Back pain – GP, Specialist, physio, chiro, osteo, your personal trainer, thai massage, sports massage, acupuncture, pilates, yoga – so many options for treatment it is hard to know who to see to set you on the path to recovery. It is a dilemma for a huge number of people, it is estimated that 70 – 90% of the population will experience low back pain at some point in their life. In the 2011/12 Census, 3 million Australians (13.6% of the population) had back pain. For some it may last a matter of days, even hours but for others it can affect them for much longer. Whether it is back pain from performing a lift, moving awkwardly, poor posture or if there's no real reason for it at all, you want to make sure you understand what is going on and the best way to manage it.  

When I see a patient come in with back pain I always try to identify a source and the structures involved in the injury. If there is not a specific 'injured' site in the back – and this is often the case with people presenting with back pain – then I at least want to identify the locations of pain. By coming up with this 'diagnosis', it is then possible to understand what movements, activities, postures, or other areas of the body may be contributing to the pain. Having done this the injury can be explained to the patient, as can the contributing factors and the treatment approach. Education about your back pain is very important, it helps put you back in control and gives you the confidence to move on with your recovery.  

Once a better understanding of the injury has been established what is the best way to treat back pain? It is now widely accepted that the most important thing to do is stay as active as possible – keep moving and return to work as soon as possible. If serious pain is significantly inhibiting your ability to move then your GP is the first port of call. They will assess your injury, can prescribe you with suitable medications to help settle your symptoms and can guide you as to future treatment. 

The treatment you choose should take what I call an 'active' approach to managing your low back pain. As previously mentioned I will try to identify the contributors to the condition and discuss these with the patient. From this a treatment plan will be devised with a key feature being specific movement exercises to help restore normal movement and reduce pain – this fits in with the number one rule of managing back pain – Keep Moving. In addition to this, soft-tissue techniques can be used. This can include a combination of massage, soft-tissue release or mobilisations for the back and surrounding areas. The idea of these techniques is to help reduce pain, take load off the injured area and improve range of motion. It is unlikely that soft-tissue therapy on its own – without education about the injury or advice regarding movement – will result in effective management of the injury. 

Other things no longer recommended for the management of back pain include X-rays or other scans to diagnose the injury – unless requested by a Specialist or if a serious condition is suspected. Belts and braces are ineffective (except in the case of pregnancy where a belt may help reduce SIJ pain). Traction is no longer recommended, nor acupuncture or electrotherapies such as ultrasound, TENS (nerve stimulation) or interferential therapy. There is also limited evidence for surgical and injection therapies at the moment and these should only be considered with your managing GP and Specialist if the above conservative treatment approach has failed.  

Research, my own experience and that of many others suggests an 'Active' approach to the management of your back pain is most effective. Something to consider when deciding on the treatment approach you take for your back pain. 

Stuart McKay
APA Physiotherapist 

*The advice in this article is in line with the NICE (National Institute for Health and Care Excellence) Guidelines published 30 November 2016; Low back pain and sciatica in over 16s.