Low back pain is the leading cause of disability worldwide and is becoming more common as our population ages. Most people who have an episode of low back pain recover within six weeks, but two-thirds still have pain after three months. By 12 months, pain may linger but is usually less intense

A series of low back pain by the global medical journal The Lancet outlined that most sufferers aren't getting the most effective treatment. The articles state that recommended first-line treatments – such as advice to stay active and to exercise are often overlooked. Instead, many health professionals seem to favor less effective treatments such as rest, opioids, spinal injections, and surgery.

Risk factors for low back pain

The cause of most people's low back pain remains unknown. But we do know of some risk factors that could increase the chance of developing low back pain. These include a physically demanding job that involves lifting, bending and being in awkward postures. Lifestyle factors such as smoking, obesity and low levels of physical activity are also associated with developing low back pain.

Exercises such as Tai Chi, yoga, motor control (to restore strength, coordination and control of the thick core stabilizing muscles supporting the spine) and aerobic exercises (such as walking, swimming, cycling and general muscle reconditioning exercises) are recommended.

If any of these therapies fail or stop working, the guidelines point to manual and physical therapies such as spinal manipulation (Denmark, UK, US), massage (UK and US) and yoga and acupuncture (US) – particularly for low back pain lasting more than 12 weeks.

Exercise and psychological therapy

The guidelines are based on many studies that have shown the benefits of exercise and psychological therapies. For instance, a 2006 study compared pain levels across two groups of physically active people with chronic low back pain.

Participants who followed a four-week program using Pilates exercise equipment reported a more significant reduction in pain and disability than those in a control group who received usual care (consultations with a health care professional as needed). The benefit for the exercise group was maintained over a 12-month period.

Chronic pain is linked to chemical and structural changes at all levels of the nervous system. These include the level of neurotransmitter changes that alter pain modulation and sensitization of the nerves involved in transmitting pain signals. Incoming pain signals can be modified by our response to persistent pain.

In a trial including 342 participants, around 45% of those who had completed eight sessions of cognitive behavior therapy or mindfulness-based stress reduction had clinically meaningful improvements in bothersome pain at 26 weeks of follow-up. This was compared to only 26.6% of people who had received usual care.

Physiotherapists, chiropractors, and osteopaths are required by law to be registered with the Australian Health Practitioner Regulation Agency (AHPRA) to practice in Australia. To be registered, a person must complete a minimum of four years' study at a university in a degree that includes a focus on non-pharmacological (drug-based), non-surgical management of musculoskeletal conditions, including low back pain.

Under the government's Chronic Disease Management Plan patients with persistent low back pain may be referred to physiotherapists, chiropractors or osteopaths for evidence-based therapies such as spinal manipulation and massage. If patients are unfamiliar with these therapies, they can discuss the referral with their GP.

Physiotherapists, chiropractors, and osteopaths can also be consulted without the referral. Their services are usually covered by private health insurance. The AHPRA website lists registered practitioners in your area.

The message to the public and health professionals is clear. People with non-specific low back pain need to learn how to independently manage their pain while remaining active, staying at work and maintaining their social life as far as possible.