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Long lasting low back pain can be distressing and disabling but its rarely life threatening and you are very unlikely to end up in a wheelchair.
Although it is a widespread belief and concern that getting older causes or worsens back pain, research does not support this, and evidence-based treatments can help at any age.
Backs are strong, if you have had an injury, tissue healing occurs within 3 months. So, if pain persists beyond this time it usually means there are other contributing factors. A lot of back pain begins with no injury or with simple every day movements. These occasions may be linked with stress, tension, fatigue, inactivity or unaccustomed activity which makes the back more sensitive to movement and loading.
Scans are only helpful in a minority of people. Lots of scary sounding things can be reported on scans such as disc bulges, degeneration, protrusions, arthritis, etc. Unfortunately, the reports don’t say that these findings are very common in people without back pain and that they don’t predict how much pain you feel or how disabled you are. Scans can also change, and most disc prolapses shrink over time.
When pain persists, it is common that the spine and surrounding muscles become really sensitive to touch and movement. The pain you feel during movement and activities reflects how sensitive your structures are – not how damaged you are. So, it’s safe and normal to feel some pain when you start to move and exercise. This usually settles down with time as you get more active. In fact, exercise and movement are one of the most effective ways to help treat back pain.
How we sit, stand and bend does not cause back pain even though these activities may be painful. A variety of postures are healthy for the back. It is safe to relax during everyday tasks such as sitting, bending and lifting with a round back – in fact its more efficient.
Weak ‘core’ muscles do not cause back pain, in fact people with back pain often tense their ‘core’ muscles as a protective response. This is like clenching your fist after you’ve sprained your wrist. Being strong is important when you need the muscles to switch on, but being tense all the time isn’t helpful. Learning to relax the ‘core’ muscles during everyday tasks can be helpful.
The same way lifting weights makes muscles stronger, moving and loading make the back stronger and healthier. So, activities, like running, twisting, bending and lifting are safe if you start gradually and practice regularly.
Whilst pain flare-ups can be very painful and scary, they are not usually related to tissue damage. The common triggers are things like sleep, stress, tension, worries, low mood, inactivity or unaccustomed activity. Controlling these factors can help prevent exacerbations and if you have a pain flare-up, instead of treating it like an injury, try to stay calm, relax and keep moving.
Spine injections, surgery and strong drugs like opioids aren’t very effective for persistent back pain in the long term. They come with risks and can have unhelpful side effects. Finding low-risk ways to put you in control of your pain is the key.
Content adapted from a summary provided by South Tees Hospitals NHS Foundation Trust.
Reference: O’Sullivan P, Canerio JP, Osullivan K, Lin J, Bunzil S, Wernill K, Back to basics: 10 Facts about low back pain. BJSM 2019