Lower back pain (LBP) affects many people throughout their lifetimes, ranging from acute to chronic stages. Non-specific LBP accounts for about 80-90% cases, with the remaining caused by LBP with specific pathology or serious/systemic pathology. It is important to know that movement can be medicine without needing to use medication or surgery. When it comes to injuries like LBP it shouldn’t be just the injured site that is taken into consideration. Looking at the biopsychosocial side and more of a multidimensional approach is essential for treatment.
This biopsychosocial model is broken into 3 groups of factors:
- Biological factors: e.g. biomechanics, Central nervous system (pain sensitivity), genetic predisposition, inflammation, nociception
- Psychological factors: e.g. fear avoidance, self-efficacy, depression, catastrophizing, coping strategies, beliefs, emotions, behaviours
- Social factors: e.g. education, socioeconomic status, family, smoking, alcohol consumption, occupation.
All these factors can influence the road to recovery. Although pain is a natural and protective mechanism this is also a major predictor in individual’s decision to commence exercise or not. This is not only from biological standpoint but rather can be heavily influenced by fear induced avoidance, catastrophizing, self-efficacy which results in persistence and exacerbation of pain. This is where support, education and self-management play an important role in recovery.
Physical inactivity can negatively impact individual’s pre-existing injury and also increase the risk of developing a new injury. Adherence is imperative during the management of LBP for exercise to achieve the best possible outcome. No evidence demonstrates that one mode of exercise is superior to another, so participating in any exercise is better than none at all. For the management, exercise has shown to be effective by strengthening the muscles around the spine for support, increasing spine mobility and muscular flexibility and reducing stiffness. Other treatment options such as manual therapy and acupuncture have shown short term positive outcomes although the quality of evidence is low to moderate, these are recommended over exercise in the more acute/subacute stages. The goal is for non-pharmaceuticals and non-surgical options to be the first point of call of rehabilitation, whilst surgery and medication to follow more as last options.