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Low Back Pain

Incidence, Prevention and Treatment

Mark McCabe MSc (Sports Med) MISCP CSCS

Low Back Pain (LBP) is an extremely common and often disabling injury throughout sport, activities of daily living and the workplace.  A recent EU commission study suggests that 67 million people in the EU are currently suffering from spinal pain currently (1).  For the active workforce, LBP is a common cause of sick-leave and long term disability and time out of employment (2).  The likelihood of each individual experiencing LBP in their lives is estimated at anything between 59% to 90 %( 3).

Research indicates that the majority of LBP episodes settle inside 6 weeks regardless of whether one attends extensive treatment to reduce symptoms (eg. Massage, Mobilisations, Chiropractic or other) but many run a much higher risk of recurrence subsequently with further acute episodes affecting 44% of individuals within one year and a lifetime recurrence rate of 85%(4).  One of the major reason for recurrences is weakness of the musculature that supports the lumbar spine like a corset.   There are many possible sites for injury in the lumbar spine (Disc, Ligaments, Bony vertebra, facet joints...) and frequently it is very difficult to isolate a specific pain generator in a clinical examination.

However once the initial acute episode subsides the main focus should be on identifying the cause of the LBP, residual or pre-existing weakness and faulty movement patterns which may predispose to repeat injury.

Frequent causes of LBP:

• Prolonged sitting: Excessive load to the Lumbar Spine especially the disc leads to weakness and a large increase in compressive load to the spine.
• Lifting or bending with faulty /weak movement patterns: Your trunk muscles need to control the lumbar spine during lifting protecting it from excessive forces. Uncontrolled Flexion and rotation forces easily damage the spine.
• Pushing and pulling movements that are uncoordinated and don’t fully engage a proper connection between the upper and lower limbs. Hence don’t be surprised if we prescribe some push ups for your rehab programme post LBP.
• Poor Hip mobility:  Modern life means sitting and a lot of it!!  As a result there is major scope to lose hip mobility particularly extension and rotation.  Strong and mobile hips are vital to spare the lumbar spine, so stiff and weak hips are BAD!
• Deconditioning:  Poor general fitness will increase the likelihood of LBP.  Once you’re fatigued, poor movement patterns increase the risk.  Plus, the fitter you are the less likely you are to have hip or upper back mobility issues.

Treatment and Prevention:

• Treatment and Prevention are really one and the same.  Once the incident happens the injured area needs to heal.  A good assessment will indicate appropriate recovery time or necessary investigations.  Following from this should be a Plan of Care to address weaknesses and existing risk factors.
• Primary goal is to retrain the musculature that surrounds the lumbar spine to perform its function of stabilising the spine.  Starting points and level of end progression will vary according to the severity of the injury and the end goals of the client.  We rehab sedentary office workers with similar techniques but completely different intensity to our Olympic athletes.
• Identify and treat any adjacent joints that have reduced mobility or control that may contribute to LBP.
• Educate the client, educate the client and educate the client re:  Safety, exercise selection and how to fix themselves.

Above all, we treat LBP according to each individual case history and client goals.  All we require is that you understand that all evidence on reducing and preventing LBP indicates that improving fitness, movement patterns and strength offer the best results.  As such if you attend  www.sportsmedireland.ie for treatment, you will most likely have to do as much work as we will.

Mark McCabe MSc(SportsMed) MISCP CSCS

References

(1) European Commission, Special Eurobarometer, 272e, Nov 2007

(2) European Commission website: “Europa - Public Health - Health information - Dissemination of information - Disease and conditions information sheets - Major and chronic diseases - Musculoskeletal conditions.” http://ec.europa.eu/health/ph_information/dissemination/diseases/musculo_en.htm accessed 1 Feb 2008.

(3) Dr. Veerle Hermans, 2000, “Research on work-related low back disorders,” Institute for Occupational Safety and Health, Brussels

(4) The Bone and Joint Decade Report, 2005, European Action Towards Better Musculoskeletal Health, European League Against Rheumatism (EULAR), European Federation of National Associations of Orthopaedics and Traumatology (EFORT) & International Osteoporosis Foundation (IOF)