Hi, I'm Dr. Andrea Furlan and today I'm going to talk about low back pain.
Low back pain is a condition that affects so many people. Almost 100% of people will have at least
one episode of back pain in their life. So, let's talk about it.
In this video today I'm going to explain what people can do when they are experiencing an
episode of low back pain and also, what they can do to prevent recurrence or
future episodes of low back pain. So how do we define low back pain?
Actually, low back pain is defined as pain in the area between the lowest ribs and the gluteal folds
and this area of the body is very mobile. We can do many things. We can bend forward,
we can extend, we can bend laterally, we can also rotate this area of the spine. It's an
area that is very mobile and therefore can be affected by many different conditions.
So the bones are called vertebras and they are very strong and they're very
thick pieces like a puzzle that is put together one on the top of the other,
and the weight of our upper body has to go through those bones called vertebrates.
And between those vertebras there are these joints or articulations,
one vertebra articulates with the vertebra above and with the vertebra below and when they connect,
it's a joint and those are called facet joints. And also, to connect these vertebras together
like tapes or glue there are the structures called ligaments. And then are the muscles
that they connect to the vertebras to make them move and the muscles are also responsible for
the stability of the spine. And last, I'd like to mention a very important structure that is inside
of the spine it's the spinal cord and the nerves, they are protected inside of the vertebral canal,
and they are an extension of the brain the spinal cord is an extension of the
nerves that come from the brain, and when they exit the spine, they are called the nerves.
So what can cause pain in this area of the spine, the lumbar spine? Well,
any structure that I mentioned before can be a generator of pain actually, and what's really
important is to exclude or rule out any serious or life-threatening condition that affects this area,
such as a fracture, or infection, or a tumor, cancer, or inflammation of the joints,
or any compression of the spinal cord, or these nerves, the nerve roots that are exiting from
the spine. But fortunately these conditions, the more serious conditions they are very rare,
they're not common, and when we examine the patient and we ask a number of questions, when
we put together the symptoms, the signs that we've seen the physical examination we basically have an
idea if we are dealing with a serious condition, or if it's a non life-threatening low back pain.
So once we exclude those serious conditions causing the low back pain we know that the person
has a benign low back pain, and we call this nonspecific low back pain. That's the name that
we get non specific means there is not a specific serious condition causing the low back pain.
So for this benign nonspecific low back pains, there can be many different types of pain, if
the pain is an acute episode, the onset is a very acute sudden onset, we call this acute low back
pain, but if the person is having pain in this area, the low back pain area, that is ongoing,
every day for at least three months, we call this chronic nonspecific low back pain,
and it's important to differentiate if this is an acute low back pain or a chronic low back pain,
because the treatments are going to be different. So we will talk about that.
So what is acute low back pain? Well, first of all I'd like to say that the pain is really bad,
it can be very, very intense. It's difficult to move, it's difficult to find a position to sleep,
and the person gets worried and anxious. What's going on? And because the anxiety is also there
present, the fear that this is something serious, usually when there is anxiety and stress the pain
even gets worse. We know that when we have stress in our lives the stress hormones go higher,
like the cortisol and adrenaline, and those hormones make the pain worse. So, we need
to be careful that an acute low back pain is very painful but it can also be aggravated by anxiety.
So, during in an acute episode of a nonspecific low back pain, what is it the person can do? Well
there are many things. The first thing is we tell them to keep going with their normal activities,
there is no need to take rest, especially bed rest, so we don't recommend anyone with
a nonspecific low back pain to bed rest. We tell them keep doing activities as normal as possible,
do what you can, because there is evidence that if they do this, the low back pain
will resolve quicker, the acute low back pain. The other thing that they can do is also take
some over-the-counter analgesics they can talk to a pharmacist and ask what is available here for
me without a prescription that I can take. There are some muscle relaxants, anti-inflammatories,
analgesics that they can take and they could take high doses and ask the pharmacist how
much high they could take, and they could take this for you know how long as the pain is there
maybe a couple of days or a couple of weeks. The other thing that they can do at home is
also to apply a hot pack or ice. Some people prefer ice packs and other people prefer hot,
whatever they prefe,r whatever makes that pain better they can apply that at home.
