Back pain

More than 70 per cent of people living in developed countries develop back pain at one point or another during the course of their lives. It is also one of the most frequently used excuses of absenteeism at work, since it effects the economically active population between the ages of 20 and 55. Generally, back pain is self limited, i.e., is acute or under 12 weeks and is non-specific or uncomplicated, meaning, without an apparent pathology or underlying cause.

Humankind has been afflicted with lower back pain all through the approximately 3,500 years of recorded history.

What is worrying though, is the chronic disability stemming from simple back pain.

The prescription of bed rest for uncomplicated acute lower back ache, which has been the course of therapy since the 19th century, began to be seriously questioned in the 1980s. Such was the profound conviction about the efficacy of this treatment that initial studies only investigated its duration. Much evidence has been gathered to this end, leading to the unfortunate conclusion that much of lower back disability is iatrogenic — induced by the words or actions of the physician.

Bed rest is thought to work by decreasing the weight bearing forces on your back, relieving pressure from, if any, damaged disc or nerves, strained muscles and hence pain. While, really with prolonged bed rest the joints stiffen, lumbar muscles atrophy, pressure sores form, there are losses in muscle protein and bone calcium, and people run a risk of forming blood costs, not to mention the undesirable psychological and monetary results it has.

Research has uncovered that bed rest prolongs recovery from acute lower back pain, while resumption of normal daily activities after modification according to pain threshold is the route to take, and is even preferred over back-mobilising exercises (e.g. flexion or extension). However, this conclusion also depends on the nature of daily activities, which vary between individuals.

Though, the usefulness of bed rest to treat back pain has been entirely discredited, the value of back exercises is still debated. Different studies have termed it to also be of little use to acute situations; nonetheless, it is considered effective for chronic back pain.

In addition, many of the studies made methodological errors of not applying exercises specific to the signs or symptoms. Exercises specially adapted have shown promise to reduce recurrence, which is also a problem patients commonly face. Additionally, recurrence is also reduced in the physically active.

Uncomplicated back pain, accounts for around three per cent of all doctor’s visits. The afflicted go to orthopaedics, chiropractors, physiotherapists, massage specialists, primary care physicians, but 95 per cent of them recuperate regardless of the specialty of the healthcare provider or the nature of the intervention. These stark statistics indicate the sizable impact a change in therapeutic approach can make to the healthcare system in monetary aspects and patient care.

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