Back pain
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Lower back pain
Lower back pain is a very common health problem worldwide, and is a major cause of disability. However, for the vast majority of people, lower back pain isn't serious and should settle quickly, if it is managed correctly. Serious causes of lower back pain are very rare.

Many people with lower back pain don't manage it well because of the wrong advice – there are an awful lot of unhelpful stories about the causes of back pain and the best treatments for it. Many of the assumptions made about back pain are not only wrong, they may actually be harmful.  

The following information is based on the findings of lots of medical research into the best ways to help with lower back pain.

Our brilliant backs
The spine is incredibly strong and brilliantly designed. It protects the spinal cord, or the big bundle of nerves that runs down your back, yet at the same time allows us to bend and stretch and move in lots of different directions. It is actually very hard to do anything any permanent damage.

What causes lower back pain?
For most cases we don't know for definite. There are lots of ligaments, tendons, muscles, nerves and joints that make up your spine; that's what makes it so strong. If these structures are overstretched or pulled they can produce pain, and it is impossible for us to single out one culprit because they are all so closely connected. It is most likely that a simple sprain or strain to one or more of these structures is the cause of the pain. It's similar to twisting your ankle and spraining the ligament. 
Sensitive spines
When you have an episode of back pain, it doesn't mean you've done anything any serious damage – it's just an indication that the spine is really quite sensitive. So, being in a funny position for a while, or lifting awkwardly, can 'sensitise' some of these tissues in the back to the point that they complain, and cause pain.  

Studies have shown there are other things which can affect how sensitive the spine is, and how readily it will produce pain. These include being inactive, tension, stress, worry, anxiety, lack of sleep and low mood. So these things need thinking about too. 

Do I need a scan?
One of the most common things we are asked when someone has lower back pain is 'do I need a scan?'. For most people, the answer to this is 'no'. Scans give us an awful lot of information but what they don't always do is tell us what is causing the pain. It won't tell us, for example, that a ligament or tendon or muscle has been overstretched. 

A common scan report may show a small disc bulge but which is not necessarily the cause of pain, although often that is the incorrect conclusion we jump to. Discs bulge a bit as we get older – it's perfectly normal and not necessarily the cause of your pain. However, if we are at any point concerned about the source of your back pain, we will not hesitate in referring you on for a scan.

What to do?
The most important thing is movement. Your back is designed to move – the joints, ligaments, tendons, muscles and nerves are all designed to move, and they don't like it too much if they don't move. Studies show that longer periods of rest and avoiding activity actually leads to more pain, longer recovery times and longer time off work. 

During the first few days, you may have to modify how active you are. However, staying as active as possible and gradually building up to your previous activity levels is very important for your recovery. It is perfectly safe to exercise with back pain. Do not be afraid to bend and twist and stretch. That's what your back is designed to do and by doing it you'll make your back stronger, more flexible and healthier in the long run. Muscles that might be in spasm due to the pain relax when they are gently stretched and moved. Back pain should not stop you enjoying exercise or regular activities. Research shows that continuing with your regular activities can help you get better sooner.

What type of exercise is best?  
Most types of exercise are of some benefit to people with lower back pain, with no particular type of exercise being better than another. Walking, running, swimming, cycling, yoga and pilates, for example, are all good. The most important consideration regarding exercise is to choose something you enjoy. When you are in pain, starting to exercise can feel hard, especially if your back is not used to it. Feeling stiff and sore after exercise isn't a sign you've damaged yourself – it's simply a sign your body is not used to that activity and the stiffness and soreness will ease as you strengthen up from doing that activity.

There are some gentle exercises for you to try on this website and, as you feel more confident, you can gradually increase what you do.

It is worth pointing out that no pill or tablet will give you all the benefits exercise does.

How can we help you?
Physiotherapists are very well educated in helping you manage your back pain. From teaching you exercises, advising and educating you about your back, providing treatment in a one-to-one setting, or enabling you to participate in one of the gym-based classes, there are so many ways the physiotherapy team can help you with your back pain symptoms. If you would like to come and see one of our specialist teams based in Knowsley and St Helens, you can collect a self-referral form from your GP practice or from any of the physiotherapy bases across our boroughs.
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