Back Pain: Quick 5
Back Pain: Quick Fire Questions
Back pain is one of the most commonly reported musculoskeletal conditions across Aotearoa, New Zealand. That means that a lot of people are affected by back pain. When people come to see us, there are a few questions that usually pop up that people are understandably worried about. In this blog we are going to go into the top FAQs we get to hopefully help you get on the right road to recovery!
1. Is it something serious?
Back pain can be very debilitating and resulting pain levels can be high. Our first thought is that naturally, something bad must have happened.
The good news is that the incidence of serious pathology of the spine is very low. Most commonly, we see sprains and strains of the muscles, ligaments, joints and sometimes irritation of the discs and the nerves. These can all cause very high pain levels but are all conditions that will heal well with the right care and management strategies.
2. But how can you assess whether it is serious if the pain is high? Surely that masks serious issues?
Another good and valid concern! As physios, we are constantly on the lookout for tell tale signs of more serious conditions. These can include issues with your spinal cord, or severe nerve injury. There are some symptoms are commonly referred to as “Red Flags”
NB: This is not an exhaustive list and does not replace a thorough assessment with a trained professional
Signs of sinister and serious pathology include
- Changes to your bladder or bowel function and control:
- Inability to know when you need the bathroom
- Accidents, leaking, incontinence
- Unable to tell if your bladder is full or empty
- Sensation Changes between your legs
- Numbness of your inner thigh
- Altered sensation or numbness in your genitals or back passage
- Changes in sexual function
- This could be sensation or the function of your genitals
- Symptoms on both sides
- Symptoms like pins and needles, numbness and pain running down both legs.
When you see your Doctor or Physiotherapist, they will spend time going through these symptoms. If you don’t have any then it is unlikely you have serious spinal pathology (That’s good!).
If you do have any, then your healthcare provider will arrange appropriate investigations into them.
3. Do I need a scan?
Despite popular belief, you might be surprised to hear that most cases of back pain don’t need a scan! This is because the findings on MRIs do not always explain our pain symptoms, they are just a picture of a moment in time and don’t always tell the full story.
Here’s an example to help demonstrate this point…
A big study completed by Brinjikji et al (2015) looked at MRIs of over 3000 people that HAD NO BACK PAIN. They found that many of the findings that are often thought of as “bad” are seen in people that have no pain at all.
By 20 years old, 30% of people had disc bulges and protrusions. By 50 years, that number jumped up to 60%. In other words, if you scan 100 pain free people, there’s a good chance they will have some of these changes on their scans.
The bottom line here is that we can’t always attribute the findings on MRI to your current pain. There’s a chance they were already there since your 20s!
4. Is it better to move, or to rest?
There used to be a saying… Rest is Best! This is probably one of the biggest myths of back pain! Over-resting in most cases will not help, but might actually make your symptoms worse.
Gentle movements, within pain tolerance, are the best place to start. This is more likely to improve your recovery then rest alone. This might be as simple as walking for 5-10 minutes. The specific movements are going to be completely personal to you. This is why the “single best exercise for back pain” videos on social media don’t always work - there isn’t one!
This is where Physiotherapy comes into play. We can help you find the best movements that suit you.
5. How long does it take to get better?
For most people with onset of non-complex low back pain, the sharp, acute pain should start to settle within the first 1-2 weeks with the right management. Full resolution of symptoms can take longer, usually around 4-6 weeks.
For some people with other symptoms like sciatica (a nerve irritation that can give you symptoms such as pain and pins and needles running down the leg sometimes into the foot), improvement can sometimes take longer to resolve. This might look more like 3 to 12 months.
What you should see is slow progression and improvement over these time frames.
REFERENCES
Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., Halabi, S., Turner, J. A., Avins, A. L., James, K., Wald, J. T., Kallmes, D. F., & Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811–816. https://doi.org/10.3174/ajnr.A4173
