Lower back pain: Dr Joe Kosterich

The lower back is probably the most common spot where people experience pain. Dr Joe Kosterich talks about low back pain, including why it occurs, what causes it, what it feels like, simple things you can do, and when you should seek help.

Video transcript

The lower back is probably the most common spot for people to experience pain. Hi, I’m Dr. Joe. Almost everyone at some point will experience some pain in their lower back. Fortunately, the vast majority of this pain will be fairly transient in nature, and not due to anything serious. In this video we’re going to talk a little bit about lower back pain and some of the simple things that you can do.

Causes of lower back pain

Now, there are a lot of theories about why lower back pain is so prevalent. Some people put it down to the fact that we haven’t been walking on two legs for long enough, and we’re not quite evolved such that our lower backs are strong enough. Other people view it as a function of how we live our lives, and particularly, the amount of time that we spend sitting down. Other people will say it is related to us trying to lift, and carry, and do more stuff than we’re actually cut out to do. Regardless of all the theories, the next thing becomes what are the causes of pain in the lower back? Now, the vast majority, and we’re talking in excess of 90%, probably 95%, are due to muscle strain and soft tissue type strains that might involve the ligaments, but as I said, most commonly the muscles. There’ll be a small percentage which may be due to problems with the bones, including fractures of the lumbar vertebrae, and that obviously will relate to trauma, although in an older age group one may get stress fractures in this area. Sometimes that will also happen with athletes if they are overtraining. There can also be problems with the discs in the lower back. The discs are the softer cartilage like material that sits between the vertebrae. Now, again, when we have lower back pain sometimes it will be obvious. If you’ve been out digging in the garden all day and you come back in, there is a fair likelihood that your back will be a little bit sore.

Simple treatments for lower back pain

Again, what can you do? You can put a hot pack on your back, and maybe rub in a little bit of some liniment type rub, maybe get somebody to give you a little bit of a massage, and it will probably all be gone by tomorrow morning. Sometimes it relates to more major injuries, and that can be either again from work that you’ve done, or sometimes obviously from trauma. Now, this leads to the really important point, that if you do experience some pain in the back, there are simple things that you can do first at home, and we’ve just touched on a couple of those.

Seeking professional help

So then people will quite reasonably say, “Well, when should I seek help about back pain”? I suppose the answer to that is if it is not settling down with fairly simple measures, such as your hot packs, perhaps some stretching, maybe a bit of a rub, and if need be, some simple pain killers. Now some people may head off to a physiotherapist, other people may head off to a chiropractor, other people may go to their doctor. This is the sort of instance where, again, it doesn’t always have to be the doctor who is the first port of call. People will argue about this, but a lot of people, particularly if they’ve had back injuries in relation to sports, or other strains that they’ve done, may head off to a physical therapist and have some treatment there.  Once again, if it is not settling down, or if there are other problems with the back, for example, if people are getting tingling, or pins and needles down the legs, or if the pain is spreading out, that would certainly be a time to go and see your doctor and get it checked. Now, that may not necessarily, but it may indicate some pressure on some of the nerves and again treatment may need to be directed towards that.

Scans and x-rays for lower back pain

When do we need to do some scans and investigate back pain? Now, a lot of scans and a lot of x-rays are done on the back, and a lot of the bigger research meta-analyses sort of have concluded that a lot of scanning and x-raying doesn’t help as much as we think it does. It is always done more to rule out problems rather than to find them. Now, people often get frustrated when they say “I’ve got pain in my back, and I’ve been to the doctor, I’ve had all these scans, and nothing shows up”. That means there is nothing structurally wrong with your back, and this is an important point.  On scans we’ll see if there is a structural problem, but a little bit like with having a headache, you can scan the head, but you may not see anything. It doesn’t mean that it doesn’t hurt; it just means you can’t see anything. So, a normal scan is a good thing, it means there is nothing out of place, there is nothing broken, you’re not going to need any surgery. That’s a good thing. It brings us back to by far and away, the most common cause of back pain, which is muscle and soft tissue problems.

Additional treatments and prevention

So again, what sort of treatments do we look at for lower back pain? We’ve spoken about the simpler ones, the next step may be the use of anti-inflammatory tablets, or stronger pain killers prescribed by your doctor, and, certainly, courses of physical therapy, such as physiotherapy, may be useful. For some people, it may be looking at their work environment, and perhaps a change in their chair, or their work station, or different work practices. For example, making sure you bend from your hips when you’re lifting, rather than bending from your back. It sounds obvious, but it makes a difference. Exercise for the back is important, so, strengthening the muscles. Swimming is good for the back, and there are specific back exercises to do which can help strengthen the back muscles, and that is something that doesn’t improve overnight, but if you can stick with that for a number of months, you’ll make your back more resilient.

To sum up, back pain is very, very common. For most people it is not going to be serious, and you can pretty much manage it yourself with the simple measures that we’ve spoken about. If it isn’t settling down, or there are other symptoms of concern, that is when it is time to seek help. Strengthening your back through regular exercise, and caring for your back are the most important things for keeping your back pain free.