All about Common Low Back Pain
by Romain Lambert
Common low back pain (scientists also call this non-specific low back pain) accounts for 85% of all low back pain that can be encountered (hence the term "common").
What is common low back pain?
Lumbalgia literally means “pain in the lower back.” “Lumbar” meaning the lower part of the back (English speakers call this Low Back Pain) and “Algos” coming from Greek and meaning pain. Some also call it Lumbago which is a common term for acute low back pain. The area of pain can span the entire surface of the lower back, into the buttock, and can also go all the way above the knee without a nerve root necessarily being involved.
Common low back pain (scientists also call this non-specific low back pain) accounts for 85% of all low back pain that can be encountered (hence the term “common”). It is characterized by its absence of gravity and direct link with any bodily structure that would be damaged/injured (hence the term aspecific). However, this does not mean that the pain felt or the discomfort caused is minimal! This is a situation that can be very disabling for everyday life.
Why and how did I catch this?
In popular beliefs and received ideas, the answers to these questions would probably be “because you didn’t keep your back straight” or “because of a wrong move”. This is not entirely accurate.
The population most affected by back pain is professionally active people whose work is sedentary. The muscles and joints of our human body remain healthy thanks, in particular, to movement. There is no such thing as perfect posture or bad posture. We now say “The best posture will be the next one you take”. We also note that the difference between a person with low back pain and an asymptomatic person (showing no symptoms) is not the type of posture they adopt but the frequency of change of posture / frequency of movement. In summary, striving to keep your back straight all the time is not a good idea and when a posture is held too long – no matter which one – can cause discomfort.
Conversely, low back pain can also occur during unusual physical exertion. The famous “false move”. In reality, there really is no such thing as a “false move” or absolutely forbidden move. The secret is in the dosage. If we repeatedly perform a movement that we are not used to (called “new use”) or a known movement but much more intensely (called “overuse”), we exceed the limits of our physical capacities. and the body does not appreciate that. It makes us notice it by producing pain.
In short, it’s about finding the right balance between moving enough and not overdoing it.
Where does this pain come from?
Again, in popular beliefs, it is often accepted that the main causes of pain are osteoarthritis and herniated discs.
These beliefs are again wrong. They reflect where scientific research on back pain stopped in the 1960s and 1970s. In 50 years, research has advanced enormously and our understanding of back pain is now quite different.
Pain is an unpleasant and complex sensory and emotional experience. I say complex because it depends on many factors, but it is not complicated. Let’s imagine for a moment that our body and our mind form a container. A glass. The capacity (size-diameter) of this glass is directly proportional to our internal resilience, our resources (if we have slept well, if our diet has been balanced lately, if we practice regular physical activity, etc.). Then imagine that we fill this glass: the vagaries of everyday life acting as the liquid (stress at work, at home, anxiety, social isolation, unusual physical effort, anger, lack of support). If the space taken up by these hazards exceeds our ability to cope with them, then the glass overflows and the excess corresponds to pain.
In summary, pain is the accumulation of several factors that, at some point, exceed our ability to cope with it. These factors can be physical (accident, excessive stress, unusual effort) but also psychological (stress, anxiety, fear) and social (isolation, lack of support). This model of understanding pain is called the bio-psycho-social model.
Is that bad? Should I go see a surgeon?
The use of medical imaging (radiography, scanner, MRI, ultrasound) as well as surgery as a first resort is strongly discouraged in common low back pain (as a reminder: 80% of low back pain). The observations most frequently encountered in the results of medical imaging, such as osteoarthritis and disc protrusions, are in the vast majority of cases completely harmless and unrelated to the current pain.
The risk, the danger when introducing these methods early is to develop a chronicization of the pain. Most people with chronic pain have gone through the following stereotypical journey: “At first it all started with a little pain in my back as I leaned forward suddenly. I had medical exams and they told me that my back was badly damaged, that my X-ray was that of someone in my 80s and that I risked ending up in a wheelchair. So I had an operation but I didn’t feel better afterwards, even worse. Now I don’t even dare to play sports, or even go out with my friends. I am constantly on my guard. My life is ruined, my body is broken.” Early recourse to surgery based solely on the findings of medical examinations is at risk of causing the “Failed Back Surgery Syndrome (FBSS)”.
On the other hand, surgery is indicated in other cases of low back pain (20% remaining) if there is a loss of strength, loss of reflex and/or loss of sensitivity.
What are the solutions?
There is no a miraculous recipe. Each person is different. If we refer to point 3) “where does this pain come from”, we understand that we must address the various factors that contribute to the present pain. Total rest is not a good idea because it can prolong the painful period. Movement is the most powerful painkiller. Excessively painful activities/positions should be temporarily avoided/replaced with other types of movement. If the situation does not improve or if you feel helpless about it, seek help and contact your physiotherapist.
How is rehabilitation carried out?
The sessions begin with an anamnesis, where the physiotherapist listens carefully to the patient and guides the interview with specific questions. It is truly a therapeutic alliance where the patient and the physiotherapist seek to identify the various contributors to the problem together in order to establish the therapeutic objectives. As a reminder (point 3), the contributors can be physical, social (the objective being the resumption/reintegration of daily activities and the improvement of the quality of life) and psychological. ! Beware of this last point! The goal is not to play the apprentice psychologist. It is a question of detecting inappropriate attitudes/behaviours, sometimes unconsciously put in place, which could contribute to the persistence of your pain.
For this the main tools of the physiotherapist are:
- Communication/explanation techniques: These aim to provide clarity and answers to the patient’s questions. When we understand his problem, it is already partly solved.
- Manual techniques: these aim to reduce the intensity of your pain and improve your ease in performing movements. They can be an excellent introduction to physical exercises that would not have been possible without them.
- Physical exercises: In addition to being therapeutic, they are also preventive and will improve your resilience, internal resources.
Will I ever have back pain again?
Yes, more than likely. It should be noted that the factors that have the most correlation with a long symptom duration are: Lifestyle (poor sleep, poor diet, tobacco, alcohol, physical inactivity) as well as depression, hypervigilance, catastrophizing and fear of movement (called kinesiophobia – no no that does not mean fear of the physiotherapist).
What can I do to speed up the process?
Be optimistic and fully involved in your treatment! The caregiver-patient relationship is not an active-passive relationship. It is you who hold the keys to your healing. We help you find them and use them.