Back pain? Ask Professor Phelps

I have been suffering lower back pain for some time. I admit I’m about 20kgs overweight, but could this really be affecting my back?

Being overweight definitely contributes to back pain.  Excess weight, particularly if it is carried in your mid-section, creates an abnormal posture of the spine and puts an extra strain on the muscles and ligaments in your lower back.  Osteoarthritis of the spine is also a common cause of low back pain and is more common in people who are overweight.  A physiotherapist can help you with exercises to strengthen the muscles in your back and core. Our dietician Jaime can help you with an eating plan for weight loss, and our acupuncturist Amanda can help pain management with acupuncture.

I have heard that it’s possible to manage back pain (or any chronic pain) using a type of thinking. Could you explain how this works please?

There is growing concern about the use of strong pain medication for chronic low back pain. Strong motivation to get better and an optimistic outlook are known to improve results for people with chronic back pain. Psychological treatment to learn pain management skills (such as pain distraction and relaxation/stress management techniques) is also beneficial. Research tells us that mindfulness meditation and cognitive behavioural therapy often work better than pain medications and other medical treatments for chronic back pain. Dr Lucy Herron has a special interest in mindfulness.

I sit for long periods at my desk each day and always leave work with an aching back. Is there anything I should be doing to help myself during the day?

Prolonged sitting is hard on your back.  Even though you have a job that requires you to be at your desk for long periods, there are some things you can do.

• Stand up when you are on the phone
• Stand up to read documents and when you are waiting for computer downloads
• Position items in your desk so you avoid reaching and twisting movements.
• Take a walk during your breaks instead of just going to sit in a different location.
• Use the stairs instead of the elevator
• Have meetings while walking instead of sitting.
• Work on your general fitness.
• Make sure you have an excellent quality chair with adjustable seat height and a lumbar support. It is a worthwhile investment.

For years, I’ve been a jogger but now my back pain is so bad I can’t run anymore. I thought I was doing the right thing by exercising and now I learn I’ve been harming myself. What are some good exercises for people with back pain who want to remain fit?

You can’t necessarily blame the jogging for your back pain.   I would suggest you get an individual exercise program from a sports physiotherapist or exercise physiologist. Generally speaking though, it is essential to keep your muscles well-toned and your level of aerobic fitness up.  Find types of exercise that challenge you but do not cause pain.  For example walking, some swimming strokes, aquafitness, Tai Chi and yoga (the instructor will need to know you have back problems) can keep you moving.  Make sure you do a series of gentle stretches before and after exercise.

Is it better to choose a chiropractor, an osteopath or a regular physiotherapist to get help for an aching back?

There is no simple answer for this question.  Some people find that a particular approach or a specific health professional is able to help them with their back pain where others might find that a different approach works for them.   Most people with mechanical low back pain find a combination of physical “hands on” therapy, analgesia, back exercises and back care instruction most helpful. First try to confirm the cause of your back pain.

When would a doctor recommend surgery for back problems such as a prolapsed disc? How successful is back surgery? 

The majority of people (around 90%) with a prolapsed disc get better without surgery.  You would need an MRI and a surgical opinion if your symptoms were still causing problems after 3 months or if there were signs of significant pressure on a nerve.  Surgery involves removing the protruding part of the disc to make more room for the nerve being compressed, and it has a high rate of success in expert hands.  If you have difficulty with bowel or bladder function, decreased sensation around your genitals, or progressive leg weakness, this may be an indication of a medical emergency.   These days, minimally invasive surgical techniques are used where the scar is very small and recovery is expected within weeks.  If you are considering surgery, talk to your surgeon at length about the technique, possible dangers and expected recovery time.