Before you back down

By Physio Dept, 2HSB

Lower back pain (LBP) in the military is common and often recurs. It can be severely debilitating, attract a negative stigma and result in considerable time away from the workplace. Early diagnosis and treatment is essential to minimise the extent of the problem.

LBP can develop gradually or occur suddenly. Causes which occur gradually include poor posture, poor workplace design and poor lifting technique. Gradual damage can be done over time without being aware of it and without feeling any pain. LBP of sudden onset is often the result of an accident such as a fall or from lifting, bending or twisting incorrectly. Often a seemingly harmless action initiates the pain.

The structures involved in any injury may be the vertebrae (bones), intervertebral discs, muscles, joints, ligaments or nerves. Diagnosis of the cause of pain is based on the examination by a doctor and physiotherapist. Tests such as x-ray, CT scan and MRI scan may aid the diagnostic process.

Initial treatment of moderate to severe LBP is usually controlled rest and pain relief for up to three days or until the acute pain settles. Gentle walking is advised during this stage. Physiotherapy manual techniques, strengthening exercises, stretches, hydrotherapy, electrotherapy, taping, posture correction and advice may then help optimise recovery.

Once the acute pain has settled, a gradual return to activities such as swimming and walking should be undertaken. Instruction in the correct technique of performing potentially harmful activities such as bending, lifting and sit-ups should be included in the rehabilitation program.

Deep abdominal muscle training is essential to stabilise and support the lower back. Specific exercises are prescribed by the physiotherapist and should be continued as maintenance exercises even after the pain has subsided. Good control of the deep abdominal muscles is vital in preventing recurrence of LBP.

Education plays a major role in the prevention of back pain. Posture correction and back care education are important to minimise stresses on the spine with everyday activities.

For example, a rolled towel in the small of the back may help keep the normal curve and distribute stresses correctly, particularly when sitting for prolonged periods.

Workplace assessments are often extremely beneficial in preventing undue loads on spinal tissues owing to poor positioning. Simple modifications of behaviour can help minimise these stresses, such as regular changes in position and avoiding prolonged standing or sitting.

The best piece of advice for anyone with LBP: the sooner it is treated, the better the chances of full recovery. Get the problem checked out by an MO as soon as possible.

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