Lower back pain
Two Types of Lower Back Pain:
Non-Specific Lower Back Pain – normally a muscle/ligament strain
Specific Lower Back Pain – attributed to disease/pathology or a structural problem in the spine (such as degenerative disc disease or a disc bulge).
Chronic Lower Back Pain:
Lower back pain can become chronic (lasting longer than 3 months in the absence of pathology or once the acute cause of the lower back pain is treated).
Recovery Timeframes:
- Muscle Strain: From a few days to up to 3-4 weeks and 6-8 weeks at worst. Note that back strains often heal quicker than peripheral muscle strains due to their improved blood supply and ease of mobilising;
- Bulging Disc: 6-8 weeks (with no nerve impingement);
- Nerve root impingement – Radiculopathy: 6-12 weeks;
- Disc Herniation: 6-12 weeks;
- Annular Tear: 18 months to 2 years.
Treatment – Conservative:
Research indicates that most cases of lower back pain respond best to conservative treatment including RICER (Rest Ice Compression Elevation Referral) for the first 72 hours and analgesics, followed by physical therapy. Physical therapy should include both passive and active modalities.
- Passive Modalities (Physio and Chiro): This includes massage, dry needling, heat and ice packs, mobs, passive stretches and adjustments;
- Active Modalities (Exercise Physiologist): A holistic strength and conditioning program including self-massage (myofascial release), aerobic, strength, proprioceptive and flexibility training as well as education on biomechanically advantageous lifting patterns and safe manual handling techniques.
Treatment – Surgical:
Sometimes, if the damage is too great or conservative treatment has not been successful in relieving pain, surgery is considered. This is especially true for patients with consistent radicular pain from a protruding disc impinging the nerve root. Surgical procedures can include (micro)discectomy, laminectomy, or spinal fusion. Your surgeon will provide you with the pros, cons and risks associated. Research suggests spinal surgeries have about a 50% success rate so conservative treatment is trialed first in most cases.
If you are a worker, employer or doctor who requires assistance with managing return to work after a lower back injury, please get in touch on (02) 4927 0577.
Nick Feather, Exercise Physiologist/ Rehabilitation Consultant