Crap, I have lower back pain
How did I do this
Why did this happen to me
Is this permanent
What happens next
Will it ever go away
Is my back never going to be the same
Will I be able to do what I love
Lower back pain… It’s an emotional rollercoaster. For some of us, it is a constant battle to encourage ourselves that our lower back pain will get better and facing the harsh reality of the actual pain. This is a common issue, and research indicates that up to 4 in 5 people will experience lower back pain during their lifetime (Rubin, 2007). That statistic is staggering, and highlights the need for good information regarding lower back pain.
Lower back pain can occur from sport, lifting something too heavy or even during random occurrences that happen bending over to do something trivial. What does happen following the onset of lower back pain can be a flood of emotion, anxiety, worry and anger. Then, the sudden flurry of how did I do this, what should I do, how can I prevent lower back pain from happening to me, why me…?
The Golden Rule
Our number one rule for dealing with any back pain is:
Do Not Worry.
Lower back pain happens, and is a natural occurring part of life. Do not get hyper focused on the cause and the pathology of your lower back pain. Even experienced health practitioners are unable to diagnose you and deduce the exact anatomical reasons for your lower back pain. Investigations may be warranted in SOME situations, but are rarely necessary. What we want to make sure is we:
- Take a deep breath
- Calmly analyse the situations and rule out red flags
- Use immediate pain relief strategies to get you going through your day
- Plan and formulate a structured program for long-term pain management and prevention
- Keep calm and keep moving!
Often following onset of lower back pain, our muscles will seize up. We will stress and worry about whether the next move we make will hurt our back. Good thing is, any movement you do is unlikely to cause any harm to your lower back (provided you don’t have any red flags). Instead, all kinds of movement is much more beneficial and can have fantastic effects on your pain and functional movement.
The One Big Myth
However, there is one myth in particular that can be damaging to your recovery and refuses to die. That is:
You must keep your back straight when you lift.
But in today’s world of modern science and medicine, is this actually relevant? Will you break your back if you lift from the ground with a bent back?
First things first… Slipped discs and broken backs are terms of the old. There’s now more than enough evidence to suggest that even with a “broken back” you could also have very little pain or issues. Even the MRI results that you receive is usually insignificant in establishing the link to your lower back pain. Instead, we should be focusing on aspects of your life including your physical activity levels, psychological barriers or even variables such as home or work stress.
What does the research say?
There is a large plethora of research to support the notion that lower back pain is not increased when bending your lower back while lifting (Nolan et al., 2018; Saraceni et al., 2020; Swain et al., 2020) . With no consistency of evidence that support the belief that lifting with a straight back is safer, why is it recommended?
In fact, the implementation of lifting advice in health care HAS NOT resulted in reduced lower back pain in occupational environments.Saraceni et al. (2020
Well it seems that for many health professionals, previous experience and negative beliefs of lower back pains drives these recommendations (Nolan et al., 2018). Fortunately, with the advent of new research healthcare practitioners are steadily becoming informed. So why is this important?
Negative Beliefs and Lower Back Pain
Well, your lower back pain can improve by reducing the amount of factors that we need to worry about. Particularly, when considering the link between the severity of lower back pain AND negative beliefs (Urquhart et al., 2008). In a study of 506 participants, it was found that negative beliefs were associated with high pain intensity of those with lower back pain (Urquhart et al., 2008).
Through the use of a negative beliefs questionnaire, they were able to establish which individuals had poor perceptions of their lower back pain. An example of a negative beliefs questionnaire is the Fear Avoidance Belief Questionnaire (FABQ). Which includes questions such as:
- I should not do physical activities which (might) make my pain worse
- My work makes or would make my pain worse
- I do no think that I will be back to my normal work within 3 months
What should we be worrying about?
There is emerging evidence that loading of the lumbar spine may be a risk factor for the risk and persistence of lower back pain (Saraceni et al., 2020). Essentially what this means is:
- Heavier objects to lift = more stress on lower back
The natural response for most people would be to avoid lifting heavy objects. However, what do you do when lifting heavy objects is your job? In these situations, avoiding lifting is impossible and another solution is required. A simple principle can be applied when identifying these issues, and is one primarily built on the principle of “load tolerance.”
Take these two case studies for example:
Case Study 1
- John initially came in complaining of lower back pain during a lifting task of his workplace equipment ~20kg. John started off lifting the bar (20kg) for the deadlift exercise in the gym. Initially he is hesitant, and lifting the 20kg bar was heavy and difficult to complete.
- Over the next few weeks, John improves his strength and is able to lift progressively more and more weight. 12 weeks later, John is able to lift 60kg for the deadlift exercise in the gym. Now when John warms up for his session, the 20kg bar is now warmup weight and he does not need to be mentally focused or ready to complete this exercise.
- This is because John has built up “load tolerance,” and now has 40kg off leeway from his heaviest attempts to complete his warm-up deadlifts. Now when John goes to work, lifting the 20kg equipment is significantly easier.
Have no fear, because… Unless you have clearly identified red flags that warrant immediate medical attention, your lower back pain will get better. While not having a straight back doesn’t have evidence to support its utility from any normal lifting motions, doing whatever feels comfortable for you and what will let you go through daily life is the most important.
However, we must learn to limit the amount of negative connotations and thoughts we have associated with lower back. As negative mental status can lead to detrimental outcomes in lower back pain.
- Nolan, D., O’Sullivan, K., Stephenson, J., O’Sullivan, P., & Lucock, Mi. (2018). What do physiotherapists and manual handling advisors consider the safest lifting posture, and do back beliefs influence their choice? Musculoskeletal Science and Practice, 33, 35 – 40.
- Rubin, D. (2007). Epidemiology and Risk Factors for Spine Pain. Neurol Clin, 25(2), 353 – 71
- Saraceni, N., Kent, P., Ng, L., Campbell, A., Straker, L., & O’Sullivan, P. (2020). To Flex Or Not to Flex? Is There A Relationship Between Lumbar Spine Flexion During Lifting and Low Back Pain? A Systematic Review With Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 50(3), 121-130.
- Swain, C., Pan, F., Owen, P. J., Schmidt, H., & Belavy, D. L. (2020). No consensus on causality of spine postures or physical exposure and low back pain: A systematic review of systematic reviews. Journal of biomechanics, 102, 109312.
- Urquhart, D. M., Bell, R, J., Cicuttini, F. M., Cui, J., Forbes, A., & Davis, S. R. (2008). Negative beliefs about low back pain are associated with high pain intensity and high level disability in community-based women