There are many causes of lower back pain which is why generic treatments rarely provide anything other than short term relief. If you’re still suffering after having been given a vague diagnosis such as ‘nonspecific back pain’ and some pills to numb you down then the good news is that you still have other, more effective options to explore.
To treat back pain successfully you have to identify and eliminate the cause of the pain instead of just treating the symptoms. While it’s sensible to start by seeing a physician to rule out any red flags such as a tumour, it’s far more likely that there is a mechanical or neurological cause of your pain. There may also be psychological factors that modulate your pain but these are less likely to be the root cause.
Is surgery necessary?
Some people avoid seeking professional help because they’re scared that surgery is the only option for them. Fortunately, this is rarely the case. Dr. Stuart McGill (author of Low Back Disorders and The Back Mechanic), widely regarded as the world’s leading expert on low back pathologies, sees only the absolute worst cases of low back pain. He attests that 95% of these challenging patients do not need surgery despite having been told it was the only cure available to them.
McGill emphasises that if you have good and bad days in terms of pain you are not a candidate for surgery. Instead, you need to identify the cause of the changing pain.
Identifying the cause of your pain
A good place to start is by making a list of all the activities that increase your back pain throughout the day. Then make a second list of all the activities that do not increase your pain and those that you can perform pain-free. Compare the lists and look for common movements, postures and loads that aggravate your pain.
For example, if you find that sitting for more than 15 minutes, tying your shoelaces and driving a car all increase your pain then your pain mechanism is posture, specifically a flexed spine posture. In this case, to eradicate your pain you’ll have to become more conscious not to flex your spine while going about your day. Continuing to provoke your pain through flawed movement patterns will further sensitise the affected tissues, making further triggering of pain more likely.
The age-dependent nature of back pain
Another factor to be taken into account when trying to identify the precise cause of your pain is the age of your spine. Generally, people in their thirties, forties and fifties are more vulnerable to discogenic pain originating from a damaged intervertebral disc. But, once you get beyond the age of 55, this type of debilitating pain becomes less common as the spine stiffens and becomes less mobile.
Senior citizens who experience low back pain are more likely to be dealing with spine arthritis and stenosis (a narrowing of the spinal canal that pinches nerves). Particularly those who have lived lives characterised by lots of spine motion, for example, plumbers, dancers or recreational squash players. As a result they are more likely to have developed arthritic changes in their vertebra. This additional bone growth narrows the canals through which the spinal cord and nerve roots travel, making them more susceptible to becoming irritated.
Evaluating your pain triggers and learning how to avoid them
Regardless of your age or the source of your pain, the path to a pain-free back begins with successfully identifying and eliminating your specific pain triggers. The lists you made previously will have given you an idea of what these are.
The next step is to perform a series of tests designed to deliberately provoke your pain. These will help you hone in on your specific pain triggers and know which strategies to use to avoid them. You can either follow the steps outlined in McGill’s book, Back Mechanic or get a competent movement professional to assist you.
Once your pain triggers have been identified you’ll need to find pain-free postures while sitting, standing and lying down. Then, you'll need to learn some basic movement tools so that you’re able to move in the most spine-conserving way possible. This will involve bracing the abdominal muscles at an appropriate intensity for the task in hand in order to stabilise the spine, whilst moving through the hips and shoulders (instead of the spine).
These new movement patterns must be applied to all of your daily activities for your pain to wind down successfully. This practice is known as spine hygiene. Remembering to move correctly when sitting down, standing up, cleaning your teeth, opening doors, using the vacuum cleaner, picking something up, etc. will be a fundamental part of your recovery and get you ready for the next stage.
Building a resilient back
Once the goal of becoming pain-free is achieved the next stage is expanding your pain-free capabilities and developing a resilient back for life. This involves increasing the endurance of all the muscles of the torso to make them more effective at stabilising the spine and minimising micro-movements that irritate nerves.
McGill identifies the exercises most effective at developing muscular endurance whilst simultaneously sparing the spine as: the modified curl-up, the side bridge and the birddog, collectively known as 'The Big 3’. Developing muscular endurance is more important than developing strength at this stage.
The other essential component of any back pain elimination program is simply walking. It’s important to maintain an upright posture and walk briskly in order to allow the back muscles to relax. For older individuals whose pain increases with walking, the program should be performed in shorter intervals to gradually build up capacity.
This article was first published in the magazine for the AAWE’s Retire and Thrive event (October 2019).