5 things you should know about back pain – 03/12/2023 – Equilibrium and Health

In many developed countries, back pain has become a kind of epidemic and is considered one of the most relevant health problems in society. The disease affects more than 80% of the population at some point in their lives.

To better understand this issue, we must first make the necessary distinctions, as this type of discomfort receives different names depending on the part of the back that hurts.

The terms are formed by joining the suffix “algia” (meaning pain) with each of the vertebral regions. Thus, we have neck pain, when the pain affects the cervical region (neck); back pain, if the region that hurts is the back; and low back pain, in the lower part of the back.

It is common to find these words in a multitude of clinical reports, but in fact they do not represent a diagnosis: we are just indicating that there is pain in a specific region.

1. When should you be concerned?

Although almost everyone suffers from back pain at some point in their lives, fortunately the problem is not serious in most cases. For the most part, the pain subsides within a month of onset.

Physiotherapists and doctors use the expression “red flags” (English translation “red flags“) for signs and symptoms that could reveal a serious illness in the spine or elsewhere in the body.

Some warning signs are sensory and muscle changes (tingling in the limbs, loss of strength, urinary incontinence…), unexplained weight loss, having suffered a blow, feeling pain in the thoracic region or having a fever.

Therefore, although back pain is generally benign, a health professional should be consulted whenever there is any doubt. As long as there are no red flags, we must remain calm, because there are no signs of serious pathology.

2. Does the way of facing pain influence how it evolves?

Psychosocial factors, called “yellow flags”, are essential for the pain to end up lasting for a long time. In other words, it becomes chronic.

Some examples of yellow flags are: adopting a negative attitude (we must bear in mind that pain is not necessarily synonymous with serious injury or disability); stop doing physical activities for fear of discomfort or that the problem gets worse (so-called kinesiophobia); thinking that passive treatments are better than exercises; and also end up suffering from social, family or financial problems.

3. In case of pain, should I have an X-ray?

This is a decision that must be made by the physician, as X-rays are not innocuous. After the age of 50 it is normal for us to suffer from degenerative processes in the spine or changes in the intervertebral discs, but healthy people also suffer from this.

The diagnosis of these diseases through imaging tests contributes to overmedication (when drugs are prescribed for more than necessary) and to an increase in the number of days away from work.

The International Association for the Study of Pain indicates that pain is nonspecific (cannot be associated with a specific problem) in 85% of cases. Therefore, X-rays are most often used when there are red flags.

4. What are the best exercises for pain, according to science?

Considering all the options available, from specific activities for a region of the spine to full body exercises, it’s difficult to summarize everything without ending up leaving out relevant information. The physiotherapist prescribes exercises 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 had clearly better results than others.

However, some recent publications venture to propose Pilates and McKenzie method exercises (which focus on back extension movements) as notable in relieving low back pain.

In our research, we also observed that therapeutic exercise and correct patient counseling enhance the treatment effect.

Therefore, physiotherapy offers multiple alternatives. Many exercises are aimed at improving spinal mobility and stretching muscles (for example, the spinal extensor muscles, hamstrings, and iliopsoas).

Others seek strengthening and adequate control of the musculature, mainly in the central region (the so-called “core” muscles), in addition to postural education as a preventive measure.

But any activity, from the simplest, is beneficial. Science indicates that walking reduces pain and improves quality of life, as well as preventing movement avoidance behavior as a result of chronic low back pain. Plus, this is one of the easiest and most affordable ways to stay active.

The important thing is to perform an activity that the patient likes: the worst exercise is the one that is never done.

5. Can I play sports after suffering from back pain?

A sedentary lifestyle, the great enemy of our health in general, favors prolonged back pain and generates disability. Therefore, inactivity must be duly justified and limited to the minimum possible time.

Playing sports (recreational or competitive) has not been shown to cause back pain to return. On the contrary, sport favors the maintenance of the benefits of physiotherapeutic treatment, as long as it is regulated in intensity and duration.

In any case, we must choose the right activity and rely on the advice of an expert. This is the case, for example, with swimming, whose practice must be supervised if we choose the butterfly style. In cycling you need to adjust your position in the saddle to maintain 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, the serve is especially stressful because of the movements it requires from the back.

Running activity generates repeated impacts and stress in the lumbar region in the heel strike phase, which supports a compression that oscillates between 2.7 and 5.7 times the body weight. Hard running can be a risk factor for lower back pain, but moderate running even improves any back discomfort.

In short, the best way to treat back pain is to reassure the patient, insist on avoiding unnecessary inactivity, controlling excess medication and getting out of a sedentary lifestyle.

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Lorenzo Antonio Justo Cousiño is a physiotherapist, doctor in Neurosciences and professor at the Faculty of Physiotherapy at the University of Vigo, Spain

Article originally published on the academic news website The Conversation and republished under a Creative Commons license. Read the original version (in Spanish) here.

– This text was on the BBC News Brasil website.