The Specifics of Non-Specific Low Back Pain
Did you know that back pain is one of the most common conditions that affect Australians every year? In fact, 1 in 6 Australians experienced back problems in 2017-18 (Australian Institute of Health and Welfare, 2020). The evidence also tells us that 4 out of 5 persons will experience low back pain in their lifetime! (Rolli Salathé & Elfering, 2013). Particularly in the current climate where working from home has become commonplace, it is highly likely that either you or someone you know has dealt with back pain at some point in recent years. Yet despite its high prevalence, it is often misunderstood and misdiagnosed, and therefore mistreated.
In order to better understand back pain, it is important to first consider the anatomy of the lower back. The low back, or lumbar spine, consists of five vertebrae whose primary function is to support our body weight. The lumbar spine also protects and houses the spinal cord - an integral part of our central nervous system. Many structures pass through the small spaces between each vertebrae, including blood vessels and peripheral nerves. The low back consists of 10 intervertebral joints that allow the movements of flexion and extension (bending forwards and backwards), lateral flexion (bending side to side), and rotation (turning). These movements occur through the contraction of various muscles in our lower back, including the erector spinae, quadratus lumborum, and multifidus.
The intricacy and complexity of the lumbar spine, with all the muscles, joints, and overlying connective tissues, as well as its close relationship with the pelvis, hips and thoracic spine, makes it very difficult to specifically identify the cause of low back pain. As such, your physiotherapist will use a triaging system to rule out any serious pathologies or “red flags” which make up less than 1% of all low back pain, and nerve root compromise which is attributed to less than 5% of all low back pain. If you fall in to the other 95% - which you probably do! - then your physiotherapist will likely diagnose you with Non-Specific Low Back pain (NSLBP). This term is used as an overarching term to classify low back pain that is not attributed to a known pathological reason (e.g. infection, lumbar spine fracture, osteoporosis, etc.) and is about as specific as we can be. Unfortunately, imaging does not assist us with making a more specific diagnosis. Although abnormalities may be picked up on CT scan and MRI, they can also pick up A LOT of false positives, and often don’t help us make a diagnosis or change the way in which we treat.
Typical characteristics of NSLBP will include:
back pain that is described as dull or achey
muscle stiffness/tightness
a history of obesity
sedentary lifestyle
psychological stress
NSLBP consists of three subtypes:
Acute (< 6 weeks)
Sub-acute (6 to 12 weeks)
Chronic (> 12 weeks)
Whilst some people with NSLBP will recover before reaching the chronic stage with no treatment, many will report symptom recurrences within 3-6 months. As such, it is important to seek early physiotherapy intervention to stop symptoms from progressing to a chronic stage, as well as minimise the chance of NSLBP recurrence. Physiotherapy management will consist of a detailed assessment followed by treatment that may include education, symptom management strategies, manual therapy and exercise prescription.
If you are experiencing back pain, contact any of our physiotherapists for a chat about how we can assist you!
To find out more about imaging and low back pain, check out our info sheet on our resources page.