If you have ever had low back pain (LBP), you are not alone. Over 80% of Canadians have experienced back pain at some point in their life.1 Approximately 62% of Albertans have had an episode of back pain within the last year and over three quarters will have a recurrence of LBP in the future.2 Close to 40% of these individuals will have visited a health-care provider about their back pain.2
The good news is that most episodes of back pain resolve within a few days or weeks without intervention from a health professional3 and less than 2% of LBP is related to serious spine conditions that require further medical or surgical interventions.
Although there are many causes of LBP, the most common diagnosis is non-specific LBP. Approximately 90% of LBP cases fall into this category.2 This means that, although you are experiencing pain in your back, there is no single, clearly identifiable, pathology or disease process that can be blamed for your pain.4 There are several factors that may contribute to back pain. Some of these include:5
Working in awkward or bent postures
Improper or heavy lifting
Weak back and core muscles
Often, the first symptoms of LBP are a low-grade ache and/or stiffness in your back after activity or after sitting for a period of time. These symptoms may be relieved by changing the activity, taking a break or moving around, and “loosening up” or doing some light exercise. In the past, bed rest was a common suggestion for treating LBP. However, current evidence indicates early, simple and gentle movement or activity is the best treatment.6 Walking, modifying your posture or activities and moving around are the best treatments for you at this stage. Using heat (hot pack, hot showers) may also provide some temporary relief of stiffness and make moving around more comfortable.6
Following these basics of care, most low back pain resolves on its own. You usually do not need to consult a health-care professional.
When to seek help from a physiotherapist
If the pain persists in spite of your best efforts to keep moving, limits your ability to do the things you need to do, and does not improve with gentle activity, you may need more help. This is a good time to ask a physiotherapist for advice on how to manage your symptoms and for exercises to help prevent future episodes of back pain.
Physiotherapy is the ideal choice for the management and treatment of LBP. Physiotherapists are highly skilled at examining and treating people with back pain. You do not need a doctor’s referral to see your physiotherapist so they can be your first stop when you need help. Your physiotherapist can help determine the best way to get you moving and on the road to recovery. They can also help you regain control over your injury or pain to allow you to return to your usual activities.
Your physiotherapist will:
Assess your condition, ask questions, watch you move and bend, and examine your back.
Screen out serious causes of back pain requiring further investigation or medical follow-up.
Develop a customized treatment plan to help you manage your problem.
Provide guidance on what exercises or stretches will help relieve your pain and decrease the risk for future episodes.
Provide specific treatment (e.g., manual therapy, modalities, acupuncture, heat, cold) to reduce pain, restore mobility and strengthen your core.
Teach you about what is causing your pain, ways to manage your symptoms and strategies to prevent or minimize a reoccurrence.
Do I need an x-ray?
Your physiotherapist will ask you questions about when, where and how your pain started, what movements make it worse and what positions make you feel better. From this history taking and a thorough physical examination, your physiotherapist will be able to rule out potentially serious causes for your back pain and recommend the appropriate treatment plan. However, if your physiotherapist or doctor suspect something more serious, diagnostic testing may be indicated, and an appropriate referral will be made.
When signs of serious issues are absent, x-rays for back pain are typically not helpful for its management. It is very common for x-rays or other diagnostic imaging to show incidental findings such as bony changes. While that may sound concerning or like a possible cause for your back pain, it’s important to know that the same types of changes are often found in people without back pain and are usually not the cause of the pain.7
What can I do if I have back pain?
Keep moving. This will help when you initially have back pain but is also important to prevent recurrences of your pain in the future. Any amount of movement will help but 30 minutes of gentle exercises are recommended to maintain a healthy body.8
If you sit for long periods of time, stand up and move around several times a day.
Be aware of your posture at work, rest or when relaxing at home. Maintaining a good, neutral posture will help relieve your pain, decrease the chance of aggravating your symptoms and prevent future episodes.
Have a look at your work site to see if you can adjust your workstation, work practices or the amount of time you spend in one position.
See a physiotherapist for a personalized exercise program and other treatment to help you to address your current symptoms and learn how to prevent or manage future episodes of low back pain.
To find a physiotherapist that can help you recover, manage or prevent LBP click here.
Statistics Canada. Back pain. 2006. Available at: http://www.statcan.gc.ca/pub/82-619-m/2006003/4053542-eng.htm . Accessed on Sept 17, 2019.
Guideline for the evidence-informed primary care management of low back pain. 2nd edition (2011) Available at http://www.topalbertadoctors.org/download/572/LBPGUIDELINESNov25.pdf Accessed Sept 17, 2019.
Back Pain. PhysioCanHelp.ca. Available at https://physiocanhelp.ca/symptoms-conditions/back-pain/ Accessed Sept 17, 2019
Hayden JA, Cartwright J, van Tulder MW, Malmivaara A. Exercise therapy for chronic low back pain (Protocol).Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD009790. DOI:10.1002/14651858.CD009790.
Physiotherapy Alberta. Conditions: Back Pain + Injury. Available at https://www.physiotherapyalberta.ca/public_and_patients/conditions/back_pain_injury. Accessed Sept 17, 2019.
Institute of Health Economics Alberta. Toward optimized practice: So you’re your back hurts… Available at http://www.topalbertadoctors.org/uploads/112411_Aaz8xtZ7EYek2QE_160952.pdf. Accessed Sept 24, 2019.
Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, Halabi S, Turner JA, Avins AL, James K, Wald JT, Kallmes DF, Jarvik JG. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology. 2015; 36(4): 811-816.
Government of Canada. Canadian 24-hour movement guidelines. Available at https://csepguidelines.ca/ Accessed Sept 17, 2019.
Regulating Alberta's physiotherapy profession and acting as an association by providing member services.