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Physiotherapist treating a patientLow Back Pain (LBP) is an incredibly common complaint with 40% of all adults reporting at least one day of LBP each year. For most LBP sufferers they are troubled a lot more often than that. It accounts for 37% of all chronic pain in men and 44% in women, costs £1.623bn a year to treat and costs the UK economy £12.3bn a year.  It’s a big problem.

When doctors consider the cause of LBP they are encouraged to consider broad diagnostic possibilities:  Serious pathology (eg cancer), inflammatory (eg Ankylosing Spondylitis), specific (such as fractures) and non-specific.

Non-specific LBP is what the vast majority (85%) of people have.  This term basically means that nothing specific can be found with blood tests, x-rays or scans to explain the symptoms of LBP.  It is well known that most of the common findings on MRI do not relate to LBP, such as disc and joint wear and tear (in fact most of the things found on MRI in someone with LBP are also commonly found in people without LBP) and there are very few ‘specific’ findings that do.

So, once the nasty things and the few specific things have been ruled out everyone is left with this diagnosis of non- specific (or non-specific mechanical) low back pain.

The problem with this ‘diagnosis’ is that it groups a lot of people together based on a lack of clear guidance from the medical investigations but doesn’t consider people on an individual basis to look closely at their LBP.

This has lead to everyone with this diagnosis being treated in the same way, with very mediocre results, leading to a lot of frustration for those living with and treating non-specific LBP.

Although this large group of people may not have specific medical causes of their pain many do have issues that make their problem specific to them.

Some people have pain when inactive that gets better when active but for some it’s the reverse. Some people have pain bending but are OK standing and walking whilst some get pain while upright that is relieved by sitting slumped.  It can be very different for different individuals with the same broad diagnosis.

We know that, broadly speaking, people who exercise have less LBP that those who don’t and those who are stressed, anxious or depressed and those with sleep problems are much more likely to have LBP.  It has been proven that those who think negatively about their problem (often as a result of a negatively interpreted scan) have more problems than those with a positive outlook.

All these issues need to be considered when exploring why someone has LBP. You can then develop a diagnosis and a management plan more specific to that person by dealing with the issues specific to them.  This approach is then much more effective than treating everyone the same.

For a lot of people with persistent LBP, this is the reason why it’s become persistent. Their specific issues have not been recognised or managed.

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Chris Pinches

I joined the Central Health Physiotherapy team in November 2004. Currently I am lead out-patient physiotherapist, working closely with a consultant orthopaedic spinal surgeon. My specialist areas include management of a wide range of musculoskeletal conditions with a special interest in spinal pain, sports injuries, shoulders. Prior to that I spent time in both the NHS and private sector, including the academy of football at West Ham United FC.

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