Non-specific Low Back Pain (NSLBP)

What is NSLBP?

NSLBP refers to lower back pain without identifiable structural pathology (e.g., disc herniation, fracture).

• Affects 90% of LBP cases
• Diagnosis relies on excluding red flags through clinical assessment
• Involves complex interactions between muscles, joints, nerves, and psychosocial factors

"The absence of imaging findings doesn't mean the pain isn't real – it means we need to look beyond simple structural causes."

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Non-Specific vs. Specific Low Back Pain

• Non-Specific LBP (90% of cases)
  • No identifiable structural cause (e.g., normal imaging)
  • Diagnosis based on exclusion of red flags
• Specific LBP (10% of cases)
  • Clear pathological cause identified (e.g., disc herniation, fracture)
  • Pain arises from spinal pathology, neurological deficit, and inflammatory disease
  • Confirmed via imaging/tests (MRI, X-ray, clinical signs)

Understanding NSLBP Through the Biopsychosocial Model

The Biopsychosocial model is a framework used to understand and manage conditions like non-specific low back pain (NSLBP). This model contrasts with older, purely biomedical views that might solely focus on physical tissue damage. The Biopsychosocial model suggests that disability and the experience of pain are influenced by a combination of: biological/physical, psychological, and social factors.

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Clinical Implication: Effective management requires addressing all three components.

Biological 🧬

• Physical Contributors:
  • Age (peak 30-50 years, increased risk 65-79 years)
  • Obesity/weight fluctuations
  • Sedentary lifestyle & poor fitness
  • Smoking & metabolic disorders (diabetes, hypertension)
  • Unhealthy eating/sleep patterns (late meals, skipped breakfasts)

Psychological 🧠

• Key Risk Factors:
  • Depression/anxiety
  • Catastrophizing & fear-avoidance behaviors
  • Somatization (emotional distress manifesting as physical pain)
• Critical Impact:
  • Strongest predictor of pain becoming chronic

Social 👥

• Lifestyle Risks:
  • Cluster of unhealthy habits (poor diet + inactivity + smoking)
  • High-stress occupations (manual labor OR sedentary desk jobs)
• Workplace Factors:
  • Job dissatisfaction & work-related distress
  • Poor ergonomics (prolonged sitting/standing)

Implications for Management

• The biopsychosocial model supports a holistic approach to managing NSLBP
• Effective strategies need to consider the interplay between biological, psychological, and social factors, rather than focusing solely on physical interventions
• Multidisciplinary assessment and treatment, which can involve a combination of diagnostic expertise from physicians, physical therapists, and psychologists, aligns with this model, particularly for patients with persistent pain and psychosocial factors

In essence, the biopsychosocial model explains NSLBP is not just as a physical problem, but as a complex experience influenced by a person's thoughts, emotions, beliefs, lifestyle, and social context.

Common Causes of NSLBP

• Muscle strain or ligament sprain
• Joint dysfunction (facet/SI joint)
• Poor posture
• Stress or tension
• Deconditioning

Symptoms of NSLBP

• Dull or achy pain localized to the lower back
• Pain may radiate to glutes or thighs (not past the knee)
• Pain varies with movement or posture
• Muscle spasms
• Pain with bending, twisting, lifting, standing, or walking can worsen the pain.

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The Progression of NSLBP

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Recurrent Episodes

Recurrence is common, with 30–50% of individuals experiencing another episode within a year. Regular physical activity, core strengthening, and ergonomic adjustments can reduce flare-ups.

Diagnosis

Clinical Assessment

• Findings:
• ✔️ Normal spinal alignment
• ✔️ Muscle tenderness (paraspinals/SI joint)
• ✔️ Reduced ROM without neurological deficits
• ✔️ Possible antalgic gait (walking to minimize pain or discomfort)

Special Tests

1. Nerve Root Involvement:
   • SLR test (pain <60° leg raise)
   • Femoral nerve stretch (prone knee flexion pain)
2. SI Joint Dysfunction:
   • FABER test (hip flexion/abduction pain)
   • Gaenslen's test (hyperextension pain)
3. Facet Joint Pain:
   • Kemp's test (extension + rotation pain)

🚨 3 Emergency Signs You Should Never Ignore

1. "Saddle Area" Numbness + Bathroom Problems
   • What to check:
   • ✓ Loss of feeling in inner thighs/groin (like sitting on a bike seat)
   • ✓ New bladder issues (can't pee, leaking accidentally)
   • ✓ Bowel control problems (unexpected accidents)
   • Why it matters: This could be cauda equina syndrome – a rare but serious nerve emergency.
2. Unexplained Weight Loss + Night Pain
   • Warning signs:
   • ✓ Back pain that wakes you up at night
   • ✓ Losing weight without dieting
   • ✓ Fever/chills with back pain
   • Possible causes: Infection or other serious conditions.
3. Severe Trauma
   • Examples:
   • ✓ Back pain after a car accident or hard fall
   • ✓ If you have osteoporosis and new back pain after lifting

Imaging Guidance

⚠️ Not recommended for typical NSLBP

✅ Only indicated if:

• Trauma (fracture suspected)
• Neurological deficits
• Suspected infection/tumour

💪 Why Physiotherapy?

