Back Pain FAQs

There are many possible causes of back pain, therefore having back pain doesn’t necessarily mean that your core is weak. It is almost certainly true to say that having weakness in the core is the most common cause of back pain. The best way to figure out whether your back pain relates to a weak core is to work with a practitioner who knows how to do a thorough assessment of your core strength. 

It is not advisable to tackle your own, or often even your PT’s core exercises at the gym if you have back pain. Sit-ups and planking type exercises for example have been shown to irritate a bad back in many instances. The truth is that no practitioner who has trained extensively in rehabilitation of back pain would ever prescribe you traditional core type gym exercises from the outset. If your back is hurting and you want to keep up the gym work without aggravating it the research indicates that general light activity or ‘keeping moving’ is the best approach. Light stretching to keep the back loose may also be helpful. 

Yes, it’s fine to get a massage when you have back pain. Massage can be very easing and a percentage of people get very significant short term relief from massage. As a treatment for back pain massage is considered by researchers to be significantly less effective on average than pain killers, acupuncture and spinal manipulation. If massage works for you though, it works for you. 

This really depends on how much pain you are in and what is causing your back pain. If you have stubborn,  long standing or niggly pain doing very carefully targeted core exercises that access the deeper layers of the core is often the best approach. Some people with ongoing pain also need to do strength exercises for the leg and foot alignment.

If you are having an episode of severe pain it is best to limit your exercise to gentle stretches and general light activity. Research into this kind of back pain indicates that it is not easy to exercise your way out of, it is easy to aggravate with the wrong exercises though. 

International guidelines for the management of back pain give clear indications as to what tends to work and what tends not to work. Seeking acupuncture, pain killers, spinal manipulation and qualified exercise prescription all score well, going to back schools in hospitals and spinal surgery do not score well. If you want to use painkillers alone to manage your pain call your doctor. If you want a more hands on approach you should call an osteopath, chiropractor or a physiotherapist who specialises in back pain. Osteopaths, chiropractors and physio’s are qualified to refer you for x rays and surgical consults of needed,  so it’s not necessary to go through your doctor.  

Whether you need an x Ray for your lower back pain depends on many factors. If you have a history of certain symptoms and circumstances an x Ray may well be indicated. There are many simple examinations, procedures and tests that a qualified practitioner like a physiotherapist, chiropractor or osteopath can perform to establish the cause of your back pain without and x ray. If you are in good physical health and you have all the normal signs of mechanical (movement related) back pain, you should be able to proceed with treatment without needing an x Ray. 

The good news is that only a small minority of back pain cases involve ‘slipped discs’. When a disc does ‘slip’ what really happens is some fluid escapes from the disc,  which can sometimes put pressure on a nerve. The main symptom that is associated with an obvious disc issue is very severe leg pain, the type of leg pain that people put their life on hold for. The best thing to do if you are concerned you might have a disc issue is get checked out by a qualified professional who knows how to run some simple tests. 

Pinched nerves in the back are virtually an old wives tale. There are rare instances where a nerve can become compressed, by some advances arthritic change or a very bad injury. Virtually everybody who says they have a pinched nerve, or have been told they have a pinched nerve actually have another kind of problem all together. A locked or pinched ‘facet joint’!!! Facet joints are the small weight bearing joints in your back, when they lock they can feel very sharp and stabby in certain positions. Facet joints are a major cause of back pain, pinched nerves are not. 

The best exercise to strengthen your lower back are exercises that target the ‘inner core’. The good news is that if you can learn to target the deeper muscles of your core it may very well end up feeling like a cure for your back problem. The bad news is that like so many worthwhile things in life, you can’t just expect to jump in and have a great chance of success. Doing sit-ups and planks does not target the deeper layers of the core. Even doing a yoga or Pilates class does not guarantee you will activate your core in the way you need to, in fact it usually doesn’t. If you are serious about strengthening your core,  find a practitioner or resource for ‘multifidus muscle’ strengthening. That’s the deep work ! 

Gentle stretches are generally the best stretches for back pain, the more pain you have the more gentle you should be. A good principle when stretching your back is to use ‘time’ to stretch out rather than ‘effort’. Set a timer for 3 whole minutes and hold each stretch gently for that long, it will feel like a long time. Two excellent resources for lower back stretches are ‘McKenzie Stretches’ and ‘Yin Yoga Back Stretches’, if you put those terms  into YouTube you will find some great options.

The term cure is an awkward one. If you did everything just right for your back over the next 5 years, banished your pain and completely and  resolved your underlying issues we might call that ‘cure’. You could still get up the next morning and have fall 2 flights of stairs and ‘uncure’ yourself. 

If we take ‘cure’ simply to mean gain control of your back pain in a very stable and lasting way,  the news is definitely good. Through the right combination of treatments and exercises, countless people have found long lasting relief and freedom from back pain. There was a time before modern treatment and rehabilitation methods that bad cases of back pain were more often than not a ‘life sentence’, those days are thankfully gone.

Yes, foot problems can most definitely cause lower back pain. We take countless thousands of steps on concrete and paving every year of our lives. The amount of mechanical stress that our lower spines endure from all the standing, walking and running we do on hard surfaces is beyond reckoning. If you have unusually high arches or unusually flat feet you may be particularly susceptible to developing back pain caused by your feet. There is however good news if your back pain does come from your feet, a combination of orthotic insoles and appropriate exercises are likely to be of great help to you.