Treating and Preventing Back Pain: Interview with Dr. Mattia Bisconti

Back pain is a complex clinical condition that often depends on multiple factors. We interviewed Mattia Bisconti, a doctor of physiotherapy, specialist in Musculoskeletal and Rheumatology Physiotherapy (OMPT) and Sports Physiotherapy (SPT) at UPMC Salvator Mundi International Hospital, and President of the Manual Therapy and Musculoskeletal Physiotherapy Group GTM-AIFI (Italian Physiotherapy Association), about this common problem that, most of the time, is manageable through targeted physiotherapy treatments and therapeutic exercises that can help manage loads and daily activities, as well as pain.

Dr. Bisconti, we are talking about a rather common condition. Could you explain in detail the various types of back pain that exist?

The most common back pain, however, is so-called lumbago. Contrary to what one might think, it is not necessarily due to a specific health condition, such as a herniated disc or a disc protrusion. Basically, almost all of us experience low back pain at least once in our lives. In the vast majority of cases, it is not particularly alarming and can depend on various factors. Back pain is usually classified according to a time order, whereby it is defined as 'acute' when it lasts 6 weeks or less, 'subacute' if it lasts up to 12 weeks, and 'persistent' if it goes beyond that.

What are the main symptoms of low back pain?

Underlying causes can lead to a wide range of symptoms. For example, the pain may be sudden or gradual, localised in a specific area or occur over a wider area. In some cases, there may be feelings of muscle spasm, weakness, insecurity and fear in movement. In situations that may be complex, akin to neurological involvement, symptoms may extend below the knee and manifest as numbness, the sensation of a tight sock around the foot, or 'electricity' down the leg.

Dr. Bisconti, could you explain in detail the main causes of back pain?

Back pain can result from a number of factors. One of the most common causes is incorrect load management or over-exertion that is not in line with one's abilities and over a prolonged period of time. Other common circumstances that can contribute to developing an acute or persistent form of back pain are holding a position for too long, or with inadequate ergonomics, e.g. if we spend many hours every day in front of the computer without changing position. It should be emphasised that it is inappropriate to speak of correct or incorrect posture: the important thing is to vary the position of our body as much as possible and subject it to a variability of stimuli suitable for carrying out daily activities.

Finally, factors such as fear of movement, lack of confidence in one's abilities, work and family stress, and poor sleep quality can also contribute to the onset, or worsening, of low back pain.

What can we say about less common causes?

Less common causes of back pain include conditions such as arthritis, radiculopathies due to impaired nerve conduction of spinal nerves due to herniated discs and stenosis. More rarely, back pain may be caused by serious comorbidities or concomitant and as yet unidentified clinical conditions, such as inflammatory diseases (spondylodiscitis), tumours or fractures. Some of these conditions may be more complex to recognise and identify. A physiotherapist specialising in musculoskeletal and rheumatology physiotherapy (MMPT) will recognise the symptoms and will be able to contact the appropriate specialist physician.

Dr. Bisconti, what are the effective strategies to reduce back pain without resorting to surgery?

Conservative treatment is usually the first line of intervention against back pain. The use of over-the-counter painkillers and anti-inflammatory drugs, such as ibuprofen or naproxen, can be helpful in managing the pain, always under the advice of your doctor. In the acute phase, it is important to go along with your body's sensations and remain at rest in the position that best relieves your symptoms for a period of up to 24/48 hours. After this time, it is necessary to undertake specific physiotherapy to regain movement or to return to a lifestyle that is as active as possible, compatible with one's state of health. It is absolutely inadvisable to remain in a state of absolute rest beyond the indicated time. If there is no improvement in symptoms, a specialist should be contacted.

Although the pain may last for days, therefore, it is important to keep moving and gradually resume life and daily activities. If your back is very painful, it is advisable to take breaks, but avoid standing still for too long. Walking is a simple but effective exercise, as it stimulates blood circulation and helps reactivate the muscles, allowing us to regain confidence and reduce any fears.

Depending on your specific needs, your physiotherapist can recommend specific exercises to strengthen, relax, improve your perception of your body and your movements, and also to better manage pain. The exercises can vary and should involve progressively larger body segments: they can start with movements of the lumbar region on a mat to involve upper and lower limbs with exercises in a sitting or standing position.

Could you explain what manual therapy involves and when it is appropriate to use it?

It is a specialisation of physiotherapy that involves a set of techniques specific to the specialist in musculoskeletal and rheumatology physiotherapy (OMPT), aimed at modulating the perception of pain and promoting a gradual recovery of movements to resume normal daily functions. They may include joint mobilisations, high-speed and small amplitude manipulations (HVLA), or soft tissue manipulation techniques such as muscles. Manual therapy can be effective in the acute phase due to the stimulation of the nervous system and the ability to guide the person's recovery of movement. However, it is important to emphasise that manual therapy cannot relocate vertebral segments or reposition hernias or the like: this is a false myth that must be dispelled so as not to create false expectations in the patient.

Dr Bisconti, how can lower back pain be prevented from returning? Do you have any advice to offer our readers?

Absolutely, prevention is essential to avoid the return of lower back pain. Here are some tips that can help keep your back healthy and prevent discomfort.

Varying our posture as much as possible, whether during work or relaxation activities, is essential to prevent the onset of back pain.

Regular physical activity is a key element in the prevention of back pain. Activities such as walking, swimming or cycling can help train muscles and improve flexibility. These are only suggestions; it is important that the person chooses the activity that best suits his or her preferences. The recommendations of the World Health Organisation recommend a minimum of 150 minutes of moderate-intensity aerobic physical activity during the week, or a minimum of 75 minutes of vigorous activity plus strengthening exercises of the major muscle groups 2 or more times a week.

Sleep: restful sleep is for our health in general, and for the health of our backs. The WHO, again, recommends sleeping 7-8 hours a day.

Strengthen the back, which is already one of the strongest and most resilient parts of our body, through correct load management. Except for specific pathologies, if our body is used to it, lifting weights is not a risk.

Ergonomic workplace: if you spend a lot of time sitting or standing at work, make sure you vary your position as much as possible, including exercises. Using 5-wheel chairs with a back support, placing both feet on a small elevator, having the desktop at eye level, can be simple and effective measures to facilitate load distribution during working hours. Taking regular walking breaks if sitting for a long time or changing position if standing for a long time are other important tips.

Healthy lifestyle habits: Maintaining a healthy lifestyle, including quitting smoking, reducing stress through meditation techniques, eating a balanced diet, and getting adequate and regular exercise, can all contribute significantly to preventing back pain.

Discover UPMC Salvator Mundi International Hospital physiotherapy services and book a free consultation at Physiotherapy Open House, November 4.