Prevention of Low Back Pain

I firmly believe in being proactive rather than reactive when it comes to LBP. While there's no guarantee that you can completely prevent LBP, you'll never know when you've successfully prevented an incident of it if it never happens. By implementing preventative measures, you're giving yourself the best chance to avoid LBP.

1. Exercise

We know that being overweight and having increasingly sedentary lifestyles are risk factors for developing LBP. So let's try to follow the government recommendation of at least 150 minutes of moderate intensity activity or 75 minutes of vigorous intensity activity per week. Moderate intensity activity can include brisk walking, cycling, or dancing, while vigorous intensity activity can include running, fast cycling, or team sports.

If for whatever reason this isn’t achievable for you, that’s okay! But don’t be disheartened. Any physical activity is better than none, so try to find enjoyable activities that you can incorporate into your daily routine.

2. Posture

Although posture has not been identified as the sole cause of low back pain, it is still important to be mindful of it. So, if you find yourself in a desk-based job, make sure you take regular breaks to stretch and move around. Similarly, if you find yourself standing for extended periods, try to maintain a balanced weight distribution and engage your core muscles to help support the spine. These can both be effective ways to prevent low back pain and maintain optimal spinal health.

3. Strength Training

Evidence suggests that individuals who engage in regular strength training are less likely to experience low back pain compared to those who do not (McGill et al., 2009). Particularly, exercises that target the core muscles, such as planks, bridges, and bird dogs, can significantly reduce the incidence of low back pain. These exercises help to improve muscle strength and endurance, which in turn helps to support the spine and reduce the load on the lower back muscles (Steffens et al., 2016).

4. Exercise/Activity Preparation

In the short term, this can be done by making sure you properly warm up before engaging in any strenuous activity or exercise. This can help to prepare your body for the demands of the activity and reduce the risk of injury or strain. Whereas, in the long term, building up your fitness and strength over time enables you to prepare it for the demands of more challenging exercises and activities, such as deadlifting or heavy lifting when moving house.

Your body is highly adaptable, and by taking a proactive approach to your physical fitness, you can help to reduce the risk of injury and improve your overall health and wellbeing.

5. Stress Management

Stress has been shown to be a significant risk factor for the development of low back pain. High levels of stress can lead to increased muscle tension and reduced blood flow to the muscles, which can contribute to the development of pain and discomfort in the low back. Therefore, stress management techniques could be an important tool for preventing low back pain (Cherkin et al., 2016).

Treating Low Back Pain

Despite our best efforts, low back pain can still occur. In such cases, it is important to seek evidence-based treatment to ensure the best possible outcome. The National Institute for Health and Care Excellence (NICE) is a UK-based organization that provides guidelines for healthcare professionals based on the best available evidence. For LBP, they recommend the following:

• Offering a structured exercise program, including a combination of aerobic and strengthening exercises.

• Offering manual therapy, such as spinal manipulation or massage.

• Encouraging people to stay active and continue with their usual activities as much as possible.

• Offering a referral for psychological therapies, such as cognitive-behavioural therapy, for people with persistent low back pain.

It’s worth noting that these guidelines are based on the best available evidence at the time they were published, which was in 2016. Also, the treatment of LBP should be tailored to the individual and based on specific needs and preferences. So lets see how we can implement these recommendations into our treatment protocol.

Exercise Rehabilitation

From my experience treating LBP, the 2 limiting factors are pain and stiffness. So the first thing to focus on is reducing pain and improving range of motion. I find the exercises below do exactly this.

Based on my experience in treating low back pain, the two primary factors that limit a patient's ability to perform exercises effectively are pain and stiffness. Therefore, the initial focus should be on reducing pain and improving range of motion to facilitate successful rehabilitation. I have found the exercises listed below to be effective in achieving these goals:

After reducing pain to a manageable level, the rehabilitation process shifts from pain management and reducing muscle tension to core strengthening. This provides better support to the lower back and reduces strain on the affected area, which can result in significant long-term improvements in symptoms. Therefore, incorporating core strengthening exercises into the rehabilitation plan is essential for achieving long-lasting relief from low back pain.

