’ LBP and neck pain (not related to a whiplash injury) is thought to be self-limiting, settling within 4-12 weeks under its own steam. Unfortunately, this does leave somewhere between 3-10% of you, or up to 6.3 million who will go on to develop chronic low back pain, (same pain lasting for more than 3 months consecutively). Although this group is proportionally small, it accounts for nearly 50% of all resources allocated to the treatment of LBP. The bottom line is, it is impossible to stop everyone from developing chronic LBP even in today’s age of medicine, and we need to accept this fact. What we can do however is strive to limit this occurrence where possible, and help those of you where it is not preventable
Up to 90% of you will experience back pain in our lifetime but thankfully
nearly all of you will also get better all on your own. For those that do get better, and benefit from some form of therapy, be aware there is also no evidence, or medical need, for '6 weekly top up's', monthly maintenance, or similar, thereafter- despite what you may be told!
An important part of this approach is the adoption of the ‘bio psychosocial‘ model. This is supported and encouraged by most of the health organisations in the developed world and recognises the importance of addressing any psychological and environmental aspects of your presentation as well as the physical. This DOES NOT mean that we think it is in your head, but simply that most of us will adapt behaviours and thoughts towards everyday practices in response to our pain.
This may range from something as simple as not sitting for too long in the evening to making a lengthy plan on how you will be able to get dressed in the morning. In recognition of this, nearly all spinal pain should aim to be treated with a rounded approach and should involve you, the patient, in the leading role. Whether it is simple self management, professional rehabilitation or even surgery, you will need to be prepared to adopt a temporary or permanent change in your lifestyle to reach your full potential.
Assessing and treating low back pain in across Northamptonshire and South Leicestershire is a challenge that we have significant experience in at Team Rehab uk Ltd. There are very few clinics in either area that have had the same exposure to spinal research, surgical rehabilitation and preventive care, as our own, so if you need some first time help or advice, or a second opinion, be confident that we can provide both the expertise and honesty that you deserve.
[i] Waddell W. A new clinical model for the treatment of low back pain. Spine 1987; 12(7): 632-44
[ii] Kelsey JJ. Epidemiology of musculoskeletal disorders. New York: Oxford University Press, 1982
[iii] Biering-Sorensen F. A prospective study of low back pain in a general population: 1. Occurrence, recurrence, and etiology. Scand J Rehab Med 1983; 15: 71-9
[iv] Borenstein DG. Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain Cur Opin Rheum 2001; 13: 128-34
[v] Clinical Standards Advisory Group. Back pain: Report of a CSAG committee on back pain HMSO, 1994
[vi] Maniadakis N, Gray A. The economic burden of back pain in the UK. Pain 2000; 84: 95-103
[vii] Nachemson AL. The natural course of low back pain. In: White AA, Gordon SL. Eds. Symptoms of idiopathic low back pain. St Louis: Mo, Mosley, 1982; 46-52
[viii] Thomas E, Silman AJ, Croft PR, Papageorgiou AC, Jayson MI, Macfarlane GJ. Predicting who develops chronic low back pain in primary care: A prospective study. Brit Med J 1999; 19: 1662-7
[ix] Watson PJ. Psychosocial Assessment; The emergence of a new fashion, or a new tool in physiotherapy for muscular pain. Physiotherapy 1999; 85(10): 530-5
[x] A systematic review of conservative treatments for acute neck pain not due to Whiplash. Howard T. Vernon, DC, PhD,a B. Kim Humphreys, DC, PhD,b and Carol A. Hagino, MBA Journal of Manipulative and Physiological Therapeutics Treatment of Acute Neck Pain July/August 2005
[xi] Pengel LHM, Herbert RD, Maher CG, et al. Acute low back pain: Systematic review of its prognosis. BMJ 2003; 327: 323-5
[xii] Reid S, Haugh LD, Hazard RG, et al. Occupational low back pain: Recovery curves and factors associated with disability. J Occ Rehab 1997; 7: -14
[xiii] Nachemson A, Jonsson E. Neck and back pain: The scientific evidence of causes, diagnosis and treatment. Philadelphia: PA, Lippincott Williams & Wilkins, 2000; 495