Lower back pain – an updated approach to management, exercise and expectations

Written by: Tom Bennett (Accredited Exercise Physiologist)

Chances are if you’re a human, you have or will experience back-pain. It is one of the leading
causes of disability worldwide and is prevalent in all age groups and demographics.

Most episodes of back pain do not have a specific cause or immediate threat to your health. In
fact, around 90-95% of people who experience back pain have what is labelled ‘non-specific’
back pain, meaning that there is no serious threat even in the presence of pain.

There are rare instances where people will present with ‘red flag’s’ and may need to be referred
for further medical investigation, however this is rare and will be picked up by your medical or
allied health professional.

So, where to from here? We know that upwards of 90% of our back pain is ‘non-specific’
So how do we improve it?

Let’s begin by touching on some unhelpful beliefs and treatment modalities as a segway to
improving your experience with back pain.

Image Source: John Hopkins

X-rays, ultrasounds, MRI’s and medical imaging

Those who present to our clinic with back pain are often accompanied by a flurry of unhelpful
beliefs and behaviors, which is not their fault! Often those who suffer with back pain have been
told to go and get a scan (MRI, xray, ultrasound etc), which is used to image our anatomical
structures, not detect where and why we are experiencing pain. The reports that accompany
these scans can be scary and hard to understand. Words like degeneration, disc bulge and loss
of disc height are enough to scare anybody into thinking that there is something wrong with their

The truth is, these are all common findings and do not equal pain or explain your pain. For
example, if you scanned 100 healthy individuals on the street who were not experiencing pain,
it’s likely that a lot of those reports come back with some form of “disc bulge, degeneration or
other medical term”.

Beliefs, behaviours and its effect on our bodies

Others present to our clinic with closely held beliefs that their posture, the way they lift things, or
even individual muscles are the reason for their back pain. Sometimes other clinicians have
enforced this belief (incidentally, maybe) which results in a cascade of unhelpful beliefs and

This looks like; avoiding normal spinal positions like slouching and bending, stiff
guarded movement and slow and cautious movement. Unfortunately these behaviours can
impact the way we think about ourselves and our body, resulting in an increase in fear and pain
vigilance, decrease in self-efficacy and reduction in activities we love.

It’s important to understand that our bodies are strong, flexible, adaptable and incredibly resilient!

Now that we’ve brushed over some of the unhelpful beliefs and behaviours, how can we
best manage our back pain with the help of an Exercise Physiologist?

1. Patient education

We can help you make sense of your pain or why you are experiencing back
pain (hint, it’s not just your posture, a single muscle or a certain movement).
Having a better understanding of your back pain puts you in control!

You can Learn about your body which will improve beliefs and view of your
body. Think “my backs out, buggered or has wear and tear” to “My back and body
is strong, mobile and resilient even with some discomfort”.

2. Self-management strategies

  • We don’t want you to have to solely rely on us, or any other allied health
    professional to manage your lower back pain! We believe a collaborative
    approach is best.
  • Flare ups, or periods of higher intense pain or discomfort are normal and
    sometimes inevitable.
  • An exercise Physiologist can help with self-management strategies when you’re
    not working directly with us. This can help promote autonomy and ultimately put
    you in charge of your back pain.

3. Exercise

  • If you google “best exercise for back pain” you’ll get thousands of different
    results. Truth is, there is no one exercise, one protocol or even modality of
    exercise that has been proven to be “the best”
  • We know that a combination of both progressive exercise (think weight training
    and aerobic training, combined with education is likely the most effective
    combination in managing back pain.
  • Takeaway; move often, exercise in ways you enjoy, progressively move more,
    learn about your body and if you need guidance speak with one of our exercise

Below are a list of resources for both patients and practitioners

Patient resources:

Clinician Resources: