Low back pain is one of the most common musculoskeletal conditions that healthcare professionals, including TCM Physicians and Physiotherapists, treat on a daily basis. It is important to note that Low Back Pain is a general description - low back pain has many different sources from an anatomical point of view, and this can hugely influence both influence assessment and treatment.
The 1-year incidence rates, between 2018-2019, of Low Back Pain for the global population is estimated to be between 1.5-36% of the population. Incidence rates refer to new cases of a health condition in a given time period.
It is estimated that the societal cost of chronic low back pain sufferers in Netherlands, in terms of utilisation of healthcare services, unpaid productivity, absenteeism etc., amounted to 3.5 billion euros in 2007. A similar trend was observed in other developed countries, United States (100 billion USD), Australia (9 billion dollars), and Switzerland (6.6 billion euros).
A few risk factors that increase the occurrence of back pain have been identified. In men ages between 36 and 59 years, smoking, fewer years of formal education and a diagnosis of hypertension have been linked to developing low back pain. In females, the factors were occupational activities that involved heavy lifting, sustained forward leaning postures and sitting at a desk 3 or more days a week.
Now, before you meticulously make a checklist to avoid all these risk factors, do consider that these factors are largely contributed by a sedentary lifestyle.
How Google has all the answers but the right ones require assessment:
In my practice, one of the most common types of back pain is referred to as discogenic lower back pain, or more commonly known as 'disc protrusions' or a 'slipped disc'.
I have a slipped disc...am I now no longer able to go back to exercising?
This is a common and valid question that I get asked frequently.
Managing disc protrusions, also known as herniated or slipped discs, involves various approaches aimed at relieving pain, reducing inflammation, and improving mobility. The types of treatment will vary from person to person.
The common management strategies include: conservative vs. non-conservative treatment.
With conservative treatment there are a few usual approaches for treatment.
Conservative management approaches
Most doctors would recommend a period of conservative rehab before escalating care. The goal of conservative rehab is to improve pain and restore function as much as possible before needing to resort to consider treatment options that might potentially increase the risk of adverse side effects (wound infection etc.).
1. Rest and Activity Modification:
Rest: Short periods of rest can help alleviate acute pain, but prolonged inactivity can weaken muscles and prolong recovery.
Activity Modification: Avoid activities that exacerbate pain, such as heavy lifting or prolonged sitting.
2. Physiotherapy and TCM treatment:
Strengthening exercises: A Physiotherapist can design a program to strengthen the core muscles supporting the spine, improve flexibility, and promote proper posture.
Manual Therapy: Techniques such as massage or spinal manipulation can reduce pain and improve mobility.
Spinal decompression therapy: Unlike traction which provides a continuous force on the spine, decompression devices like the BTL decompression (Psst, this machine is available at our Lucky Plaza branch!) can help to reduce pressure on the discs and alleviate pain.
3. Medications:
Over-the-counter Pain Relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can reduce pain and inflammation.
Prescription Medications: For severe pain that involves the nerve structures of the spine, muscle relaxants, narcotics, or nerve pain medications (like gabapentin) may be prescribed.
Check out some of the treatments on our Tik Tok page: https://www.tiktok.com/@yongkangtcm/video/7395937884819295495?is_from_webapp=1&sender_device=pc&web_id=7398036369534207495
Invasive/surgical management approaches
Once a trial of conservative rehab has been done with minimal improvement, or that if the patient is not satisfied with their level of progress, the surgeon can recommend surgical treatment depending on the severity of the condition.
1. Pain relief injections
Corticosteroid Injections:
Delivered directly into the epidural space of the spine to reduce inflammation and alleviate pain.
Epidural Steroid Injections:
Corticosteroid Injections: Delivered directly into the epidural space of the spine to reduce inflammation and alleviate pain.
Nerve Blocks:
Selective Nerve Root Block: An injection around the affected nerve can reduce pain and inflammation.
2. Surgical options for lumbar disc protrusions:
Microdiscectomy:
Minimally Invasive Procedure: Removes the portion of the disc pressing on the nerve.
