Understanding causes and symptoms
Many people seek a specific cause for their low back pain experience. This is understandable as it may inform future prevention, and provides a sense of reassurance from knowing what happened. The surprising truth is that outside of a few specific examples e.g. trauma, it is actually impossible to determine a singular ‘cause’ of regular low back pain. Any physio who pretends to know, and tries to blame “Poor technique” is either uninformed or a scammer.
In reality, there are countless variables that contribute to someone’s overall risk or chance of low back pain. It is then a chance game, based on that risk, when or if they will experience a bout of low back pain. For example, someone with high blood pressure is at increased risk of heart attack. Nevertheless it still remains a chance game, so they might never experience a heart attack in their lives or might experience one tomorrow.
It’s also important to differentiate between soreness from training (DOM’s) or injury. Both are an unpleasant sensory side effect that may occur post-training in a dose-dependent manner. At a certain point, which is completely made up, severe DOM’s might be classed as an injury. I say this to help conceptualize both these phenomena as being on the same spectrum, with no definitive line in the sand. Roughly, I would class a pain experience as an ‘injury’ rather than DOM’s if:
- A meaningful change in training program is required
- Pain is disproportionate to the preceding exercise
- Sudden rather than gradual onset of pain
- Persists for longer than a week with minimal improvement
Preventative measures
Based on the best research to date, here are some of the best preventative strategies you can do to minimize your chances of low back pain:
- Well-designed programming that controls fatigue well
- Changes in programming, technique or exercise choice should be gradual
- Ensure out-of-gym fatigue/stress is also managed well
- Sleep
- Diet
- Work/personal/social stressors
- Remember that our back is quite strong and robust, do not overthink intricacies of technique or assume bad outcomes
Stress Impact
This study among college athletes, found that students were 3.19x more likely to sustain an injury during times of high academic stress (e.g. assessments), when physical stress (training) remained unchanged. This highlights the importance of considering psychological stress in injury prevention or management.
Treatment and management
Treatment will always revolve around your own goals, expectations, baseline function and independent risk factors. After a thorough assessment, treatment will often involve an in-depth education session about what’s going on physiologically and coaching on how to self-manage during the day. A detailed rehab program will be tailor made with the goal to desensitize the area, prevent deconditioning and rebuild confidence. A long-term management plan will then be discussed to minimize your risk of future flare-ups.
Core Strengthening and Flexibility
A common blame for low back pain, again by physios who honestly don’t know better or wannabe scammers who want to sell you unnecessary follow-up sessions or programs. Neither core strength of flexibility have shown to have relevance in the low back pain experience or any other body part. In the case of strength, we would expect the world’s strongest people to be essentially immune to low back pain!
Professional Advice and Consultation
Medical consultation may be recommended in certain cases where we suspect there may be a serious pathology going on. This might include loss of bowel/bladder function, concerning ongoing worsening of symptoms, certain sensory changes etc.
For over 90% of cases, a personalized treatment plan by a physio based on someone’s condition and pain levels leads to excellent results.
Educational Approach
Education is key to managing low back pain, especially here at SportsPhysioOnline because if were able to educate in a way that leads to a boost of confidence and the ability to self-manage pain flares and other uncertainties in training, the evidence tells us that this is a very strong predictor of a good outcome. People are able to modify their own risk factors once they are equipped with the knowledge.