You’re worn down by intermittent back pain. It’s an unpredictable beast. It can come on so strongly you cannot walk, or sit.

Key points:

  • New research on back pain encourages exercise, and the view that pain is a protective mechanism, not a measure of tissue damage
  • There are some exceptions where it’s necessary, but too many people are having back surgery needlessly when the evidence of benefit is weak
  • Scans, x-rays, cortisone injections and long-term opioid use are often unhelpful, experts say

At least you think you can’t (but read on).

In desperation, you consider surgery — but this is not always a good move.

The evidence of benefit from surgery is weak at best, as a recent Lancet series on lower back pain found.

Despite this, plenty of people are still going under the knife. Lumbar spine surgery rates are doubling roughly every 10 years, according to University of NSW professor of orthopaedic surgery Ian Harris.

And, he said, the operations are getting more complex, and therefore more risky.

“What we are seeing is an increase in complex surgery over simple surgery, in particular fusions, in particular multilevel fusions.”

There are however, cheaper, more effective ways to deal with back pain. We asked the experts what works — and what doesn’t.

Get moving

Yes, even if it hurts. Once you have the all clear from a doctor or physiotherapist, you are safe to move.

Developments in neuroscience indicate that the brain creates pain as a mechanism to protect us.

In the case of chronic pain, the pain system gets more sensitive. Our body learns pain — and so we feel it more acutely.

When it comes to chronic pain, the brain is being overly cautious. Pain is increased by fear of re-injury and a whole host of other factors. And so, over time, our body creates a bigger than necessary pain buffer zone.

But you can still move — and exercise — within that pain buffer zone, without causing tissue damage, according to University of South Australia professor of clinical neurosciences Lorimer Moseley, who is at the forefront of Australia’s world-leading brain and pain research.

When people realise they are safe to move, they can start to get better, he said.

Associate Professor Mark Hancock, a physiotherapist researching lower back pain at Macquarie University, agrees.

“If people stop moving they get weaker and stiffer and it often causes more harm. Moving into a little bit of pain is appropriate,” he said.

Move how?

There’s a plethora of activities promising to be good for backs, from Pilates to the Alexander Technique, to half a dozen forms of yoga.

Associate Professor Hancock said although there is no strong evidence that one type of exercise is superior to another, most exercise is beneficial.

“There is no evidence that any specific exercise is dangerous if done appropriately or by people who are ready for it,” he said.

But if after an acute onset of back pain there is not improvement over two weeks, perhaps seek advice from a physiotherapist.

“A good clinician will help find the most appropriate exercise for the person,” he said.

“If muscles are weak around the spine then it’s strength exercise.”

If there are coordination or movement problems, it could be a different exercise.

A patient’s preferences are important, too. There’s no point taking up swimming if you don’t like water.

And movement has an added bonus. Most back pain is recurrent, but exercise has an important preventative role.

“It’s a good news story,” Associate Professor Hancock said.

US journalist and author of Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery, Cathryn Jakobson Ramin, said her own back has responded to some fairly simple intervention.

Now 61, she had suffered back pain since the age of 16, but these days is mostly free of it.

“What I discovered is I had a very weak upper body,” she said.

“I had a lot of fear, which was taking its toll. I’d had enough pain that I was afraid to do anything that might cause more. I realised I had gluteal amnesia. My butt had fallen asleep.

“Once I began to do the exercises that recruited those muscles, and recruited all the pelvic muscles, things got better and they got better fast.”

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