I was taken aback to read recently that almost 70 per cent of us will experience lower back pain at some point in our lives. The lifetime prevalence of the condition is increasing in the western world, leading some experts to label the problem an epidemic. Our sedentary lifestyles and obesity are major contributing factors.
I have lived with back pain for more than 20 years. Indeed, I have had back surgery on two occasions – one successful intervention, the second not so good. I have good days and bad days, which I suspect is typical of most sufferers.
Exercise really helps and you have to be careful lifting; my one bugbear is when I bend down when writing at a flipchart or when I pick up a book from the lowest shelf in a bookstore, I am prone to “locking” in the bent position.
There has only been one embarrassing teaching moment – so far!
In the majority of cases, lower back pain comes from either soft tissue (muscle, ligaments) over the spine or the discs and joints of the spine. Serious causes of lower back pain such as tumours, fractures and infection are uncommon and generally present with “red flag” symptoms and signs such as unexplained weight loss and urinary symptoms.
Bouts of lower back pain are short-lived and self-limiting in most cases, but frequently re-occur and in some of us become more persistent and chronic.
Treatment
I caught up with consultant spinal surgeon Ashley Poynton recently to chat about the latest thinking on the treatment of lower back pain. A specialist at the Mater Private Hospital, Poynton sees patients with a wide spectrum of spinal problems, many of which need operations to preserve neurological function.
But most do not need surgical intervention, he says: “The best approach to treating low back pain in the vast majority of people, once serious underlying causes have been ruled out, is education and exercise.”
To address the increasing volume of people being referred for back pain and as a means of promoting his philosophy of education and empowerment for patients, he has set up the Poynton Spine Care Institute around the corner from the Mater hospital on Dorset Street.
“It is important that people understand the problem they have and that the solution in the majority of cases does not involve drugs, injections or surgery but does involve using exercise to restore normal function. Reassurance that exercise and movement is good for back pain is vital,” he says.
The multi-disciplinary team at the institute – physios, nurse specialists and medics – have created a novel assessment method called “SpineCheck”.
It involves a full musculoskeletal and neurological analysis that identifies modifiable risk factors for spinal pain, movement restrictions and muscle function impairments. Following this assessment, a bespoke exercise and flexibility programme is put together, with prevention of recurrent back pain being the main goal.
Preventative strategy
SpineCheck is also suitable for people who have never had back pain, but wish to have a preventative strategy. This is not only relevant to those with jobs that involve manual handling, but probably even more so for those of us with sedentary lifestyles. The assessment involves a full analysis of the nervous system and a state of the art online musculoskeletal movement analysis, The Performance Matrix (TPM).
The first TPM accredited movement centre in Ireland, the SpineCheck team also addresses modifiable risk factors such as ergonomics and occupational workloads. On completion of the assessment, a report of the analysis is generated along with a customised exercise programme.
People then have the option of one-to-one training sessions with a specialist physiotherapist to address any movement and structural faults which may predispose to recurrent spinal pain.
If only this had been around 20 years ago...