Key Notes:

• Some discomfort may be felt during exercises, but you shouldn’t experience sharp pain at any point. If you do then cease the exercise and get in contact with your healthcare professional.

• Perform programme x3-4 per week in a slow controlled manner. Avoid staying in one position for any length of time.

• Apply HEAT and perform gentle movements to reduce stiffness.

• My next step would be to continue to progress your exercises tailored to what your goals are.

Manual Therapy

There is some evidence to suggest that massage and manipulations may be effective in the treatment of low back pain. A 2011 systematic review found that spinal manipulative therapy (SMT) was associated with an improvement in short-term pain relief and function compared to other interventions such as medication, physical therapy, or standard care. Similarly, a 2015 systematic review found massage therapy to be associated with significant improvements in low back pain and function compared to control groups.

However, the long-term benefits of both treatment modalities is questionable and further research is needed to better understand the mechanisms for their effectiveness when treating low back pain. It is also important to note that these interventions may not be appropriate for all individuals, and should be used as part of a comprehensive treatment plan tailored to the individual's specific needs and preferences.

Psychological Therapies

Psychological therapies have been shown to be effective in treating persistent low back pain by addressing the cognitive, emotional, and behavioural factors that can contribute to the experience of pain. Cognitive Behavioural Therapy (CBT), in particular, has been extensively studied in the context of low back pain and has consistently shown promising results.

A 2019 systematic review found that CBT was associated with significant reductions in pain intensity and disability in individuals with chronic low back pain, compared to usual care or other active interventions (Apóstolo et al., 2019). Other psychological interventions, such as mindfulness-based stress reduction and acceptance and commitment therapy, have also shown promising results in reducing pain and improving function in individuals with chronic low back pain.

But as with everything else mentioned so far, psychological therapies should be used as part of a multidisciplinary approach to treating persistent low back pain. Additionally, it is important to tailor the approach to the individual's specific needs and preferences.

Conclusion

Low back pain is a common problem that can greatly impact daily life. However, by adopting preventative measures such as exercise, being mindful of your posture, and by conditioning both your body and mind, you can reduce the risk of developing low back pain. When it comes to treatment, a multidisciplinary approach that addresses a person's individual needs is key. This may include exercise rehabilitation, manual therapy, and psychological therapy. By taking a proactive approach to low back pain, individuals can not only prevent it from occurring in the first place but also effectively manage it if it does arise. Ultimately, the key to avoiding and treating low back pain is to prioritise an active and healthy lifestyle that promotes overall well-being.

References

• McGill SM, Karpowicz A. Exercises for spine stabilization: motion/motor patterns, stability progressions, and clinical technique. Arch Phys Med Rehabil. 2009;90(1):118-26.

• Steffens D, Maher CG, Pereira LS, et al. Prevention of low back pain: a systematic review and meta-analysis. JAMA Intern Med. 2016;176(2):199-208.

• Cherkin DC, Sherman KJ, Balderson BH, et al. Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA. 2016;315(12):1240-1249.

• Rubinstein SM, van Middelkoop M, Assendelft WJ, et al. Spinal manipulative therapy for chronic low-back pain: an update of a Cochrane review. Spine (Phila Pa 1976). 2011;36(13):E825-E846. doi:10.1097/BRS.0b013e3182197fe1

• Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514-530. doi:10.7326/M16-2367

• Bervoets DC, Luijsterburg PA, Alessie JJ, Buijs MJ, Verhagen AP. Massage therapy has short-term benefits for people with common musculoskeletal disorders compared to no treatment: a systematic review. J Physiother. 2015;61(3):106-116.

• Apóstolo, J. L. A., Arnetz, J. E., Dias, C. C., Ferreira, A. C., & Sánchez-Moreno, J. (2019). Psychosocial interventions for chronic low back pain: In what contexts are they useful? A systematic review of effectiveness and moderators of effectiveness. International Journal of Behavioral Medicine, 26(1), 13-26.