Physio: Chronic pain, including back pain, affects every aspect of our society

Eight out of every 10 North Americans experience back pain at some point in their lives.

If you suffer from back pain, you are not alone. In fact, eight out of every 10 North Americans experience back pain at some point in their lives (NIH, 2012).

Chronic back pain is a major public health issue which affects not only you, but also your family, the health care system, your work, and society as a whole. It can cause absences from work or social activities and even lead to a loss of a job.

Chronic pain can also be associated with anxiety and depression.

Research shows that two out of every three people who experience back pain cannot even identify any specific mechanism of injury, saying: “It just happens”.

But why does it happen?  Can it be controlled, managed, or prevented?

As a physiotherapist, back pain is by far the most common complaint we treat in the clinic, and yet, we find that our society knows very little about simple back health.  We have been taught how to brush and floss our teeth to maintain good oral health and we even know how to maintain our vehicles so they run efficiently and safely.  But somewhere along the line, basic back care education for our own bodies is missed.

There are many factors that play a role in back pain, many different ways it manifests and many different ways that it can be addressed.  We can’t discuss this all in one article. However, in my experience, I feel that the majority of cases have to do with how we use our bodies and can be prevented.

Here are some tips that can help prevent back pain:

• Frequent position changing:  prolonged sitting or forward flexion puts the most load on the low back and can contribute to disc problems. Prolonged standing or repetitive movements in any one direction can also place unfavourable strain on the spine.  Frequent mini-breaks or position changes may seem ‘time consuming’ and unproductive at the time, but it can save you from debilitating pain in the long run.

• Use correct body mechanics:  Most people seem to understand they need to “use the legs when lifting or bending, strengthen the back and abdominal muscles, and exercise”.  Unfortunately, most back pain patients I see are commonly performing exercises unsafely or incorrectly, or not at all.  I rarely witness optimal posture or correct use of body mechanics with activities such as getting in/out of bed, bending forward to tie your shoes, reaching, lifting and carrying. These are just a few of the activities we do daily that can eventually cause back pain if not performed correctly.  It is simple to learn, but accurate instruction and even demonstration from your physiotherapist can be helpful.

• Optimizing postural alignment:  positioning your spine so that it maintains its 3 natural curves is key to a healthy back.  When these healthy curves become too flattened or too arched, it can compress the vertebrae and the discs in between, causing pain or irritation of the nerves coming out of the spine.  Whether you’re sitting, walking, lifting, exercising or sleeping, your spine should primarily be in its optimal position.

• Proper footwear:  improper shoes can affect your postural alignment and can cause certain lower extremity muscles to become shortened which can contribute to back pain.  Orthotic inserts may be beneficial for some people.

• Manage your stress:  many scientific studies have shown that stress is a major factor in back pain.  Find effective ways to manage your stress.  There are numerous approaches that are not within the scope of this article.  Finding time to mindfully unwind and participate in a regular exercise regime (performed correctly) has been shown to assist in stress reduction.

• Overall physical health:  maintain a healthy diet and body weight. Perform regular stretches, strengthening, and spinal stability/mobility exercises in a safe and effective manner. Many people with low back pain have poor core stability (or rarely know what true core stability means) and tight lower extremity muscles that both play a role in back pain.  Numerous studies have shown that both pilates and yoga (performed safely and correctly) can help reduce low back pain.

Unmanaged back pain warrants a visit to your doctor to rule out a serious medical condition.  Your physiotherapist has the skills to assess and treat a variety of back conditions and knows when to refer back to your doctor if further investigation is required.

Incorporating healthy back habits into your daily life is another way you can take an active approach to your overall health and well being.

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