Preventing and Managing Low Back Pain: A Practical Guide for Adults 18 to 64

Preventing and Managing Low Back Pain: A Practical Guide for Adults 18 to 64

Mid 20s to 50s?

Sitting all day for work? 

Can’t get rid of your back pain? 

Unable to return to prior sporting or recreational activities? 

You may be one of the millions who exhibit this certain category of back pain. With recent changes in the work environment to now include the home, this new development may also hold costs to people’s long term health – spine health, in particular. 

Prior to the COVID-19 pandemic, about 80% of the U.S. population would suffer from low back pain at some point in their lives. In epidemiological U.S. studies, an estimated 5-20% had yearly low back pain incidences. Moreover, discogenic low back pain (DLBP) accounted for the highest incidence for chronic low back pain at 39%, and about 30% was due to lower disc herniations.¹ This means about 69% of all chronic low back pain can be caused by a discogenic injury! 

How middle-aged adults are at risk for low back injuries

So why should anyone in their 20s or 50s care about this? Since discogenic low back pain is the most common type of lumbar spine injury, it is even more crucial to understand how this disease process begins. 

When abnormal or excessive forces to the spine are accrued, it may begin biomechanical and biochemical degeneration to the intervertebral discs, and tissues surrounding the discs. Physical activities to induce this without proper training are: any type of running, cutting, or sports that require you to brace your core from a vertical jump or impact. Other known behavioral factors include: aging, obesity, smoking, poor posture, and vibrations from transportation.^1,2 

Figure 1: Tearing to disc annulus fibrosus⁸

These activities and behaviors may lead to a cascade of effects related to fissures (tearing) to parts of the disc and tissues, and the onset of inflammation. Both of these could stimulate internal nerve root receptors around the discs, without compressing any type of spinal nerve root (meaning no signs of sciatica).³ 

When these stresses occur frequently or acutely enough, it may also lead to degenerative changes to the disc and eventually the normal structure of your spine. All of this is even more pertinent to the 40-50 year-olds who are on the onset of physical age changes, and may not be prepared for high impact activities that do not normally injure adolescents. 

As our society is progressing into more of a work-from-home paradigm, the risks for spine injuries may increase in the years to come. More of a sedentary lifestyle may only be induced with our novel work environment, and behaviors we choose to abide by day-to-day. For adults 20-60, now is the time to take action on finding resources to maintain good spine health and management. 

What can Physical Therapy offer for the treatment of DLBP?

Physical therapists are not only educated on all lumbar pathologies and how to diagnose them, we are also highly trained specialists in how to treat your back AND get you back to your A-Z activities.

In a 2014 study, it was deemed that the initial treatment for discogenic low back pain should be non-operative.⁴ Some positive effects from this initial treatment could be reduced pain, return to function, and it is most economical at healthcare micro and macro levels. 

Further, recent studies have shown that surgical treatment or epidural injections does no better in outcomes when compared to physical therapy using a biopsychosocial approach.⁵ Now here’s some information to save a buck!

Preventing Low Back Pain

Incorporate these simple habits into your routine to support spine health:

1. Stay Active: Engage in low-impact activities like walking, swimming, or cycling.
2. Strengthen Your Core: Regular core exercises improve stability and prevent injury.
3. Practice Good Posture: Ensure your workstation is ergonomic, with your monitor at eye level and your feet flat on the floor.
4. Take Breaks: Stand up and stretch every 30-60 minutes to reduce muscle stiffness.
5. Manage Stress: Practice relaxation techniques like yoga or meditation to alleviate tension.

Yoga with low back pain

For healthy young adults, an alternative option to maintain good spinal health can be with the practice of instructed yoga. From the perspective of a physical therapist, yoga offers multiple methods in enhancing lumbar mobility and core stability strengthening. With consistent practice, yoga is well suited to supplement other sports with its plyometric strengthening, mobility, and flexibility focus; in order to improve performance and reduce the incidence of injuries. Other supplementary exercises to enhance performance and reduce chances of injury are resistance training to muscle groups associated with the activity or sport being done. 

The costs and burden of low back pain

A study published by JAMA in 2020 was conducted to account for the U.S. healthcare costs between 1996-2016. During this 20-year period, an estimated $1.4 trillion that was spent on healthcare in 1996 has more than doubled to $3.1 trillion in 2016 ($9655 per person), accounting for about 18% of the U.S. GDP. Also in 2016, of the $3.1 trillion spent, neck and low back pain accounted for the highest amount with the 154 diseases studied – at $134.5 billion!⁷

As we can see from the above, healthcare costs are only increasing every decade, and spine related pathologies are the largest contributor to healthcare burden costs and work productivity lost. As of today, we know that the best non-invasive treatment methods available are customized physical therapy biopsychosocial programs, along with epidural injections or pharmacological treatment. If this method is implemented early enough, it may slow the rate of lower spine conditions burdening the healthcare system, and the individual. 

Summary of key points to take away 

• The age range for initial onset of a low back injury that is discogenic in origin is late 20s to 50s. 
• The majority of lumbar spine injuries involve a discogenic pathology.
• Chronic low back pain is most associated with a discogenic pathology. 
• Physical therapy, and guided supplementary exercises to a sport or physical activity have much benefit in treating or preventing low back injuries.
• Healthcare costs at micro/macro levels for cervical and lumbar pain are the highest recorded out of any other physical or chronic ailment in the U.S. 

References:

1. Zhang, Yin-gang et al. “Clinical diagnosis for discogenic low back pain.” International journal of biological sciences vol. 5,7 647-58. 13 Oct. 2009, doi:10.7150/ijbs.5.647.
2. Zhang, Yin’gang et al. “Advances in susceptibility genetics of intervertebral degenerative disc disease.” International journal of biological sciences vol. 4,5 283-90. 2 Sep. 2008, doi:10.7150/ijbs.4.283.
3. Anderson D, Tannoury C. Molecular pathogenic factors in symptomatic disc degeneration. Spine J. 2005;5:260S–266S.
4. Lu, Young et al. “Nonoperative management of discogenic back pain: a systematic review.” Spine vol. 39,16 (2014): 1314-24. doi:10.1097/BRS.0000000000000401.
5. Zhao, L., Manchikanti, L., Kaye, A.D. et al. Treatment of Discogenic Low Back Pain: Current Treatment Strategies and Future Options—a Literature Review. Curr Pain Headache Rep 23, 86 (2019). https://doi.org/10.1007/s11916-019-0821-x.
6. Wieland, L Susan et al. “Yoga treatment for chronic non-specific low back pain.” The Cochrane database of systematic reviews vol. 1,1 CD010671. 12 Jan. 2017, doi:10.1002/14651858.CD010671.pub2.
7. Dieleman JL, Cao J, Chapin A, et al. US Health Care Spending by Payer and Health Condition, 1996-2016. JAMA. 2020;323(9):863–884. doi:10.1001/jama.2020.0734.
8. Figure 1: The Ageing Process and Back Pain | Buxton Osteopathy Clinic