In November 2016 NICE published new guidelines for the management of lower back pain and sciatica (the previous ones were published in 2009). For those who don’t know, NICE stands for the National Institute of Clinical Excellence. It is a governing body which pulls together all the latest evidence and research on a medical topic to provide guidelines for public health and social care. Essentially, it is there to improve the care you receive from health professionals.
You may ask why is this important to you? Well, many of us will suffer from lower back pain in our life time. And many of us will seek care from a Physiotherapist, Chiropractor, Osteopath or even a Surgeon. But, are you receiving the best advice and treatment from them?
There are a lot of preconceived ideas about what to do when you suffer from back pain – here we discuss some of them in light of the latest evidence.
Myth: “When you have back pain you should rest in bed for a few days and then start moving slowly.”
Fact: Don’t stay still! Movement and exercise are central to the new guidelines and resting in bed is certainly not recommended. Corsets and braces should not be used. If you have an acute onset of lower back pain try and go for a short walk and change position regularly. Speak to a Physiotherapist for further advice about how to grade your exercise up again as this should be individually tailored to your needs.
Acupuncture and electrotherapy
Myth: “I will go and get acupuncture/ultrasound for my back pain.”
Fact: In the new guidelines acupuncture and electrotherapies are not recommended for lower back pain. The reason this conclusion has been drawn is that most research studies show them not to be effective and these guidelines are based on the science. I am sure many of you are crying out “but acupuncture helped me before!”. It probably did. Everyone’s pain experience is different and if you found it an effective treatment in the past then you could consider going for it again but remember, you still have to move and exercise!
Xrays and MRI’s
Myth: “I must go and get an xray or MRI scan for my lower back pain.”
Fact: Taking an xray or MRI for your back is NOT recommended in the vast majority of cases of Lower back pain. Did you know, if you were to take 100 people off the street, aged 30, with NO back pain, give them an MRI and then look at the results… 52% of them would have disc degeneration evident and 40% of them would have a disc bulge! But hang on, they are not in pain??! Yes, what you see on the scan often does not match what someone feels. Imagine if you ended up doing surgery on these people just because of the findings on the scan.
So what must I do you are probably asking? When you go and see your Physiotherapist, GP or other health professional they will take a long and thorough history asking all sorts of odd questions seemingly unrelated to the back pain like whether your bladder and bowel work properly, do you sweat at night, is your weight stable etc. The reason for this is that they are clearing a series of ‘red flag’ questions to make sure there isn’t anything serious going on. If they think there is, trust them to refer you on for a scan otherwise it is pretty safe to say you won’t need one.
Myth: "I must go and get my back cracked"
Fact: Manual therapy (which can be anything from joint mobilisations, joint manipulations, muscle techniques or soft tissue massage) is recommended in the guideline but ONLY if it is individually tailored to what YOU need and ONLY if it is in combination with exercise.
There is a whole section in the guideline about surgery. If you are at the stage of considering this then it is recommended that you speak to your consultant about the effectiveness of every option. Remember, it is big deal going under the knife and not one that should be taken lightly.
The bottom line
Relax! I know that is hard when you have loads of pain but feel safe in the knowledge that 90% of lower back pain episodes resolve on their own within 6 weeks. Seek the advice of a Physiotherapist who is up to date with the research, who can perform a thorough assessment, treat you as an individual incorporating exercise, and someone who will work with you to get you back to your goals.