As we are settling into our new ways of living life in lockdown, the kitchen table desk set up we thought would only be needed temporarily may now be starting to look like a semi-permanent feature. It may also be starting to give you niggles with your lower back, which is no surprise. Research suggests that globally most people will experience back pain at some point during their lifetime. We look at the cause of lower back pain and the changes you can make to help manage it.
Any form of lower back pain can be debilitating and worrying but it is very common. It has been shown that it can easily be triggered by changes in our daily habits or routines which the lockdown has caused to so many peoples lives.
The back’s main function is to primarily protect the spinal cord and to effectively move and transfer load from the lower part of our body to the top part. It does all of this whilst providing as much movement as possible. It is often mislabelled as being weak or unstable, it is however quite the opposite, and stronger than you may think.
Being such a strong and stable structure, most cases of lower back pain are often a simple strain or sprain. According to research 98 per cent of people will recover reasonably quickly without the need for treatment. Some people will experience repeat episodes, which can be very distressing however, you may just need to do a little bit of muscle retraining, guided by a healthcare professional, to remind certain muscles to do their job.
There is often not one specific cause when we develop lower back pain but is more likely to be a combination of many factors. These can include being in certain postures or positions for prolonged periods of time, completing loaded or repetitive movements and some psychological factors can affect the onset of this pain too.
It has been widely documented that the COVID-19 pandemic and its effects are causing additional stress to many of our lives. You may be surprised to read that this may also be influencing the aches and pains we are feeling in our body as a result. Stress is defined as ‘a sense of uncontrollability and unpredictability’, which is a feeling that many of us can associate with in the current circumstances. In 2018, researchers at Tel Aviv University applied acute stress tests on a large group of healthy young adults to evaluate the behaviour of the body’s pain prior to and after the introduction of stress. They discovered that although people’s pain thresholds and tolerance levels seemed unaffected by stress, there was a significant increase in the intensity of pain that they felt and a reduction of being able to reduce the pain signals when they started.
This is an interesting finding and helps to reinforce the thought that many physical or psychological factors cause pain, particularly in the lower back and it is often a combination of both.
The National Institute of Health and Care Excellence (NICE) have produced clinical guidelines for the management of non-specific lower back pain in adults. They report that prolonged rest and avoidance of activity leads to higher levels of pain, greater disability, poorer recovery and longer absence from work. In the first few days of a new episode of low back pain, it may help to temporarily relieve pain by avoiding aggravating activities. However, it is still important to stay as active as possible and return to all your usual activities gradually to aid recovery. While it is normal to move differently and more slowly in the first few days of having back pain, this altered movement can be detrimental to how your back moves if continued in the long-term.
It is widely documented and reported in the NICE guidelines too, that exercise is greatly beneficial for managing the lower back. You do not need to be pain free before you can return to your normal activities or work. A study has shown that exercise is also the most effective strategy to help prevent future episodes. The charity Backcare, has a wide range of information leaflets and suggested back and mobility exercises available on its website. If you are returning to your normal activities, then start slowly and build up both the amount and intensity of what you do over a few days.
There is some evidence of the benefits of Pilates for lower back pain. Practitioners need to be able to tailor these exercises to each individual so that they target specific problems. It is therefore advisable to see a trained practitioner for a 1:1 session if it is your first time trialling this activity. It is well documented that Pilates can help to achieve improved posture, muscle tone, balance and joint mobility. This is often why it is recommended by both GP’s and physiotherapists to help recover from an episode of pain.
As tempting as it might be to find a quick and easy solution to your pain, such as buying a brace or support, there is currently no evidence to support the use of back braces in the management of lower back pain. They are also not recommended in the NICE guidelines. This is because they do not encourage our natural support system to work and can instead encourage muscles to switch off and become lazy when what we want is them to be trained to become stronger. Below is a list of top tips to help you manage an episode of lower back pain during lockdown and some rare symptoms to be aware of.
- Manage Stress – Stress can be managed in several ways. Firstly, ensure that you get 7-8 hours of good quality sleep each night. Regular practice of mindfulness has also been shown to help manage and improve stress and taking regular exercise is good too.
- Keep moving – Try not to be tempted by bedrest when the pain starts and try to keep moving. This is particularly important if you find yourself in prolonged postures or working from a desk for most of the working week. The article that was written on desk-based exercises may also be useful.
- Try regular Pilates to reduce the onset of back pain and to help recover if you have recently experienced it.
- Seek help from your GP or a Physiotherapist if it does not clear up after 6-8 weeks.
Please be aware of the following symptoms if you have got lower back pain:
These symptoms are very rare, but you should contact a doctor immediately if you experience any of them:
- Difficulty passing urine or having the sensation to pass water that is not there
- Numbness/tingling in your genitals or buttocks area
- Loss of bladder or bowel control
- Impaired sexual function, such as loss of sensation during intercourse
- Loss of power in your legs
- Feeling unwell with your back pain, such as a fever or significant sweating that wakes you from sleep
Rosie Cardale is a Physiotherapist. She has a regular clinic at Bristol Physiotherapy Clinic or you can follow her on Instagram @pilateswithrosie