Preventing Chronic Pain
Ms. LAW Ka Yee, Rainbow
Centre-in-Charge, Physiotherapy Centre
Lower back pain is a prevalent issue that affects individuals across various professions and levels of physical activity. Studies have shown that over half of adults will experience lower back pain at some point in their lives, with most people recovering within a few weeks with proper management. However, many patients fail to address poor posture or habits that may cause the pain to return. In this article, we aim to educate the public on preventing acute lower back pain from becoming chronic pain.
In situations where there is sudden and severe lower back pain, it is important to rule out serious underlying conditions such as cancerous tumours or infections. These conditions usually cause additional symptoms such as fever, loss of appetite, or weight loss, and may require urgent medical attention. If the acute lower back pain is caused by a significant trauma, seeking immediate medical attention is also necessary to rule out the possibility of minor fractures.
Once serious conditions have been ruled out, it is essential to understand the common causes of lower back pain and begin the process of regaining mobility and function. Lower back pain may have different causes in people of different ages. Generally, older people or those engaged in heavy physical labor may experience degenerative or occupational-related lower back pain, with multiple potential sources of pain requiring individual assessment. As for younger people without long-term illnesses, herniated lumbar disc is a common cause, with 80% of patients with lumbar disc injuries fully recovering within a few weeks. For the majority of lower back pain patients, the following should be noted:
Stop Vigorous Exercise Immediately
If the pain is very severe, it is necessary to immediately stop vigorous exercise/activity. Rest in moderation, temporarily avoid lifting heavy objects, bending movements, and even sitting with a slouching posture are also useful. The key is to avoid excessive "vigorous" activity. Patients should maintain light daily activities within the tolerable level of pain, as excessive bed rest can weaken muscles and reduce the ability to protect the spine.
Control Pain and Inflammation
It is crucial to effectively control pain in the early stages of the illness in order to reduce ongoing pain due to sensitisation of the nervous system. A suitable amount of anti-inflammatory and pain-relief medications can effectively alleviate pain, but it should be taken as prescribed by a doctor. It is important not to wait until the pain becomes severe and unbearable before taking medication. Delaying pain relief may affect the sensitivity of the nervous system to pain, potentially increasing the dosage of pain relief medication and the risk of long-term pain conditions.
Continue with Rehabilitation Exercises
Once the pain is manageable, it is crucial to begin rehabilitation exercises promptly. Supervision by a physiotherapist specialised in pain management can facilitate the recovery. Regular exercise, with the intensity and frequency of back exercises tailored to the individual’s condition, severity, and inflammation is the key to speedy recovery. The idea of “No Pain, No Gain” is not applicable here. The exercises prescribed should be able to alleviate pain and restore activity. It is common to focus on the following two main areas during the rehabilitation process.
Reduce stiffness: Generally speaking, when there are still obvious signs of inflammation, it is advisable to only do gentle exercises to maintain the range of movement as pain tolerated. Once inflammation is under control by rest or medications, more intensive stretching exercises should be performed to prevent joints or soft tissues tightness. Physiotherapists can identify the stiff joint/ tight soft tissues after a thorough physical examination. Discomfort during stretching exercises is common. Muscle soreness is also a normal reaction, but it should not cause excessive pain. Again, exercise with supervision by a physiotherapist specialised in pain management can facilitate the recovery.
Restore muscle strength: when inflammation and pain are under control, trunk muscle exercises aiming at stabilising and strength training can be performed with varying exercise intensities. The key to successful recovery lies in selecting exercises that are suitable for the condition. For more severe cases, gentle trunk exercises should be done first, such as lying on the bed and using a fitness ball to unload the spine during the muscle strength training. Pilates and yoga also include many exercises for the trunk muscles, but they should be selected according to the condition to avoid provoking the pain again.
Preventing Recurrence and Chronic Pain
Physiotherapists assist patients with back pain in gradually regaining their ability to perform daily activities, and also provide recommendations to prevent recurrence based on the patient’s daily habits and work needs. In one case, a patient who had suffered from long-term back pain found relief from medication and physical therapy, but the pain still recurred occasionally without any serious cause. After a detailed assessment, it was discovered that the patient’s habit of bending over to wash her hair may be the culprit of the recurrence of her back pain. After changing this habit, the back pain seldom recurred.
In conclusion, one of the common causes of back pain is poor spinal posture during daily activities, which increases the pressure on the spine and intervertebral discs, exacerbating degeneration and causing injury to the muscles and ligaments. It is essential to have the cause diagnosed by a doctor during an acute condition and to control the pain promptly, while getting advice specific to your daily activity and continuing rehabilitation exercises under the guidance of a physiotherapist. With cooperation from all three parties, short-term pain can be effectively prevented from becoming a long-term condition.