Also, they can go to a therapist like a massage therapist, an acupuncturist,
a chiropractor, a kinesiologist, a physiotherapist and those professionals
can help them to alleviate those symptoms with manual therapy, adjustments, modalities,
that can also be very helpful, especially when people cannot take those analgesics medications.
The other thing that it's very helpful, is to find a position that you can do at home that usually
doesn't cause any pain. I tell my patients it's usually a Z position, and this is the Z position
that I like to recommend to a lot of people to do at home, if this when you do this position
you feel no pain, your low back pain goes away, I recommend them to stay in this position for about
20 minutes, every day, because this will relax the muscles, relax the structures that are hurting,
and when the person gets up they will feel better. But some people don't feel pain free
when they do this position, and some other people will get better when they hyperextend their spine,
and also this is very helpful, if this helps your pain when you do this you feel that the
pain is relieved, then do this many times during the day do this posture many times during the day.
And some people have a bathtub at home, and they have access to a warm pool it's very good because
that will relax the muscles will help also to release the stress from the acute pain, if they
can soak in a bathtub with a very warm, very hot water, and put some magnesium salts, because the
magnesium will relax the muscle, and soak there for maybe 30 minutes every day, that's very
relaxing and will help the acute low back pain. And it's also important to remember that the acute
low back pain usually resolves within a few weeks. The majority of people get better within two weeks
and sometimes even after four or six weeks so we have to be patient and wait and it will go away.
So now a different thing is chronic low back pain some people have chronic pain which means that
they have every day ongoing for at least three months, and it's a chronic problem it can be very
annoying, very depressing, and it's constant, and there are some things that the person can
do to also alleviate the chronic back pain. It's possible that a person that has chronic
back pain, like they have a some sort of ongoing pain every day,, they may also have an acute
episode of pain like a flare, and if that's the case they can do the things that I recommended
before for acute low back pain. But sometimes the person just is living with that constant
nagging chronic low back pain, what they can do is a couple of things they can do to help.
In some cases chronic pain is a disease of the pain system and I explained this in another
video. If this is the case then the treatment you fix the pain system is what I call the five
MIS 5 M-I-S. The five "M”s are mind, movement, modalities, manual, and medication. “I” is
injections or interventional and “S” is surgery. But the most common cause of chronic low back
pain that I see my clinic is Myofascial pain syndrome. I also have another video explaining
Myofascial pain and the treatment consists mainly of exercises. And the exercises are
the SSAR: stretching, strengthening, aerobics, and relaxation exercises.
We also have to remember that there are many other causes of chronic low back pain so you
need to consult a therapist, a physician, to see if it's not a compression of the nerves,
or spinal stenosis that could also be causing chronic ongoing symptoms.
So what I would like to explain now, is how people can prevent an episode of low back pain.
Actually how they can prevent an acute flare of low back pain. There are many things that we can
do to make the episodes of acute low back pain to be more spaced out, to not to occur so frequently,
to be more rare, and also there are things that we can do also when we have an episode of low back
pain that the duration can be shorter, it doesn't need to be six weeks, there are things that we
can do so that episode would be maybe two weeks. And also there are things that we can do so when
there's an acute flare it doesn't need to be so intense and so severe, and so debilitating. We
can help and we can do things before that flare happens, so if it happens it will
be shorter, less intense, and short duration. So the secret is to maintain a healthy spine.
So when we are faced with an abrupt movement, or we need to use some muscles or something doesn't
get in the right spot, our spine is strong and then the flare will not be so severe.
