Low back pain is now the leading cause of disability worldwide and the number of people experiencing it is forecast to keep rising. However, there is a move to change the way we treat and manage sore backs: rather than expensive therapies or medication, it is all about empowering us to help our body heal itself.
Christchurch physiotherapist Antony Bush is the author of The Back Fix: How to Beat the World’s #1 Disability. He thinks there are two reasons we have seen such an explosion in the number of sufferers. One he identifies is better access to magnetic resonance imaging (MRI).
“If someone has been in pain for six weeks, they’ll go off and get an MRI which will show them all the imperfections, disc tears and protrusions that are normal in their age group and were already there,” he says. “Then they’ll get really worried.
“As practitioners, we’ve been telling them a lot of well-meaning stuff: don’t bend your back, don’t load your back, pain is bad. All of that has been proved to be incorrect. We now understand that everyday load is good for joints, and if you unload them, they get weaker, fatigue more easily and become sore.”
The way we move in modern life is the other cause of back pain. Many of us have sedentary jobs and remain in the same position for long periods of time. Or we repeat the same motion over and over again.
“Joints need to be taken through the full range of movement,” says Bush. “They don’t like staying in one position for long periods of time.
‘If you sit at a desk all week and then on the weekend decide to dig over the garden or stack firewood, there may well be repercussions. As soon as you go over a 20% increase on what’s normal activity for you, you’re going to get sore.
“We get all these people ringing on a Monday saying they’ve put their backs out. They haven’t – they’ve just gone over their 20%. It’s normal for joints to get sore and it’ll settle down in a few days if they keep moving.”
A small percentage of people do have a serious problem that needs treatment. The remainder may need to rest and apply a wheatbag or hot water bottle during the acute phase of pain. Bush advises changing position every 15-20 minutes interspersed with short walks if possible. After 6-12 weeks, it is time to start moving again and loading up the joints.
Although a quick fix would be ideal, unfortunately with back pain there really isn’t one.
“You can go off and spend money on treatments with different practitioners – acupuncture, massage, manipulation – and they may make you feel better but they’re not going to heal you because we’re a self-healing animal and nothing can speed up the healing rate,” says Bush.
He argues that we need a paradigm shift and to start thinking of back pain as a journey that may involve some level of discomfort along the way as we start building strength again.
“Load is not harmful for backs, and pain flare-ups don’t mean you’ve got significant damage. Back pain is just part of life and we all get it.”
If someone is stressed, anxious, rundown, not sleeping or depressed, that will amplify pain. But, Bush says, sufferers often focus just on one piece of the jigsaw puzzle rather than looking at the big picture.
His role models are his parents. At 91, his father was still ski-racing and mountain biking. His mother, 87, is a keen gardener who has only just stopped playing tennis. Both experienced significant back pain but kept moving anyway.
There used to be a lot of focus on building core strength, when in fact we need to strengthen the whole body. One of the best things we can do for our backs is to walk for 11/2 hours daily. It doesn’t have to be all in one go but broken into smaller stints through the day.
Bush is also a big fan of squats.
“I think a lot of it is about mental attitude. The research is quite clear – backs are no different from any other joint; you’ve got to get them moving again. But people can become quite disabled because they haven’t understood that message.”
