Back pain is one of the leading causes of disability and lost time at work, sport and our everyday lives in Australia. In fact, back pain is the 3rd biggest disease burden (covering medical referrals, expenses, admissions and medication) In Australia. We all know someone whose back “goes”, “slips”, “pops” or is “stuffed”. That’s because 1 in 6 or 3.5 million of us have had an episode of back pain. There are many myths around back pain from who gets it, what it means and how to treat it. Let’s try and clear a few of these up.
Who gets Back Pain?
In short, anyone can have back pain at some point in their life. Men can have a slightly higher prevalence but as you can see the rates are pretty even. Your job is not a great predictor of back pain. Rates are relatively similar in manual and white collar jobs. In fact, a far better predictor of back pain was your general health, in particular, your weight, cardiovascular health and mental health.
Prevalence of back problems, by age and sex 2014–15
What does back pain mean?
Not all back pain is catastrophic. Pain is a complex part of our lives. It can indicate damage or it can be a warning of potential injury. It can be affected by many things including anxiety, stress and general physical and mental health and will be experienced differently by everyone. Back pain may fall anywhere on this spectrum.
But the scan says my back is “stuffed”…
In most routine back pain episodes imaging is of little to no value. In fact, it may heighten anxiety and pain behaviours. Degenerative changes in our backs (and the rest of our body) is an unavoidable and normal part of ageing. Around 30% of 20-year-olds have changes in their spine and this increases steadily each decade of life so that by the time were 60 around 80% of us have visible changes on imaging. Imaging does not correlate with the experience of back pain. It is useful and appropriate in cases of serious conditions such as tumours or fractures. But for routine back pain, it does little to aid diagnosis or influence treatment.
What are the best treatments?
70-90% of Australians will get back pain during their lives. About the same amount will have multiple episodes of varying intensity. About 80% of people with back pain will have resolved within 3 months regardless of whether they seek treatment or not.
So there isn’t a clear consensus on what the “magic” treatment for back pain is. But there are a few things the evidence tell us.
- Bed rest is unhelpful and counterproductive. In fact, it may increase pain.
- Medication is unlikely to improve back pain on its own
- Maintaining normal, healthy movement and activity is beneficial. It helps maintain muscle function and can be associated with endorphin release, the body’s own pain reliever
How can Physios help?
Maintaining normal healthy movement, function and activity levels is key to treatment and prevention of back pain. We can provide assessment and screening to exclude serious problems. In the most likely scenario of routine back pain, we can help to keep you moving, correct any movement problems, assess your risk factors and provide advice on how to progress towards pain-free activity.
