Non-specific lower back pain

Non-specific Lower Back Pain

4 in every 5 people will experience lower back pain (LBP) at some stage in their life. And while we may have heard horror stories of slipped discs (discs don’t actually slip, but that is a rant for another time), the truth is that approximately 90% of lower back pain has no specific pathology – thus, non-specific LBP.

Common risk factors for non-specific LBP include:

  • Age (it can affect all age groups, however prevalence increases the older we get)
  • Obesity
  • Physical inactivity
  • Sedentary work
  • Repetitive manual work
  • Smoking
  • Anxiety
  • Depression

Non-specific LBP is grouped into acute, sub-acute, and chronic subgroups, each based on the duration of a pain episode. Pain lasting less than 6 weeks is deemed acute, 6-12 weeks sub-acute, and longer than 12 weeks is considered chronic. Fortunately, many cases of non-specific LBP will recover with little or no treatment; with roughly half of all LBP resolving within 2 weeks. Some factors that may prolong an episode of LBP include:

  • Impaired strength
  • Low levels of physical activity
  • Other musculoskeletal injuries (related or unrelated)
  • Negative beliefs about pain and movement avoidance (stopping activities that cause or may cause pain)
  • Poor understanding of condition (misinterpreted symptoms or scans)
  • Depression

While much LBP is fairly short-lived, a concerning trend shows approximately a third of people will have a recurrence of their LBP within 12 months, and that lifetime recurrence is greater than 60%. So what can we do to firstly reduce our risk of experiencing LBP, but also our risk of relapse?

The best treatment for non-specific LBP

Evidence shows us that the best treatment for non-specific LBP is movement. This is important to remember, as it is often counterintuitive when we are in pain. However early movement as tolerated has been shown to improve outcomes and rate of recovery in non-specific LBP. The best place to start is walking, even if it is only for a few minutes around the house. Improving overall levels of physical activity will not only improve recovery, but also reduce risk of relapse.

For those with persistent or recurrent LBP, or those wishing to reduce their risk of LBP, a personalised exercise program is recommended. These programs aim to identify and correct areas of weakness that may contribute to the development of LBP, and can be delivered by your physiotherapist.

Will manipulations help?

Massage and manipulation techniques can be effective in reducing pain and improving mobility in individuals with nonspecific LBP. However their effectiveness reduces with the duration of treatment, so are typically only recommended during the acute and sometimes subacute phases. Ultimately, manipulations and manual therapy should serve as an adjunct to the greater goal of improved physical activity and muscle strengthening.

What about medication?

Simple pain-relievers such as Panadol or Nurofen may be effective in providing short-term relief, though like manipulations do not address underlying reasons for pain. Additionally, the Royal Australian College of General Practitioners (RACGP) now strongly advises against the prescription of opioids for the management of non-specific LBP.

Do I need a scan?

As the name suggests, non-specific LBP means there is no specific pathology responsible for your pain. As such, a scan will not improve the overall clinical picture, and in fact can do more harm than good. Common scan findings, such as “disc degeneration” or “bulges” are often found in pain-free individuals, and thus can create unnecessary stress about your prognosis, possibly prolonging an episode of pain by creating negative beliefs. The RACGP therefore advises against imaging when no specific pathology is suspected.

The bottom line

Lower back pain is incredibly common and often not associated with a specific pathology. Exercise is the best way to treat and reduce your risk of non-specific LBP. For those interested in getting more active, or in a tailored exercise program to treat or prevent LBP, call us or book in your free telehealth exercise discussion today.

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