Lower Back Pain

Lower Back Pain - A physical perspective....  [Author :: Owen Moore, Updated Mon 2 Jan 2023 ]

Physiotherapy is recommended for the management of lower back pain when other causes have been excluded - read on!

The content below is not intended as medical advice. If you have any doubts about decisions you make with this advice, we strongly urge you to speak to your medical doctor or a Chartered Physiotherapist immediately.

The original content for this page was typed in 2018, before the days of economic crises and global pandemics. With finances being pushed to the limit, I felt the need to edit this section of the website to help anyone suffering with back pain that needed quick, accurate advice. Even more importantly, what can you do right now to start helping the pain subside and return back to normal activities.
Now that we have the disclaimers out of the way, let's try and make sense of the process of assigning a diagnosis to pain in the lower back region.
Firstly, back pain is rarely serious. The symptoms arising from the lower spinal region can have other causes but for the most part I want you to consider a simple assertion - it is more likely what you are doing that is causing the symptoms and less likely what is wrong with you.
The chart below highlights the triage process (from the French - trier) used worldwide to classify the type of back pain you may have.  

See your GP or a Chartered Physiotherapist if ::

  • the pain doesn't start to improve within a few weeks
  • the pain stops you doing your day-to-day activities
  • the pain is very severe or gets worse over time
  • you're worried about the pain or are struggling to cope
Contact 999 or the Emergency Department [especially if you have these flagpng] immediately if you have back pain and ::

These problems could be a sign of something more serious and need to be checked urgently.

What can I do to help myself?
I suggest taking a moment, before contacting a Doctor or Chartered Physiotherapist, to understand that back pain is a symptom.
Back pain is not a diagnosis. With activity modification, over-the-counter analgesia from a Pharmacist and remaining active (no bed rest beyond 2 days) your symptoms should start to subside. Frequent walking, avoiding prolonged sitting and optimising your movement patterns around the spine can also help. Passive treatments are not recommened - we do not provide therapies such as massage as a stand-alone treatment:

Here is the conclusion from a 2015 Cochrane Collaboration review on back pain and massage:

"We have very little confidence that massage is an effective treatment for LBP. Acute, sub-acute and chronic LBP had improvements in pain outcomes with massage only in the short-term follow-up. Functional improvement was observed in participants with sub-acute and chronic LBP when compared with inactive controls, but only for the short-term follow-up. There were only minor adverse effects with massage."

Extended periods away from work are not recommended; 15% of people who take >30 days of work do not return to their original employment! Working is beneficial for physical and mental health and collaborating with your employer is crucial for recovery. 
At the footer of this page you can find a summary video by Dr. Mike Evans explaining the flowchart above as well as a lecture by Prof. Stuart McGill.
We have discussed the updated approach to soft-tissue injuries (PEACE/LOVE) elsewehere on our website.

"When we hear the sound of hoofbeats, think horses - not zebras." Back pain is common but it is not normal. There is a cause. It is not in your head.
Whilst some patients do have significant pathology, it is far more common to have "simple mechanical back pain." Yet back pain is a symptom and not a diagnosis.
I am paraphrasing Professor Stuart McGill & Professor Shirley Sahrmann in the first sentence but it reflects nearly 30 years of my observations and reading. When serious disease and "sciatica" have been eliminated from the diagnostic process, it is probably what you are doing that needs attention.
My favourite video that I ask patients to watch is posted below :: it is 59 minutes long but provides practical insights to apply immediately. 
Before you click the link, think :: do I know what is wrong with my movement patterns during work, sports and hobbies

3. What could you read tomorrow that could help you understand back pain, make immediate changes and start self-treatment?
I have found that most patients understand, retain and use information competently from Stuart McGill's book for non-medical professionals [Back Mechanic :: ISBN 13 :: 978-0973501827]:: 


Summary ::

There you have it.

My modus operandi, beliefs, favourite video link and book for patients and interested parties.

If you still need to see someone, please call us on 0115 922 6600 or book an appointment in our online diary.