In December 2023, the World Health Organisation (WHO) published new guidelines for the management of primary non-surgical low back pain in adults. Low back pain is incredibly common and can affect people throughout life. It was found to affect 1 in 13 people globally in 2020, which equates to an estimated 619 million people (WHO, 2023), and these are the reported cases, there are likely to be a lot more of us out there who get low back pain and put it on the back burner! It is not only a pain in the back, it costs a lot too, in time off work, in missing out on normal daily activities and hobbies, and in our mental health as chronic pain (defined as pain lasting longer than 12 weeks) takes it's toll.
So what can be done about low back pain. Low back pain can be categorised as primary (the pain is originating from structures within the low back) or secondary (pain is referring to the back from elsewhere, such as a stomach ulcer). The vast majority of primary low back pain comes from the small joints in the spine in the low back (lumbar facet joints), the large pelvic joints (sacroiliac joints), the ligaments that surround these bony structures and the large postural and structural muscles that attach onto the lumbar spine and pelvic girdle. Low back pain can also be caused by irritation (either directly or indirectly) or the nerves of the low back causing sciatica (if affecting the sciatic nerve). A small percentage of chronic low back pain are surgical cases, however most people with low back pain can be successfully treated with conservative management to not only alleviate or eliminate pain, but help prevent recurrence.
Patient Education
It is no surprise that patient education is the number one intervention on the WHO latest guidelines. There is so much you can do to help manage and treat your low back pain, and prevent it from recurring. Chiropractors spend 4 -5 years in full time education learning anatomy, physiology and biomechanics, so are specialists in how bodies move. Patient education is a large chunk of chiropractic care so that clients learn how to take care of their own bodies. Below are just a few steps you can take to help your low back pain:
Lead an active lifestyle
Know how to stretch out tight muscles
Rehab weak muscles to improve posture and functional movement patterns
Know how to mobilise the joints in your body in a functional way
Understand which movements or activities to avoid during a flare up
Know when to apply cold and heat
Spinal Manipulative Therapy
One treatment tool chiropractors use is a high velocity, low amplitude manipulation, adjustment or thrust. This involves locating a stiff joint that is not moving optimally, usually due to tight ligaments and muscles that attach onto it, but can also be due to wear and tear in that joint due to ageing or trauma. During their training, Chiropractors complete over 1000 supervised clinical hours assessing, diagnosing and treating neuro-musculoskeletal conditions. Chiropractic adjustments are very specific to the joint being treated and the force put through that joint, minimal (low amplitude) and will only be performed if required and suitable to that patient. It is usually performed by hand, however it may be performed using an activator (a small device that delivers a gentle thrust). Alternatives to spinal manipulative therapy is mobilising the affected area which is less specific to one particular joint but a very gentle and effective alternative to get joints in the low back moving better.
Massage or Soft Tissue Work
Alongside joints not moving as well as they should, the surrounding soft tissues are usually tight and tender in low back pain. Sometimes this is down to your muscles 'guarding' against unwanted movements (your back going into spasm when reaching awkwardly for something on the floor) or they can be chronically tight due to poor/changing posture (such as pregnancy), a weak core, prolonged periods of sitting or performing repetitive movements that have aggravated them. Often tight and sore muscles are the source of low back pain and can be treated with massage and soft tissue work such as stretching, some of which you can do at home. By strengthening key muscle groups, it can help rebalance functional movements in the body. Certain muscles have to overcompensate for the weak ones which are not doing their job properly. A great example of this is your large low back muscles becoming overly worked and tight trying to keep you upright and moving, because of weak deep abdominal muscles at the front of your body and weak gluteal (buttock) muscles at the back. By addressing this imbalance, it not only reduces or eliminates your pain, it helps prevent it from recurring as your body is moving in that way it was designed to. This rebalancing also helps protect those little joints in your spine and allows them to move optimally and pain-free. If the joints are moving well, and muscles are working as they should, it reduces any inflammation and aggravation of spinal nerves which cause conditions such as sciatica.
Medication -Non-Steroidal Anti-Inflammatories (NSAIDs)
The WHO guidelines also discount previous commonly used interventions such as the use of opiates when managing chronic non-surgical primary low back pain in adults, however NSAIDs are still recommended. If you are taking medication as part of your management of back pain, it is always worth visiting your GP for a review of your medication to make sure it is still working for you.
Low back pain is a very prevalent condition affecting many people worldwide. It has also historically been a poorly managed condition with detrimental advise such as bed-rest given to patients, leaving them in a perpetual cycle of further weakness, stiffness, pain and loss of function. Economically this has a huge cost in time off work and personal cost in the loss of activities and freedoms previously enjoyed. The recent WHO Guidelines provides us with a better picture of chronic low back pain and how it is best managed using the most current and best quality evidence to support it.
If you would like more information on the WHO guidelines outlined above from a chiropractic perspective, or on the chiropractic management of low back pain, then feel free to get in touch.