And how do we maintain a healthy spine? So the first thing that we can do to maintain
a healthy spine is to maintain a regular routine of exercise. That's really important. We know that
our spine is strong if we can do a plank, if we can do a side plank, if we can hold a back arch,
if we can do various many bird dogs, if we can do many dead bugs for example, or if we can hold the
position on the Superman a couple of times, or if we can do some crunches. If we can do all of
those it means that the muscles around your spine are very strong and we are having a healthy spine.
Also it's not only about maintaining the muscles strong but also stretching them. It's really
important that the muscles around the spine including the paraspinals, the gluteus muscles,
quadratus lumborum and the abdominals. All the muscles around your spine they be stretched very
often like a daily basis. I don't recommend doing this on the bed because usually the
mattress is very soft. I recommend getting a mat and doing this on the floor if possible.
Finally it's also important to do some aerobic exercises. It's important to increase activity
that increases the heart rate and when we know that we are doing aerobic exercises when we are
breathing fast, and when our heart is beating very fast, we know that that's aerobic exercise,
and examples can be things like biking, running, skating, skiing, dancing, swimming. There are
many other options so do whatever you like. And second is to maintain a healthy BMI. BMI
is a body mass index and it's a measure of how much body fat we have in our body,
and it's related to height and weight, in adult men and women. And to calculate the BMI first you
get your weight in kilograms and your height in meters, and then you divide your weight by your
height, and then divide by height again. And these are the BMI categories so underweight,
normal weight, overweight, and obesity. And third is to maintain a healthy lifestyle
and there are a couple of things that we can do. The first one that I like to say is about smoking
nicotine or smoking cannabis because the smoke of that we inhale and goes to our lungs contains a
lot of substances and these substances cause the oxygenation of the tissues impaired. So
they impair the transport of oxygen that goes to the muscles, the spine, the discs,
the ligaments. So people who have back pain, especially low back pain, should really think
about not smoking, anything inhaling any smoke, that includes cigarettes, cigars, and cannabis.
The next thing is about alcohol. People who drink too much alcohol they may have
impairments of the nerves, that may also be impairment of the liver and pancreas function,
the stomach, so those things aggravate pain in general. We know that there is a safe limit we
call this low-risk drinking guidelines, and in Canada, those guidelines recommend that
a healthy drinking means 10 drinks a week for women, with no more than two drinks a day. And
for men is 15 drinks a week, with no more than three drinks in in a day, so no binge drinking.
Another lifestyle modification that is very important for people with low back
pain is to maintain a regular sleep routine, like sleeping in a dark room, low noise,
getting enough sleep, enough that when you wake up in the morning, you're not feeling tired.
Then we know that you have enough sleep. Diet is also very important. I recommend
my patients with chronic pain to avoid food that contains glutamate, because glutamate
activates the pain pathways in our brain, and foods that contain glutamate is usually
food rich in MSG, the G in MSG is glutamate. Also for people who have chronic low back pain,
it's important to avoid constipation because if the person cannot have a bowel movement every day,
the stools will be hard, and hard to pass and that may put a lot of strain in the muscles of
the pelvis, the muscles of the lower back area. So, eating a lot of fluids, and fibers is very
good to avoid constipation. So the goal should be to have at least one bowel movement every day.
And still talking about diet, it's important if a person lives in an area that they don't have a lot
of sunlight exposure, that they need to supplement vitamin D. I recommend 1,000 units every day.
And for people who have back pain especially related to their daily activities or to work,
I usually tell my patients that they need to maintain a balance between rest and exercise. So,
for those people who sit the whole day, they work in a desk job kind of work, they need
to take frequent breaks and do some stretches and exercises, go up and down stairs, and move on. The
other side, people who are very physically active and then at work, they need to take breaks and
rest and relax, not only relaxing their muscles, but also relaxing their mind. So there has to
be a balance between resting and movement. And please remember that this video is not
intended to provide medical advice it's only for educational purposes. If you think that
you have a condition that is causing your lower back pain, please seek medical care to have a
proper diagnosis and a treatment plan for you. And if you like this video don't forget to like
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Thank you very much for watching. Bye!