In developed societies, back pain has acquired the characteristics of an epidemic and is considered one of the most relevant health problems. It affects more than 80% of the population at some point in their lives.
To better understand this concept we must make appropriate distinctions, since this type of discomfort receives a different name depending on the part of the back where it is experienced. The terms are formed by joining the suffix -algia (meaning pain) to each of the vertebral regions. Thus, we have cervicalgia, when it affects the cervical area (neck); dorsalgia, if the dorsal region hurts; and low back pain, in the lower part.
It is common to find these words in a multitude of clinical reports, but they do not really correspond to a diagnosis: we are simply indicating that there is pain in a specific region.
1. When do you have to worry about us?
Although almost the entire population will experience back pain at some point in their lives, fortunately it is not serious in most cases. In a large percentage, it decreases a month after starting.
Physiotherapists and doctors use the expression “red flags” (translation from English red flags) for those signs and symptoms that could reveal a serious disease in the spine or another part of the body.
Some warning signs are experiencing sensory and muscular alterations (tingling in the limbs, loss of strength, urinary incontinence…), losing weight without justification, having suffered a blow, feeling pain in the thoracic region or having a fever.
So even though back pain is usually benign, you should see a professional Of the health whenever there are doubts. As long as there are no red flags, we must remain calm, because there are no signs of serious pathology.
2. Does the way you deal with it influence your evolution?
Psychosocial factors, called “yellow flags”, are essential for the pain to last for a long time. That is, it turns chronic.
Some examples of yellow flags are: adopting a negative attitude (we must keep in mind that a lot of pain is not synonymous with serious injury or disability); stop doing physical activities for fear of discomfort or that the problem will worsen (the so-called kinesiophobia); thinking that passive treatments are better than exercise; and also face social, family or financial problems.
3. If my back hurts, should I get an X-ray?
It is a decision that must be made by the doctor, because X-rays are not innocuous. After the age of 50 it is normal to suffer from degenerative processes in the spine or alterations in the intervertebral discs, but people without discomfort also suffer from it.
In the end, the diagnosis of these ailments through imaging tests contributes to overmedicalize patients and increase the number of sick leave.
The International Association for the Study of Pain indicates that pain is non-specific (cannot be associated with a specific problem) in 85% of cases. For this reason, X-rays are often used when there are red flags.
4. What are the best exercises to combat it, according to science?
Considering all the options available, from zone-specific activities to full-body exercises, it’s hard to summarize without leaving out relevant information. The physiotherapist will prescribe it based on the needs and pathology of each patient.
In long-term low back pain, the international network of experts Cochrane Collaboration indicates that therapeutic exercise is more effective than other interventions or treatments, but no program demonstrates a clear advantage over others.
However, some recent publications do venture to propose the Pilates and the exercises McKenzie method (which focus on back extension movements) as remarkable for relieving low back pain.
In our research we have also observed that therapeutic exercise and correct patient counseling increase the effect of manual therapy.
Therefore, there are multiple alternatives offered from physiotherapy. Many exercises are aimed at improving the mobility of the spine and stretching shortened muscles (for example, the extensor muscles of the spine, the hamstrings and the iliopsoas). Others seek the strengthening and adequate control of the muscles, especially in the central area (the so-called core muscles), as well as postural hygiene as a preventive measure.
But any activity, from the simplest, is beneficial. Science indicates that walking reduces pain and improves quality of lifeapart from preventing movement avoidance behaviors in chronic low back pain. Plus, it’s one of the easiest and most affordable ways to stay active.
The important thing is to carry out an activity that is to the patient’s liking: the worst exercise is the one that is never done.
5. Can I do sports after having suffered it?
A sedentary lifestyle, a great enemy of our health in general, favors back pain to lengthen and generate greater disability. Therefore, rest must be duly justified and limited to the minimum possible time.
It has not been shown that practicing sports (leisure or competitive) causes back pain to reappear. Rather, it favors that the benefits of physiotherapy treatment are maintained, as long as the intensity and duration are regulated.
In any case, we must choose the right discipline and have the advice of an expert. This is the case of swimming, whose practice must be supervised if we opt for the butterfly style. In cycling we must adjust the position in the saddle to maintain a proper posture.
If we choose a team sport (football, basketball…), the important thing is to take into account the contact between the participants and the sudden and intense movements. And in tennis, serving or serving is especially stressful because of the movements it requires of the back.
As for the activity of running, it generates repeated impacts and stress on the lumbar spine in the heel strike phase, since it supports a compression that oscillates between 2.7 and 5.7 times the body weight. Intense running could be a risk factor for low back pain, but doing it moderately even improves any type of back discomfort.
In short, the best way to treat back pain is to reassure the patient, insist on avoiding unnecessary rest, control overmedication, and break a sedentary lifestyle.
*Lorenzo Antonio Justo Cousiño is a professor at the Faculty of Physiotherapy, a physiotherapist, and a doctor in Neuroscience from the University of Vigo, Galicia, Spain. The original article of his was published in The Conversation.
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