Low back pain is the most common reason people see chiropractors. Lower back pain is also one of the most common health conditions in the world, with 38% of adults experiencing back pain in any one year.
Fortunately, despite having the potential to be very severe, back pain is rarely serious. Back pain usually responds excellently to chiropractic treatment.
There are many potential causes of back pain. The most common causes involve irritation of tissues in your lower back.
People often worry about damage when they have back pain, particularly to the spinal discs, but it is incredibly unusual for low back pain to result from damage.
If you think you may have sciatica, or a slipped disc, you can read more about them on these dedicated pages:
You may hear words like acute or chronic associated with low back pain. These words describe the length of time back pain has been present for, with acute low back pain being of recent onset and chronic back pain having been present for at least six weeks.
Lumbago is just another word for low back pain.
Low back pain can have a number of different causes. These can be defined as mechanical or non-mechanical. Mechanical causes account for the vast majority of lower back pain cases.
Non-mechanical causes of back pain are rare, but include pain referred from abdominal organs as well as pain caused by disease affecting spinal tissues. Usually you will have other symptoms in addition to back pain if the cause is non-mechanical.
Mechanical back pain often involves more than one tissue, typically having some muscular involvement alongside some joint irritation. Establishing which structures are contributing to your pain is an important part of physical examination and informs the management of your pain.
Mechanical back pain can originate for seemingly no reason at all, or can result from a clear trauma. In cases where there is no clear trauma, or the level of pain is disproportionate to the trauma, long term habits often play a part.
Poor posture and deconditioned muscles are leading contributors to mechanical back pain. Sedentary lifestyles have been judged largely to blame for this.
Often you can think in terms of triggers for back pain, being bending, twisting, lifting and so forth, and causes of back pain, being weak muscles, inactivity and other underlying factors.
Because in the majority of back pain cases symptoms result from irritation rather than damage, it is useful to try to maintain normal activity levels and do all of the things you would normally do. This helps to prevent physical deconditioning.
Staying physically active also reduces the possibility of fear-avoidance, a term used to describe anxiety associated with returning to activity after a break.
There are caveats to this idea, however. Pushing through the pain barrier can increase lower back irritation, and has the potential to cause symptoms to persist for longer. So be sympathetic to your back. Small bouts of activity at a manageable level should be the aim.
A significant contributor to low back pain is tissue inflammation, which is your body’s natural response to strain. Reducing this inflammation can provide good relief of low back pain.
Over the counter (ie. not prescribed) anti-inflammatories are helpful at reducing the effects of inflammation and easing symptoms. If you have stomach problems, heart problems or are on other medication, discuss this with your pharmacist before taking anti-inflammatories.
Ice packs offer another means of reducing inflammation, with no associated side-effects. In most cases they should be applied to your lower back and kept in place for 20 minutes. Always wrap ice packs in a layer of cloth to protect your skin.
Topical gels and rubs are largely unproven, but can be worth a try.
Given enough time, back pain will often clear on its own. However, given that 85% of back pain is recurrent, a check-over to make sure everything is in working order is useful.
A chiropractor will establish the cause of your pain, making it easier for you to take preventative steps. They will also provide you with specific advice and exercises to help prevent recurrence.
Chiropractic treatment is also one of the most effective means of relieving back pain, helping you get better more quickly.
We generally advise people wait 24-48 hours from the onset of back pain before making an appointment. This timeframe can give you enough time for your body to fix itself, without having any negative consequences if this doesn’t happen.
If your back pain does not clear within 48 hours, or if the pain is preventing you from doing things, you should make an appointment to see a chiropractor.
An advantage of seeking chiropractic care is that diagnosis and a range of treatment methods can be provided under one roof, and usually at the same appointment.
There are very few instances in which seeing a chiropractor is not the right thing to do if you have back pain.
However, if you have had recent significant trauma or are having disturbances with your bowel or bladder function, your GP may be able to offer more help.
If you make an appointment to see a chiropractor and manual therapy is not appropriate, your chiropractor will refer you for appropriate treatment or further investigation.
Diagnosis of back pain involves ruling out serious causes or complicating factors by clinical questioning and neurological and orthopaedic testing.
Once this has been done, further physical examination is conducted to pin-point the specific causes of your pain.
As well as examining you to determine the structures that are causing your pain, a chiropractor will assess what underlying factors have predisposed you to back pain.
The more specific the diagnosis, the more tailored treatment and rehabilitation can be made.
Imaging, such as MRI scans and x-rays, is not recommended for patients with back pain unless serious pathology is suspected.
If you have pain in numerous other areas of your body, a blood test may be useful to rule out inflammatory diseases, but this should not be instead of physical examination.
Treatment for back pain revolves around manual therapy and exercise.
Manual therapy can include joint manipulation or mobilisation, and soft-tissue techniques. Manual therapy has been shown to be very effective at relieving back pain, as well as at reducing the likelihood of recurrence.
Massage can provide temporary relief but is rarely effective for back pain without other types of treatment alongside.
Similar to massage, acupuncture has not been shown to be very helpful for treating back pain without other allied treatments used in conjunction.
Use of ultrasound and interfential machines has largely been discredited as offering no more relief than placebo. There is some debate about low-level laser, although any effect can probably be replicated by using heat packs.
Injections and surgery are no longer recommended for back pain unless in very specific circumstances.
Although research tells us that back pain carries a high risk of returning, there are also tried and tested means of reducing this risk.
Strengthening muscles around your spine, ie. core training, is one of the best strategies for preventing back pain from recurring. Different people need to strengthen different muscles, so exercise is more effective if prescribed by a medical professional or if supervised.
Generally moving more has also been greatly associated with decreased risk of back pain returning. In fact, the more you move, the lower your chances of getting back pain in the first place.
Sitting still for long periods, being overweight and smoking are all easily addressed lifestyle factors that can affect your risk of low back pain.
Use of manual therapies is another good strategy to help reduce the risk of back pain, or of back pain returning. Research shows that people using manual therapies on a preventative or maintenance basis experience less back pain than those using manual therapies in a reactive way.