Non-specific low back pain
The term non-specific low back pain has recently been used more widely and appears to be a reasonable term to describe patients' back injury as definite sources of pathology are not easy to find. However, qualitative research has highlighted potential problems with the use of such term. Patients with low back pain expect an accurate diagnosis and are often dissatisfied when they do not receive one or receive different diagnoses from different providers. Patients also have negative feelings towards providers who do not provide a diagnosis, with patients regarding the diagnosis as important in terms of legitimising their experience of pain. The challenge here for clinicians is that many patients will not regard the label non-specific low back pain as a diagnosis. On the other hand, such term "non-specific" could be helpful for explanation to patients as why their chronic low back conditions are so difficult to treat and heal. Whatever "specific" structures had been injured initially, surrounding tissues would have been affected when the condition becomes chronic. Considering a typical minor disc injury from bending/lifting, initial inflammation and pain prevents lumbar (low back) movements especially extension (backward bending). Loss of lumbar lordosis (low back S-curve) is therefore rather common. Adopting such more forward bending alignment over strain posterior (back) structures such as other deep ligaments and muscles and the facet joints. Minor but chronic (long-lasting) irritation/inflammation occurs resulting in soft tissue and joint thickening leading to chronic stiffness of that particular intervertebral (spine) segment in certain directions especially extension. As the condition persists, other segments above and/or below could also be affected. Multiple structures and segments are therefore 'injured' making diagnosis of the original source of injury impossible or even pointless, hence our 'diagnosis' of non-specific low back pain. Perhaps non-specific implies that we DON'T know! Specific treatment techniques that target individual structure may therefore not necessary work. Perhaps we should go back to the very basic of treatment principle, restoring normal. Chemically, we aim to restore chemical equilibrium. Physically, we aim to restore normal alignment and structural balance, e.g. muscle balance and balance in joint range of movements in all directions. Clinically, patients with chronic non-specific low back pain often have restrictions in lumbar extension and reduced lumbar lordosis. Initial treatment aim may therefore be restoration of lumbar extension and lordosis.
Luck LI
Musculoskeletal Physiotherapist
Luck LI
Musculoskeletal Physiotherapist