1. Reducing Pain

• Gentle hands-on techniques (like massage or joint movements) help loosen stiff areas
• Heat/ice or mild electrical stimulation can calm muscle spasms
• Education about why pain happens helps patients worry less about movement

2. Improving Movement

• Simple stretches make the spine more flexible
• Special exercises teach your body to use the right muscles for support
• Fixing posture problems takes pressure off the back

3. Building Strength

• Safe core exercises (like modified planks) make your back more stable
• Strengthening legs and hips helps share the load
• Walking or swimming keeps your body moving without strain

4. Preventing Future Pain

• Learning how to slowly increase activity prevents setbacks
• Proper lifting and sitting techniques protect your back
• Understanding that movement is medicine helps long-term recovery

Why Physiotherapy Works Better Than Just Rest or Pills

✔️ Active treatment gives lasting results

✔️ Combines physical and mental approaches

✔️ Teaches you how to manage your own pain

By treating NSLBP as a reversible functional issue rather than a structural "damage" problem, physiotherapy optimizes both short- and long-term outcomes. The goal isn't just to stop pain today - it's to help you stay active and confident in your body's abilities. Most people start seeing improvement within a few weeks of consistent therapy.

Remember: For common back pain, moving (the right way) is usually better than resting too much!

Treatment Plan Outline

Step 1: First Visit - The Full Picture

✓ Movement check: We'll watch how you bend, walk and move

✓ Pain discussion: You'll explain what makes it better/worse

✓ Goal setting: What you want to get back to (sports, work, etc.)

Step 2: Early Relief (First 2 Weeks)

• Gentle hands-on therapy if needed
• Simple pain-safe movements
• Tips for daily activities (sitting, sleeping, lifting)
• Home exercises (only 5-10 minutes/day)

Step 3: Building Strength (Weeks 3-6)

✓ Core stability exercises

✓ Hip and leg strengthening

✓ Better posture habits

✓ Work/sport-specific adjustments

Step 4: Full Recovery (Weeks 6+)

• Advanced strength training
• Return to all normal activities
• Prevention plan
• Check-ins as needed

FAQs About NSLBP

How long will it last?

• Most cases improve within 4-6 weeks with simple care. About 1 in 10 people may experience longer-term pain.

Should I get an X-ray or MRI?

• Usually not needed. Scans often show normal age-related changes that aren't the real pain source. We only recommend imaging if we suspect something serious.

Is it safe to exercise?

• Yes! Gentle movement helps recovery. We'll show you which exercises are safe and how to progress them.

What's the best sleeping position?

• Try lying on your side with a pillow between your knees, or on your back with a pillow under your knees. Avoid stomach sleeping.

Should I use heat or ice?

• Ice for first 48 hours (15-20 mins every 2 hours)
• Heat after 48 hours (warm bath or heating pad for 20 mins)

Why does stress make my back hurt worse?

Stress tenses muscles and amplifies pain signals. We'll teach you simple breathing/relaxation techniques to help.

Will painkillers cure my back pain?

Medications may help temporarily, but they don't address the root cause. Active rehab gives longer-lasting relief.

Book a Physio Assessment Today

Serving Vaughan, Thornhill, and Toronto. Direct billing available.

📞 905-669-1221 | 📍 398 Steeles Ave. W, Thornhill

Image 1 -  Low back pain - pain conditions. painHEALTH. (n.d.). https://painhealth.csse.uwa.edu.au/pain-module/low-back-pain/

Image 2 - Central Therapy. (2024, November 29). Pain: Understanding through the biopsychosocial model. https://central-therapy.uk/pain-understanding-through-the-biopsychosocial-model/

Image 3 - Lower back pain: Symptoms & advanced spine care. The Advanced Spine Center | NJ’s Top Doctors in Spine Relief. (n.d.). https://theadvancedspinecenter.com/conditions/back-neck-pain/lower-back-pain/

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Written by: Tiffany Skye Corpus