In many developed countries, back pain has become a kind of epidemic and is considered one of the most relevant health problems in society. The disease affects more than 80% of the population at some point in their lives.
To better understand this issue, we must first define the necessary distinctions, since this type of discomfort receives different names depending on which part of the back hurts.
The terms are formed by associating the suffix “algia” (meaning pain) with each region of the spine. Thus, we suffer from neck pain, when the pain strikes the cervical region (neck); back pain, if the painful area is the back; and lower back pain in the lower back.
It is common to find these words in many clinical reports, but in reality they do not represent a diagnosis: we only indicate the presence of pain in a specific area.
1. When should you be concerned?
Although almost everyone suffers from back pain at some point in their lives, fortunately the problem is not serious in most cases. For the most part, the pain subsides within a month of onset.
Physiotherapists and physicians use the term “red flags” to refer to signs and symptoms that could indicate serious disease in the spine or elsewhere in the body.
Some of the warning signs are sensory and muscular changes (tingling in the extremities, loss of strength, incontinence…), unexplained weight loss, exposure to a blow, chest pain or fever.
Therefore, although back pain is generally benign, a health professional should be consulted whenever there is any suspicion. As long as there are no red flags, we must remain calm, because there are no signs of serious illnesses.
2. Does the way you experience pain affect how it develops?
Psychosocial factors, called “yellow flags,” are necessary for the pain to last a long time. In other words, it becomes chronic.
Some examples of yellow flags are: adopting a negative attitude (we must bear in mind that pain is not necessarily synonymous with a serious injury or disability); stop doing physical activities for fear of discomfort or that the problem will get worse (so-called movement phobia); thinking passive therapies are better than exercise; They also end up suffering from social, family or financial problems.
3. In case of pain, should I take an x-ray?
This is a decision that must be made by the doctor, as x-rays are not harmless. After the age of 50, it is normal for us to suffer from degenerative processes in the spine or changes in the intervertebral discs, but healthy people also suffer from this.
Diagnosis of these diseases through imaging tests contributes to over-medication (when medications are prescribed for more than necessary) and to an increase in the number of days away from work.
The International Association for the Study of Pain reports that pain is nonspecific (cannot be linked to a specific problem) in 85% of cases. For this reason, x-rays are often used when there are red flags.
4. What are the best pain-relieving exercises, according to science?
Given all the options available, from spine-specific activities to full-body workouts, it’s hard to sum it all up without leaving out relevant information. The physiotherapist prescribes exercises based on each patient’s needs and pathology.
In the case of long-term low back pain, the international Cochrane Collaboration Network indicates that therapeutic exercises are more effective than other interventions or treatments. But no program has had significantly better results than the others.
However, some recent publications venture to suggest Pilates and McKenzie exercises (which focus on back-extension movements) as great at relieving lower back pain.
In our research, we also noticed that therapeutic exercises and correct patient counseling enhance the treatment effect.
Therefore, naturopathy offers multiple alternatives. Many exercises aim to improve spinal mobility and muscle lengthening (for example, spinal extensors, hamstrings, and psoas).
Others seek to strengthen and appropriately control the musculature, especially in the midsection (the so-called “core” muscles), in addition to postural education as a preventive measure.
But any activity, even the simplest, is useful. Science indicates that walking reduces pain and improves quality of life, as well as preventing movement-avoidance behavior as a result of chronic low back pain. In addition, this is one of the easiest and most affordable ways to stay active.
What is important is to do an activity that the patient likes: the worst exercise is one that he never does.
5. Can I exercise after suffering from back pain?
A sedentary lifestyle, the biggest enemy of our health in general, helps prolonged back pain and generates disability. Therefore, inactivity must be duly justified and limited to the minimum possible time.
It has not been proven that exercise (recreational or competitive) causes back pain to return. On the contrary, sports prefer to maintain the benefits of physiotherapy, as long as they are regulated in terms of intensity and duration.
In any case, we must choose the right activity and rely on the advice of an expert. This is the case, for example, with swimming, the practice of which must be supervised if we choose the butterfly technique. In cycling, you need to adjust your position in the saddle to maintain proper posture.
If we choose a team sport (football, basketball…) the important thing is to take into account the communication between the participants and the sudden and intense movements. And in tennis, the serve is particularly stressful because of the movements it requires from behind.
The running activity generates repetitive impacts and stresses in the lumbar region in the heel strike phase, supporting a pressure oscillating between 2.7 and 5.7 times the body weight. Strenuous running can be a risk factor for lower back pain, but moderate running improves any back pain.
In short, the best way to treat back pain is to reassure the patient, insist on avoiding unnecessary inactivity, controlling excess medication, and getting out of a sedentary lifestyle.
* Lorenzo Antonio Justo Cosinho is a Physiotherapist, PhD in Neuroscience and Professor at the Faculty of Physiotherapy at the University of Vigo, Spain.
The article was originally published on the academic news website The Conversation and is republished under a Creative Commons license. is reading here The original version (in Spanish).
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