What you need to know about lower back pain? Part 3
If you’re just tuning in to our lower back pain series, make sure you check out Part 1 (common myths about lower back pain) and Part 2 (where your back pain is coming from). In Part 3 of this series, we’ll be looking at a simple self-assessment you can do for your lower back pain. By answering the questions below you’ll begin to understand your back pain triggers. The additional information will also help your physiotherapist pinpoint the issue and put together a treatment plan to reduce discomfort and get you moving again. So grab a pen and paper (or write some notes in your phone) and let’s get started!
1. Does the pain change in intensity?
Things to think about: at it’s worst, how would you rate the pain out of 10? Does the type of pain change? For example it goes from a dull ache to a sharp stabbing pain?
What this could mean: a change in intensity can suggest the cause of the pain. For example is the pain worse in the morning when you wake up and improves as the day progresses? This can suggest discogenic issues. Or is the pain worse with certain exercises, worse sitting in a chair for prolonged periods?
2. When you roll in bed do you suffer painful catches?
Things to think about: is it only when you roll from the right to the left or vice versa? Or are both sides affected?
What this could mean: pain when rolling in bed can suggest rotational instability in the facet joints. These joints are involved in rotational movements of the spine, and respond best to strengthening exercises prescribed by your physiotherapist.
3. What makes your pain worse?
Things to think about: note down the causes of your pain as they happen. Is it scenarios such as…
- Tying your shoelaces?
- After brushing your teeth?
- Sitting in a chair? How long for?
- Exercise? If so what exercises and when does it start?
- After stretching or yoga? What direction were you leaning into the stretch?
What this could mean: all this information helps us identify your triggers. By knowing the directions and movements that lead to an increase in symptoms we can pinpoint the problem faster. It also helps your physiotherapist identify the types of exercises needed to strengthen supporting structures and provides the starting point for most graded exercise therapy programs.
4. Was the initial cause traumatic?
Things to think about: was it after a car accident, high impact playing sport, or a traumatic fall?
What this could mean: there is a higher risk of fracture to the spine from high velocity or significant impact injuries. If this is the case imaging such as X-rays or an MRI may be requested to assist with diagnosis.
5. Do you have a history of medical conditions?
Things to think about: although rare, there are certain types of cancer, illnesses, and other diseases that present with lower back pain symptoms. Because of this your physiotherapist will take a full health history, and may refer you back to your GP for further tests if necessary. Additionally, chronic stress, anxiety and depression can trigger or exacerbate symptoms, so questions regarding your mental health are quite common.
What this could mean: you may need further investigation to find the root cause of your lower back pain. Best not to trust Dr. Google with your symptoms and leave diagnoses to the professionals!
6. Is the pain at its worst, first thing in the morning?
What this can mean: pain that presents first thing in the morning, but eases throughout the day is normal. After lying in one position for several hours the joints around the spine may become stiff, but with movement this can ease as the fluid within the discs redistributes and muscles supporting the spine warm-up.
7. Does the pain increase throughout the day?
What this can mean: pain that increases and peaks at night may indicate poor sitting or standing posture, or a lack of strength or conditioning
8. Is the pain concentrated in your middle back?
What this can mean: this can give us a clue as to the cause of your pain. The middle of the back can sometimes be referred pain from organs or it can be a sign of musculoskeletal back pain
9. Does your back pain radiate into your buttock and feet?
What this can mean: this can be caused by nerve irritation and indicate disc pathology. Alternatively, tight muscles and trigger points in your buttocks can cause this type of pain. For symptoms below the knee, it is most likely nerve structures that are impacted.
10. Does the pain increase with fast walking or does it decrease?
What this can mean: an underlying stenosis (narrowing of the spinal cord) or lateral broadbased disc bulge can be worsened by walking. However, a narrow bulge will generally improve with walking.
Whatever answers you have to above questions, know that there is an appropriate treatment plan for you! Lower back pain doesn’t have to be a lifelong or debilitating. It’s simply about finding the root cause and putting together the right treatment plan for you.
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Andrew Ilieff - BeFit Training Physio Double Bay
Andrew Ilieff is a physiotherapist based in Double Bay, Sydney. Andrew has successfully treated musculoskeletal problems and sports injuries on the basis of a thorough assessment and diagnosis coupled with evidence-based rehabilitation programs tailored to the needs and goals of each individual. Andrew specialises in lower back rehab, sports injuries and is a leading authority on Strength and Conditioning for Physiotherapists as the co-author of the University Of Technology Sydney Strength and Conditioning for Physiotherapists and casual academic lecturer. To book a consultation, click the link below.