If you've ever suffered from back pain, you'll know how debilitating it can be.
It's estimated one-in-six Australians suffer some form of back pain.
To make matters worse, it seems many of us are still being treated for back pain using outdated methods.
Bed rest, pain medication and surgery have been proven to be less effective and more risky than taking an active approach to recovery using gentle movement and gradual activity.
Now, the Australian Commission on Safety and Quality in Health Care has released a clinical care standard, which it hopes will become a road map for healthcare professionals in treating patients with back pain.
Joe Laurence's experience of back pain is common to many Australians.
He works in emergency services and injured his back at work with a seemingly innocuous movement.
"I was pulling a hose over a fence and I just sort of felt a shooting pain go from my lower back," he said.
"It went all the way down to my foot."
Months of pain
For the next three months, the 27 year old suffered severe pain, couldn't work and spent days lying in bed.
When there hadn't been any change, his doctor ordered him to get an MRI.
"I got this MRI that said really some scary things. It said disc bulges, fissures, tears, all these scary words that you don't want to see involving your back when you're 27 and have an active job and active life," he said.
For the next three years, he was treated by doctors, physiotherapists and chiropractors.
They all promoted traditional forms of treatment, including bed rest, pain medication, modifying his lifting technique and wearing a back brace.
"I started to modify how I moved – you know, sit up straight, lift with a straight back, keep a strong core, these messages are everywhere," he said.
"I really took that to a high level — I got super strong through my core because I thought that would help.
"I always braced before lifting anything, I always had a really good posture and yet things only got worse from there."
It wasn't until he saw specialist physiotherapist, Peter O'Sullivan, that his life turned around.
He was put on a course to recovery involving regular movement and activity, and Joe said that started a "one way journey back to health".
"He just got all of the movements that I was scared of and one at a time unlocked them," he said.
"He said 'your back is designed to bend, it's healthy to bend, it's safe to bend, so let's get you bending again.'"
Regular movement and activity
Peter O'Sullivan is a professor of musculoskeletal physiotherapy at Curtin University and helped write the new clinical care code.
It's estimated that back pain costs the Australian health system $4.8 billion a year.
The new standard of care has been designed to guide practitioners through a range of treatment options.
"As healthcare practitioners we need to identify the very small group of people where there's serious stuff going on, but for the majority of people, you don't need a scan," Professor O'Sullivan said.
He said results from scans could lead to fear and anxiety, and taking steps to over protect their injury which can slow the healing process.
"So it sets this perfect trap where the messages lead to over worry, a lack of confidence, over protection, avoidance and actually feeds the thing that you're frightened of," he said.
Professor O’Sullivan said the messaging around the standards is to engage in safe movement and activity.
"The important role of a clinician is to say 'Look we know this is painful, but we know that you'll get out of this quicker if we give you a program that is graduated and sensible and it puts you in control so that you can get back to all those things you value and build your confidence back in your body,'" he said.
A shift in how to treat back pain
The commission's clinical director, Associate Professor Liz Marles, said she hopes the new standard will see a shift in thinking among healthcare professionals.
"The first thing we want to do is have a proper clinical assessment where you can actually recognise the signs of serious pathology," she said.
"So even though that's rare — it's only like one to three per cent of low back pain presentations will have an underlying serious pathology — we still need to have it in the back of our mind when we do that initial assessment."
But for the majority of patients, the shift will be to help people's functionality, she said.
"They will recover really quickly, and won't lead to the level of disability and mental health consequences that we see at the moment," Professor Marles said.
Joe Laurence says he wants to get the message out that life doesn't have to be lived with back pain.
"There are so many people who are needlessly suffering with this when actually they're in the same boat as me and can get through it and can have a life on the other side of that pain," he said.
