4 part series on low back pain – Part 4C: The ultimate answer for managing low back pain

For the 80% of us with a grumbly lower back, research is telling us that ultimately an active approach is the most favourable in managing back pain in the long term.

This means you need to:

  • Keep active in your spare time

    • In part 3 of this back pain series, we discussed how our sedentary lives are the major cause to low back pain. So what do you need to do about it? Get up and get moving! 
    • Swimming is a fantastic form of exercise for people with low back pain. While you are at the pool, try some walking in the shallow end – walk forwards because it is fantastic cardio, but try walking backwards as it is a great way to help you engage your buttock muscles. 
    • Get into any other exercise that you enjoy – walking, yoga, Pilates, Physiotonic classes, cross trainer… there is so much variety you can choose from.. and do exactly that – keep the exercise varied.
    • Is cycling a good choice of exercise for low back pain? Maybe not – we’ll discuss this in a separate blog post soon!

  • Keep your weight down
    • Being overweight simply puts too much pressure on your spine. Make some changes to your dietary and exercise habits today! 

  • Work on your core strength
    • Having a strong core that will help you prevent back pain, does not mean you have a six pack and can do 100 sit ups. Your six pack muscles are the outer core and don’t support your back.
    • Instead, the deep core muscle that wraps around your trunk, is the one you need to improve and will help you get a stronger, more stable body. For more reading on your deep core visit:
    • You will need to go through how to activate your inner core with your physio in detail. Or, come along to a Physiotonic class and we will get you sorted. 
  • Work on your flexibility
  • Keep working on your posture
    • You need to learn a skill 10 000 times before your brain changes it pattern. So get cracking on teaching yourself good sitting habits! Improving your posture is a gradual process but just keep working at it! It is never too late to start!  


This is the final blog post on this series for low back pain. To help manage back pain in the long term, our message is simple…get moving! Improve your posture, core strength, buttock strength and flexibility today with Physiotonic exercise classes. Visit our website at www.physiotonic.com.au to contact us. 



4 part series on low back pain – Part 4B: What to watch out for when seeking treatment

Read below for some hot tips, so you get the most out of your treatment.

1. Be careful of radiation exposure with what investigations you are told to get. 

  • As mentioned in the previous post, CT scans should only be done if absolutely necessary. They are cheaper for you than an MRI. However, CT scans are very high dose radiation. Be careful! 
  • MRI is a popular investigation of choice for the lumbar spine. This is because it provides lots of information on both soft and hard tissue structures. The good news is that there is no radiation exposure with MRI. However, you are typically out of pocket by about $300.
  • Xrays are helpful to show us the boney alignment of the spine. If your pain is in the lower back, then you only need an Xray of your lower back. Getting an Xray for the entire spine is usually unnecessary.
  • Most commonly, your referring practitioner will be able to get the most valuable information from getting you to have both an MRI and Xray.  

Left: An MRI of the lower back, showing the integrity of the lumbar discs.

Right: AN Xray of the lumbar spine. 






2. Your pain should improve with treatment!

  • You should not get an increase in pain after a session with your physio, chiro, acupuncturist or massage therapist. If your pain does increase, make sure you let your practitioner know.
  • If your pain is not improving after a few sessions, change practitioners or see your doctor (or Sports Physician). Either they are doing the wrong treatment for you or have not diagnosed you properly. Don’t keep going back just because!
  • As your pain improves, treatment should reduce. Don’t let any practitioner tell you that you need 3-4 treatments per week for 12 months. That is costly and unnecessary! Instead, your treatments may start at once (max twice) per week and as your symptoms improve, treatments should gradually reduce to once per 2-3 weeks. 
  • The most shocking warning I need to tell you is this… don’t be conned into making an upfront payment for 12 months worth of treatment, involving 3-4 sessions per week. Read the above dot point again.. treatment needs to be reducing as your symptoms improve not staying the same.

3. Be careful of some ‘out there’ wording that some practitioners use. 

  • No your spine cannot ‘be out of alignment’ and no it can’t be ‘popped back in’. Don’t let these terms scare you. 
  • And nor can your spine change position on X-ray after a few treatments.
    • Don’t let a practitioner take an Xray of your spine, do some treatments and repeat the Xray claiming that they have ‘straightened’ your spine. We have normal curvatures of our spines that are there for a reason (see the picture below).
    • Research shows that the position of a joint (measured using an Xray) does not change before and after a joint manipulation (i.e. crack).  
    • Instead, to improve the posture of your spine, be sure to keep working on your strength, flexibility and posture. For more information on how to do this, get along to a Physiotonic class today. Visit www.physiotonic.com.au to register. 


