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Back Pain: Moving on

Back pain will affect almost everyone once in the course of life. Scientific and medical research into back pain is challenging old beliefs on back pain and its natural progress. It used to be that people lay on the floor for days and weeks with back pain or retreated from everyday activities for weeks to months, for fear of further hurt.

Over the last decade or so the medical approach to back pain has moved on in response to an important paper on managing back pain published by a Scottish research team headed by Professor Gordon Waddell, an orthopaedic surgeon, in the mid 1990’s. His findings have been further researched across the world and have stood the test of time so that they are now endorsed by health professionals and governmental bodies in many industrial countries including here in Ireland the Health Service Executive, the Health and Safety Authority, the Construction Industry Federation, ICTU, IBEC and the Irish Society of Chartered Physiotherapists (ISCP).

Professor Waddell devised a set of six proven facts about back pain, as presented here:
1.Back pain is so common that it could almost be described as a normal occurrence. In fact it is suggested that we should try to think of back pain as being a bit like the ‘common cold’, something that happens
2.Back pain, though sometimes severe and recurrent is rarely serious; recovery in days to weeks is usual. Most back pain falls into the category of ‘simple back strain’, a self-limiting condition mainly affecting muscles and ligaments. Back pain from overwork or overstrain usually gets better by itself in a couple of days, perhaps by just avoiding heavy activities.
3.Bed rest is not good for back pain. Research categorically showed that spending more than 24-48 hours in bed with back pain can actually worsen the condition, as muscles rapidly loose strength when not challenged. The after effects of prolonged bedrest can be much more serious than the initial problem. This is why doctors and physiotherapists rarely suggest remaining in bed these days. The one exception is where the back pain is accompanied by severe shooting pain down one whole leg. This can be a sign of an acute disc prolapse and is almost the only time a few days in bed will be prescribed.
4.Remaining active and getting on with your life, as best you can, in spite of the pain, is better than resting and avoiding normal activities. Perhaps surprisingly, the evidence shows that getting on with life helps to reduce back pain. One advantage of getting on with your daily activities is that engaging with your family, friends and work environment appears to help convince you subconsciously that your back is not as bad as you feared. Avoiding regular things can gradually lead to a situation whereby you start avoiding a single activity, and then if the back pain returns, a second activity is added to the ‘limited’ list. Before long you the list gets longer and longer. This leads to fearfulness of activity, known in medical research as ‘fear–avoidance’. Once this gets a grip, it becomes like a bad habit, very difficult to change. So it is well advised not to start down this path at all. This is one of the many reasons that chartered physiotherapist are always telling people ‘just act and move as normal’.
5.Remaining at work, or returning to work as soon as possible, in spite of persisting pain, is better than staying off work. This is again for the many positive benefits of being up and about rather than staying quietly at home. In the past, back pain meant that people were certified off work for weeks, until fully recovered. The modern, research based approach is that enlightened employers can assist return to work by agreeing to reduced hours or perhaps lesser duties over a specific period of time. Gradually hours and tasks are progressed up to full activities. This phased return to work has been shown to be very successful in recovering from back pain.
6.The longer a person with back pain is off work, the lower the chances of ever returning to work. Most episodes of back pain recover fully and rapidly, but where recovery is slow, every month longer than a couple of months away from the workplace make it virtually impossible to return to your previous occupation and lifestyle.
Today we know that ‘hurt’ does not necessarily equal ’harm’ and just because the back is hurting, does not mean further damage is occurring. In reality, the musculoskeletal system is made for movement and in general worsens when not moving. Compare the back to a door hinge. If the door is rarely opened or closed, the hinge gets creaky and stiff. Conversely, regular movement of the door hinge keeps it oiled and moving well. This principle applies to the collection of joints that make up the spine, exactly as to any other joint in the body.

If your back is bothering you currently, and has not cleared up of its own accord, consult a Chartered Physiotherapist now during this month of March, which is designated as ‘Move 4 Health’ month by the ISCP.

Mairead O’Riordan, MSc, MISCP is a senior Chartered Physiotherapist & CEO of TherapyXperts, an allied health network dedicated to clinical excellence.
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