QF 21 – 8 hours or so from Sydney to Tokyo. You nod off during the flight with dreams of 7 days straight of thigh deep powder, hot spring baths and delicious Japanese food. You make your way to Niseko via a couple of bus rides and another short flight. Next morning, you hit the hill; it’s hard to contain your excitement. First run – two turns in – bang, you feel your back go. The pain is unbearable. Some say knifelike, others liken it to being shot. Either way, it is not what you had planned. After a few expletives, you wonder how you are going to ski again this trip and realise that you didn’t spend $3,000+ on your holiday to watch re-runs of ‘The English Patient’ in your chalet. 85% of us will have low back pain at some point in our lives. Furthermore, 50% will have at least one recurrence of this. The good news is that 90% of all back pain will get better within a 3 month period.
The majority of back pain falls into what is labelled somatic low back pain. This is generally pain coming from damaged soft tissue such as the disc or tissues of the apophyseal (facet) joints. This is usually local to the back, yet can spread into the buttock or down into the leg. This leg pain however, is different from a more serious nerve root compression often, yet not always correctly referred to as sciatica. A smaller percentage (about 10%) of low back pain (LBP) is due to more serious pathology such as bony fracture, stress fracture, spondylolisthesis (slipping of the one vertebra on another) and narrowing (stenosis) of the spinal canal. Hip and sacroiliac joint (pelvis) injuries can also present as LBP. Generally, these more serious conditions can be screened during a consultation and appropriate management can be taken.
So how is somatic LBP treated? The best advice is to see a physiotherapist for suitable management should your back ‘go’ on you. There is no ‘set’ treatment for all low back pain and therefore a programme tailored to the individual’s presentation will produce the best results. Physiotherapy treatment may include several techniques such as joint mobilisation, soft tissue techniques, stretching and strengthening exercises, electrotherapy and taping. In the majority of cases, you should be able to get back on the hill within 2-3 days. If you are unable to get treatment the following should help:
Unless your pain is so severe you cannot move, avoid bed rest as it can cause stiffness and slow recovery. Should you need to rest, adopt pain free postures. Movements in pain free directions are encouraged and you should avoid movements that aggravate pain.
Avoid prolonged postures, (especially sitting in couches or low chairs), heavy lifting and excessive bending or twisting. A lumbar roll or rolled towel in the small of the back can help promote good spinal posture.
Analgesic and anti inflammatory medications from your pharmacy or GP can help with pain relief and inflammation. Heat is often good for muscle spasm. Ice is also effective yet may not be as desirable in the colder Niseko climate. For most acute injuries, we advocate ice as the best initial management, yet as the joints in the back are not as big as say your knee and ankle, heat is ok.
We live in a society in which we constantly bend forwards or sit for long periods at computers. Rarely do we extend or go backwards with our spines. Spinal flexibility is important in both directions. However, repeated extensions (McKenzie Extensions) can often relieve pain for the majority, but not all conditions.
As with any condition, prevention is better than cure. There are several ways to prevent your ski holiday being ruined by low back pain. This is particularly relevant for those who have suffered previous back pain. Try to concentrate on the following.
Good posture – Prolonged poor posture places undesirable loads on the lumbar spine. Work set-up forms part of this. A supportive chair with lumbar support is helpful. When lifting; use the legs, keep the load close to you, keep the back straight and brace the stomach muscles before lifting.
Core stability – this is a ubiquitous new millennium term. It refers to the muscular control required around the lower back, pelvis and hip area to keep your centre stable. It is imperative to have a stable ‘core’ or middle for a good base of support to allow you arms and legs to take load. This is a topic in itself, and the best advice is to see your physiotherapist or a well qualified Pilates instructor.
Flexibility – many muscles cross over the pelvis and lower back area. If they are tight they can affect the mechanics of the lower back. Stretching and soft tissue work can help this.
General fitness – regular activity is the best way to prevent LBP. Staying fit and moving your body around regularly generally means less back pain as exercise promotes movement. It also means you carry less weight.
Should your back pain not be responding to treatment or if you fall in the 10% of more serious pathologies, further investigations such as X-Ray, CT scan or MRI may be needed. For the majority of LBP, investigations are not necessary as it usually does not change treatment or management. On top of this, emphasis should be placed more so on a patient’s presentation as opposed to investigation findings, as these findings may not be responsible for the patient having pain. Many people have bulging discs on MRI in the absence of low back pain.
Surgery is usually not helpful for the majority of LBP sufferers. Should there be bladder or bowel function loss, non-improving nerve compression signs, or notable instability of the bones, it is generally indicated.
LBP is too large a topic to cover completely here but hopefully this snapshot can provide you with an insight into how it can be managed and how you can keep yourself on the slopes, away from the re-runs and the treatment room.
Happy skiing!