Above: the normal curvatures of the spine. 


There is one final blog past on this 4 part series to low back pain. Keep reading for more information on the ultimate answer for managing low back pain. 

4 part series on low back pain – Part 4A: Typical treatment options

Now that you are reading the final part to this series, you are becoming an expert on low back pain! Keep reading to learn about how to treat and manage your back pain. Treatment posts include:

  • Part A: Typical treatments options and when to see a doctor
  • Part B: What to watch out for when seeking treatment
  • Part C: The ultimate answer for managing low back pain


PART 4A – What are the most typical treatment options you can pursue? What do you expect to get out of these treatments? 

  1. Physio
    • Your physiotherapist will assess your spine and identify the main issues contributing to your pain. They will work out where you are:
      • Tight. Your physio will then help improve your movement by various manual therapy techniques including massage, joint mobilisations, muscle energy techniques and potentially dry needling. You will be given stretches to work on between treatments to help maintain and improve your movement.
      • Weak. After having back pain, your physio will give you exercises to help you activate your deep core (see previous blog post titled ‘the core essence of running’ to learn more about the core) as well as strengthen other muscles such as your buttock muscles that may also be weak.
    • Your physio will also give you advice on:
      • what exercise you can do while you have back pain. Exercise like swimming is particularly good for you if you are suffering from low back pain. If you don’t want to do freestyle, try walking in the pool. You will feel surprisingly good afterwards!
      • When you can return to your normal exercise regime and if this should be modified. 
      • Posture, posture, posture. You really need to get cracking on improving how you sit, stand and move. Learn how to get those core muscles switching on in functional position
  2. Massage
    • Massage therapy can be helpful at easing tension and improving movement.
  3.  Acupuncture
    • Is a form of alternative medicine that you can certainly try. Some people really like it and find it helpful. Acupuncture is holistic and seeks to improve the flow of energy in your meridians. (NB Acupuncture is very different to what a physio offers with dry needling. Dry needling targets trigger points, not meridians).
  4. Chiropractic
    • Is a form of alternative medicine that emphasizes treatment of the musculoskeletal system under the belief that mechanical disorders affect general health via the nervous system. The main chiropractic treatment technique involves manual therapy, especially manipulation of the spine.



What’s up doc?

Knowing when to see a doctor over one of the practitioners listed above can be tricky. You definitely need to see your GP if your pain:

  • is severe
  • is worsening
  • is worse at night and stops you from sleeping
  • if you have any rapid weight loss or weight gain
  • is radiating down your leg and past your knee

Your GP can prescribe medications to help improve your pain. If you have a very acute bout of low back pain, the best thing you can do is get onto the right medication and rest in bed for a few days. Going for a massage or to physio when you are in debilitating and severe pain, wont help! The medication at this stage is the most important.

Be careful as to what investigations you are told to get. Typically, an Xray and MRI is ordered. Note that CT scans are very high dose radiation and should only be done if absolutely necessary.

If you need further medical attention, I couldn’t more highly recommend the use of specialist doctors such as Sports Physicians. These doctors are the most highly qualified to clarify the diagnosis, organize appropriate investigations and provide you with details on medical options for your pain, such as corticosteroid injections. 


Keep an eye out for our next post for this series, part 4B: what to watch out for with seeking treatment. 


4 part series on low back pain – part 3: What’s causing the back pain epidemic?

In part 1 of this blog series, we learnt the staggering statistics of how low back pain affects most of us. In the second part of this series we looked at where pain in the back actually comes from. Here we are taking a close look at the causes and symptoms of low back pain.

 What’s causing this significant back pain epidemic? 

Back pain simply comes down to the fact that we are too sedentary. Generally people are unfit, weak and don’t have much muscle tone.

Everything happens automatically at our finger tips. Take for example, bringing the groceries home. We drive our car into the driveway, press a button so the garage door lifts, drive in, load our shopping into the lift and the lift takes us up to the level of our apartment. Not much physical effort is required.


So why do fit people like runners get back pain?

