General information:

Lower back pain is an extremely common condition. It is estimated that 70-90% of people will suffer from lower back pain at some point in their life. In many cases those affected will go on to have recurrent episodes. While lower back pain can present in many ways, it is usually divided into two main categories: acute back pain; and chronic back pain.

Acute lower back pain:

This is a sudden onset back pain that can vary from moderate to extreme pain and may or may not be associated with pain down the leg. Most people seek treatment either because of pain, disability, concern about the cause, or because acute episodes keep recurring. There are a number of structures in the lower back that can be vulnerable to injury including muscles, ligaments, joints, nerves, blood vessels and discs so the causes and presentations of acute back pain can be numerous and varied. However, it is the pain that comes from seemingly nowhere or while doing some innocuous movement, like turning the alarm off in the morning or bending over to tie up shoelaces that can be most perplexing. This is a common story and usually means that a weak or overloaded area of the body has finally “given way” resulting in inflammation and pain.

How can Osteopathy help?

The Osteopathic approach is to treat the lower back problem as part of a larger picture of how the rest of the body is functioning. Once the Osteopath has eliminated the need to investigate more serious causes of back pain, an examination of the body in both its local and remote parts is carried out to ascertain why a particular area is causing problems at this particular time. The Osteopath utilises information about posture, work, lifestyle, past injuries and accidents and how the body moves and functions to ascertain where the problem is coming from. Often areas remote from the site of pain can be major factors which have lead to the symptomatic area being painful. Osteopaths use multiple “techniques” and approaches to deal with lower back pain depending on the presentation and cause of the condition. A number of scientific studies have shown the effectiveness of Osteopathic treatment.

Chronic lower back pain:

Chronic lower back pain is defined as pain that has been present for 3 months or longer. Often it presents as a more long term relapsing condition with good days and bad days. It can involve a number of factors and can become quite complex. To treat chronic lower back as if it is just a longer acute episode can lead to poor results. Often complex changes involving muscle weakness and co-ordination, joint restriction, pain processing procedures and cognitive factors all coalesce to form a syndrome which will not be resolved with simple prescriptions and exercises.

The osteopathic management of chronic lower back pain differs from that of acute lower back pain often using a range of techniques which will vary from session to session depending on the needs of the client. Osteopaths often also work in conjunction with other medical and allied health professionals such as podiatrists or exercise physiologists when needed.

A word on disc problems:

While disc problems are one of the better known causes of back pain they account for only a small percentage of those presenting with lower back pain. The disc itself is the shock absorbing structure between the bony vertebrae. Inside the disc is a small ball like structure with a consistency like hard jelly that helps the disc to distribute force. If this ball like structure causes the disc to deform it is called a bulge. If the casing of the disc ruptures and the jelly like material moves outside the disc this is termed either a disc prolapse; disc herniation or “slipped” disc. These terms all mean approximately the same thing. If the disc presses on a nerve in the lower back then this may cause pain radiating down the leg.

In many cases the disc bulge diagnosis is not that helpful because many people have disc bulges but have no back pain. In other words a diagnosis of a “disc bulge” is only half the story. In a small percentage of cases disc prolapse’s may require surgery mainly because of pain or the presence of neurological problems. Just because a diagnosis of disc disease has been made does not necessarily preclude Osteopathic treatment. Osteopaths have for many years treated disc related back disorders. The Osteopathic approach aims to remove the load/strain off the disc area, rehabilitate the patient to help the disc repair and provide advice and education.

Some Myths about lower back pain:

Myth #1: Someone can put my back disc back in

No one can return a disc to its normal place. It’s like trying to get toothpaste back into a tube. This myth was perpetuated by patients that had been misdiagnosed with a disc problem when in fact they had a joint problem, which is much easier to treat. Once the need for surgery has been eliminated Treatment that is effective and long lasting involves a 3 stage process of managing the initial pain through manual therapy and if needed pain medication then improving the biomechanics of the area to take load off the affected site and then exercise to improve core strength and general muscular coordination and flexibility.

Myth #2: – I have to keep still to let it heal.

In the past people had been advised to rest until the pain eases. It is now known that this is wrong. The evidence from research shows that you are likely to recover more quickly by getting moving again. In the initial stages of lower back pain movement will be limited but keeping still for prolonged periods i.e. longer than 48 hours can lengthen recovery time.

Myth #3: My back is “out” I need someone to put it back in.

Vertebra don’t go out of position if they did you would be paralysed. The purpose of spinal manipulation is to restore mobility to restricted spinal segments. This reduces muscle spasm and returns ease of movement. However this is only part of an overall Osteopathic management programme. Unless therapy to muscles and exercise are included any benefit from joint manipulation on its own will be temporary. Osteopaths utilise a range of techniques and will be able to ascertain whether manipulation is suitable is your particular case. While many people equate manipulation with the popping sound Osteopaths utilise a number of gentle non-force techniques to use when stronger manipulation is not indicated or preferred.

Myth #4: My back scans don’t show anything so I can’t get my back treated because no one knows the cause.

Scans are useful for excluding conditions like arthritis, cancer, disc pathology, fractures etc. Scans like MRI’s CT’s and X-Rays only image the structure of the back not how it functions. It’s a bit like a car which is out of tune, you can take a picture of the engine which will look normal yet the engine won’t work properly once it’s started. Osteopaths will utilise scans to exclude serious conditions where indicated and then use motion testing of joints and muscles to detect abnormalities in the back that won’t show up on scans.

Research Links:

Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomised controlled trials.

A randomized controlled trial of Osteopathic manipulative treatment for acute low back pain in active duty military personnel.

Osteopathic manipulative treatment for non specific low back pain: a systematic review and meta-analysis.