Laminectomy:
Decompressive Surgery: Removes part of the vertebral bone (lamina) to relieve pressure on the spinal cord or nerves.
*a common misconception is that surgical option is a standalone treatment - physiotherapy after surgery is necessary for the restoration of function after back surgery.
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I have been experiencing back pain for a long time...what if I choose not to receive treatment for it?
When back pain is left untreated, several potential complications can arise, including:
Chronic Pain: Acute back pain can become chronic, leading to persistent pain that lasts for months or even years.
Reduced Mobility: Untreated back pain can limit your range of motion and make it difficult to perform daily activities.
Nerve Damage: If back pain is due to conditions like herniated discs or spinal stenosis, untreated pain can lead to nerve damage, resulting in numbness, tingling, or weakness in the limbs.
Decreased Quality of Life: Persistent pain can affect your ability to work, engage in social activities, and enjoy life.
Psychological Effects: Chronic back pain can lead to anxiety, depression, and other mental health issues due to the ongoing discomfort and limitations it imposes.
Postural Issues: To avoid pain, you may develop poor posture or abnormal gait, which can lead to further musculoskeletal problems.
Dependency on Pain Medications: In an effort to manage pain, some individuals might increasingly rely on over-the-counter or prescription pain medications, potentially leading to dependency or side effects.
Compensatory Injuries: Over time, the body might adapt to the pain by altering movement patterns, potentially leading to additional injuries or strain in other areas, such as the hips, knees, or shoulders.
Sleep Disturbances: Chronic back pain can interfere with sleep, leading to insomnia or poor sleep quality, which can further exacerbate pain and reduce overall health.
Okay...maybe I should see someone. How do I know when to see a doctor, a TCM Physician or a Physiotherapist though?
You should consider seeing a physiotherapist for back pain if:
Pain Persists for More Than a Few Weeks: If your back pain hasn't improved with self-care measures after two to three weeks, it's time to see a professional.
Severe Pain: If the pain is intense and interferes with your daily activities, seek help promptly.
Radiating Pain: If the pain radiates down your legs (sciatica) or into other areas, it might indicate nerve involvement.
Numbness or Tingling: These symptoms can indicate nerve compression or damage and should be evaluated by a physiotherapist.
Weakness: Muscle weakness, particularly in the legs, is a concerning sign that needs professional attention.
Post-Injury: If your back pain started after an accident, fall, or sports injury, a physiotherapist can help with proper rehabilitation.
Loss of Bladder or Bowel Control: This is a medical emergency often associated with cauda equina syndrome and requires immediate attention.
Chronic Pain: If you have recurring episodes of back pain, physiotherapy can help with long-term management and prevention strategies to improve your overall quality of life.
Back pain is a highly reversible condition that can be resolved when addressed in a timely manner. It is not a condition that one has to live with for the rest of your life. If you are struggling with back pain, don't wait too long - seek out a healthcare professional so you can get back to doing what you enjoy as soon as possible!
References:
Bento, T. P. F., Genebra, C. V. D. S., Maciel, N. M., Cornelio, G. P., Simeão, S. F. a. P., & De Vitta, A. (2020). Low back pain and some associated factors: is there any difference between genders? Brazilian Journal of Physical Therapy, 24(1), 79–87. https://doi.org/10.1016/j.bjpt.2019.01.012
Mutubuki, E. N., Luitjens, M. A., Maas, E. T., Huygen, F. J. P. M., Ostelo, R. W. J. G., Van Tulder, M. W., & Van Dongen, J. M. (2019). Predictive factors of high societal costs among chronic low back pain patients. European Journal of Pain, 24(2), 325–337. https://doi.org/10.1002/ejp.1488
Rezaei, B., Mousavi, E., Heshmati, B., & Asadi, S. (2021). Low back pain and its related risk factors in health care providers at hospitals: A systematic review. Annals of Medicine and Surgery, 70, 102903. https://doi.org/10.1016/j.amsu.2021.102903
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