How back pain is affecting the world's population
In 2023, The Lancet published an article titled “The Global Epidemic of Low Back Pain” detailing the extent to which low back pain (LBP) is affecting the world’s population. The article states that in 2020, there were 619 million people worldwide who suffered from LBP and that the number is expected to rise to over 800 million by the year 2050. In Australia, LBP is responsible for the country’s third largest disease burden and it is estimated that 4 million people are living with it in some form. That is a staggering number of people!
LBP most commonly affects either the joints, muscles, discs and nerves. In fact, 95%+ of all cases of LBP can be attributed to these structures. However, it is estimated that 1% of all LBP patients that present to Physiotherapy clinics will actually have a serious spinal pathology and 2% will have pain referring from an internal organ (visceral referred pain). For the vast majority of people with LBP, the symptoms are not concerning and will settle within a few days to weeks by carrying out simple measures such as heat packs, over the counter medications and stretches. However, if symptoms are persisting longer than a week or are worsening, it is important to be checked out by a trained professional.
How a Physiotherapist can help with back pain
Physiotherapists have extensive training in recognising symptoms which can indicate sinister or non-musculoskeletal pathology. When you see a Physiotherapist, they will ask you a range of questions about the nature of your pain. As well as trying to understand what’s going on, we are also screening for certain “red flag” symptoms which could indicate that something more serious is going on. Some of these questions may seem unrelated, but we are asking for very good reasons.
For example, it is estimated that around 10-12% of women aged 50-70 and 20% aged 70+ will have had a spinal fracture at some point in their lives. Most of these fractures are as a result of osteoporosis, a condition which affects the density of bones and increases the risk of sustaining a fracture. There are a number of red flags which Physios look out for and the higher the number of red flags a patient has, the more likely they are to have sustained a fracture.
Questions You Will Be Asked By A Professional Physiotherapist
As well as the usual questions, a Physiotherapist may ask you:
Do you have a history of osteoporosis?
– Have you ever used oral steroid medications?
– Did you have an early menopause (under the age of 45)?
– Do you have Rheumatoid Arthritis/Thyroid Disease/Inflammatory Bowel Disease?
– Do you have a history of Cancer? (especially Lung, Breast, Prostate, Renal, Bowel or Thyroid)
– How much alcohol do you drink? (>3 standard drinks/day)
– Do you smoke?
To the lay person, these questions may seem unrelated or even excessive, but answering yes to any of the above questions increases your risk of spinal fracture. If you do answer yes to most of these questions, it doesn’t guarantee that you have had a fracture but it can make it more likely. Physiotherapists are trained to evaluate your symptoms and determine your clinical risk of serious problems and explain to you what to do next e.g. when to get a scan. As well as fractures, Physios are trained to evaluate for other serious pathologies such as cancer, infections, inflammatory conditions, spinal cord compression and pain referred from the viscera such as the kidneys, bladder and gastrointestinal tract.
This post has not been written to scare or alarm. It is to inform you that the Physiotherapists at Scarborough Physio and Health are trained to pick up the signs and symptoms of when back pain is not just back pain.