Ask just about anyone – friends, family, colleagues – and most of them will tell you that they've suffered from some form of back pain over the course of their lives. Ninety per cent of back pain, however, goes away after a month or so. But what about those who suffer from chronic lower backache (or lumbar pain)? A new study shows that rehabilitation may be just as good an option as surgery in the long run.

One of the reasons that back pain is so tough to treat is because of the difficulty in diagnosing its precise cause. Only about 20 per cent of lower back pain patients have an identifiable injury, caused by the likes of a car accident, disease or repetitive strain. For the remaining 80 per cent, reasons as varied as posture, lack of exercise, incorrect seating at work or the rigours of everyday life are listed as contributing factors. Even more frustrating, it is often difficult for doctors to form an accurate prognosis. So when chronic back pain persists for years, patients often opt for surgery.

Surgery vs. rehab
Elective spinal fusion surgery is both costly and painful, and requires aggressive physiotherapy almost directly following the procedure. However, the British Medical Journal has recently published a study suggesting that surgery may not provide enough long-term benefit to make it a worthwhile option. The study, performed at 15 British hospitals, did show that surgery has a slight edge in helping patients. However, the data did not represent evidence that would mitigate the negative aspects of the procedure. The study suggests that 'candidates for spinal fusion surgery may obtain similar benefits from an intensive rehabilitation program as they [would] from surgery.' Additionally, the risks associated with rehab are negligible compared to those associated with the spinal fusion procedure.

The extensive study looked at 349 adults with long-term lower back pain. About half received spinal fusion surgery, while the remainder were subjected to extensive and repeated physiotherapy. Both groups were monitored for two years, and "no clear evidence emerged" that the procedure provided significant benefit over rehab alone. Although the study is not conclusive, it is already causing doctors and patients to rethink their approach to lower back pain treatment.

Preventing back pain
The lower back is notoriously easy to injure, but also relatively easy to protect from harm. Correct seating at work or in front of the computer is essential to maintaining the health of your spine. Ask your doctor to examine your posture, and make sure that you stand and walk in such a way as to avoid unnecessary strain on your lumbar region. When lifting heavy objects, always bend at the knees. And working on your core strength (the abdominal muscles and the lower back muscles) through exercise can also help protect the lower back from future strain.

At the very least, doctors and patients are starting to think around spinal fusion surgery and are looking to physiotherapy with renewed interest. So, the next time you happen to see a friend, family member or colleague slouching, tell them to straighten up. It may save them a tough choice in the future.


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