There’s no doubt that running keeps us fit and strong. But the problem lies with what happens the rest of the time. People are sitting at a desk, in excess of 50 hours per week now. This is the time that we are getting deconditioned. This is the time our core muscles in particularly get weak.

Simply running for 30 mins here or there during the week, and doing some ab crunches isn’t going to fix the deep core deconditioning if the majority of the time we are stationary. 

What we need to do is adopt a lifestyle where we are continually thinking about and engaging our postural muscles to keep them activated. This means not slouching in your chair (how are you sitting right now?) and instead, moving, sitting and standing with your deep core muscles activated. By adopting good postures, this will ultimately take the load off the spine.

You need to concentrate every day on your sitting posture. Sitting in a slumped position, causes:

  • your hip flexor muscles to become tight and overactive
  • your buttock muscles to become weak
  • pressure on lumbar discs (see previous post for what the disc is), which will in turn cause wear and tear and eventually degeneration of your lumbar structures.

The wear and tear on your spine occurs on a daily basis from years of poor sitting. Microtrauma every day, every week, every month. Then, you go and do something fairly innocuous such as picking up your shoe from the floor, or bending down to make your bed or doing an unaccustomed activity like 1 hour of gardening… and then your back goes into ‘spasm’. This last list of activities is just simply the icing on the cake. The real cause has been all the deconditioning and bad sitting habits leading up to the event.

 Improve your core and postural awareness today. Visit http://www.physiotonic.com.au/benefits/office-workers/



Pain in the back can either be a deep ache or if your pain is acute, you may experience some sharp pains. The pain is usually made worse with sitting for long periods, bending, lifting and long runs can also stir up the back pain (particularly if you lack deep core endurance because your core muscles will fatigue, placing more stress on your spine).

If your symptoms have persisted, are worsening or you are getting pain running down your leg past your knee, make sure you see your doctor or physio. 


Keep reading our next post for more information on how to treat and overcome your back pain. 

4 Part series on Low Back Pain

Part 2 – Where does pain in the back come from?

part one of this series (see previous blog post) looked into the shocking statistics that demonstrate the significant problems back pain is causing to australians. it effects so many of us. in this blog post, we look more closely into where the pain actually comes from. 


Back pain can be acute or chronic, sharp or achey, radiate to your legs or hang in the lower back and buttock. But where does the pain actually come from?

Back pain is commonly due to general wear and tear of all the structures around your back. This can include the joints, the disc, and the muscles. Typically, not just one structure is involved, but a bunch of them.  

Most commonly, however, the disc is the main source of pain (does a ‘slipped disc’ sound familiar?). There are 5 lumbar vertebrae. In between the vertebrae there are discs, which act as cushions between the vertebrae. The discs have an:

  • inner part, called the nucleus pulposus which is like soft jelly
  • outer part, called the annulus fibrosis which is like a harder jelly


Left: Demonstrates your entire spine with your cervical (neck), thoracic (mid back) and lumbar (lower back) vertebrae.
Right: Shows how the disc and vertebrate are positioned. 

When the disc herniates, part of the nucleus leaks backwards. From more minor back injury to more severe this is what happens to the disc:

  • The nucleus can just touch the edge of the disc, causing pain (protrusion)
  • the nucleus touches the edge of the disc and if the wall weakens, this can irritate the nerve roots (herniation)
  • a portion of the disc leaks out through a tear in the disc’s outer wall (extrusion) and may separate from the disc itself (worst case scenario, sequestration). 

The picture below summarises this. 

Below is what a bulging disc typically looks like on MRI (side on view). 

The disc doesn’t necessarily have to herniate to cause pain. It can degenerate or thin. In a normal disc, its height is maintained by water and protein. As we age or as the disc degenerates, the water and protein content in the disc, decreases. See below. 




Sciatica describes the symptoms of leg pain and possibly tingling, numbness or weakness that originates in the lower back and travels through the buttock and down the large sciatic nerve in the back of the leg. Most commonly, sciatica is caused by a protruding disc, degenerated disc or a narrowing of the boney canal that the nerve passes through. 

The majority of us, however, do not have 1 particular structure that is the main source of our back pain. We typically have general wear and tear that affects many structures in our back. Therefore we present to a health professional with a grumbly back that never seems to get better. Keep reading the next 2 posts, where we will cover:

  • Part 3 – causes and symptoms
  • Part 4 – treatment