Our back is a complex structure, composed of bones, muscles, nerves, joints and tendons. The back can be divided into different sections, with the lower back being the most common area that individuals suffer pain. If we are overweight, a smoker, suffer from stress or depression, pregnant or on certain medications, we are more susceptible to back pain. We can experience back pain for various reasons
- We adopt bad posture. For example, the way we sit at a desk or in the driving seat.
- Incorrect lifting or carrying.
- Sprains or strains. When we overuse muscles for example we can develop a repetitive strain injury.
- A trapped nerve.
- By twisting or overstretching.
There are many complaints which affect the back and can cause pain. Most are not a symptom of a serious condition. Back pain can be classified as acute or chronic. Pain still present after 3 months is regarded as being chronic. When a slipped disc is present, there will usually be pain in the lower back, and possibly numbness, weakness tingling or pain down one leg into the foot. This is sometimes worse in intensity than the associated back pain. Sciatica is characterised by lower back pain which is also felt in the buttock, leg and foot. It is an ongoing pain, usually felt on one side of the body. It is often worse after standing or sitting still, and relieved a little during walking. Arthritis can cause pain and stiffness in joints, especially during movement. A frozen shoulder characteristically exhibits pain and stiffness in the joint. Back pain can also arise as a result of an accident. A sudden jolt can affect all the structures of the back adversely.
A chiropractor treats disorders of the musculoskeletal system and nervous system non-surgically. Their focus is upon spinal manipulation to rectify any problems. During the initial visit, the chiropractor would ask about the symptoms and how thy arose, the type of pain, its duration, any prior injuries you may have sustained and any pre-existing conditions. An examination would include taking a blood pressure reading and pulse, as well as an examination of the problem area. The aim is to discover the range of movement, muscle tone and strength and the condition of the nerves. X-rays and MRI scans may be necessary.
A diagnosis will then be made, a proposed treatment plan and the duration of the treatment established. There will be short and long term goals, aiming to reduce pain and improve and maintain back health. Treatment will include ‘adjustments’ to correct any joint dysfunction, a personalised exercise plan to help to strengthen and stretch specific areas, if required, techniques such as traction or the use of ultra-sound, to help the soft tissues to heal and pain to diminish. Advice would be given about how to have a healthy diet and lifestyle, and how to improve posture. Massage therapy may also be used. It was demonstrated that patients who had maintenance spinal manipulation after the initial intensive manipulation therapy when suffering from non-specific chronic lower back pain had an enhanced long term outcome1.
Acupuncture is recommended as a treatment for back pain by NICE (National Institute for Health and Care Excellence). It involves the insertion of fine flexible needles at specific points. Chinese medicine is based on the theory that our body contains many channels, or ‘meridians’ which connect major organs to specific points of the body. ‘Qi’, or life-force flows through the channels. When we are healthy and pain free, the qi and blood is flowing freely. When we have pain, it indicates that there is a blockage in one of the meridians, and the flow has stopped. Many factors can influence this. Pathogens such as wind, cold and damp can enter our body via our nose and mouth and travel through the body into a meridian, and cause a blockage. A weak immune system, lack of adequate sleep poor diet, illness or trauma, aging and negative emotions can all influence the quality and quality of qi in our body. In an acupuncture treatment, needles are placed at the points where the blockage is, and help to clear it. It also encourages the release of opioid peptides, which are painkilling chemicals made in the body which also affect the immune function. Similarly, endorphin release is stimulated. Acupuncture has been demonstrated to be more effective in decreasing pain than when no acupuncture has been used2.
The approach of physiotherapy is to use physical therapy to reduce pain and increase functionality. Passive physical therapy involves using things such as heat and ice to help with pain. Active physical therapy consists of exercises and stretching to aid recovery, then a maintenance programme to prevent future recurrence of the problem. The lower back needs good abdominal and stomach muscles to support it. These can be developed by a targeted exercise programme, which would include stretching, core strengthening exercises and exercises to strengthen the secondary muscles of the spine.
An osteopath would seek to detect the problem, treat and prevent recurrence by moving, stretching and massaging the affected joints and muscles. It is the belief that with help, the body can heal itself. NICE have recommended osteopathy for treating lower back pain. Osteopaths use massage, traction, HVLA (High velocity low amplitude which corrects asymmetry in the joints), counter-force techniques (when the muscle is pressed against to help it to release), and diet and lifestyle advice. Low impact exercise would be recommended, a healthy diet, and if required, a weight loss programme. Excess weight puts greater strain on muscles, joints, discs and nerves. Posture adjustments will be given, and would need to be practiced at home. If stress is a factor, relaxing activities such as meditation, yoga and warm baths may be part of the treatment plan.
Podiatrists would be looking at the feet interact with the other structures of the body. Flat feet can cause the pelvis to tilt, the spine can curve and strain put upon the lower back. Orthotics may be required to support and correct any issues and allow pain to disperse3. Advice may be given concerning appropriate footwear in order to balance the feet, and control any abnormal function.
In a consultation, an individual will be considered holistically by whichever discipline(s) are appropriate for the type of back pain they are suffering from. There are many different approaches and techniques available, and a tailored individual programme of treatment and prevention, ensures the most effective therapy is used.
- Senna, M et al ‘Does Maintained Spinal Manipulation Therapy for Chronic Nonspecific Lower Back Pain Result in Better Long-term Outcome?’ Spine 36 2011 (16) 1427-1437.
- Brinkhaus, B et al ‘Acupuncture in Patients with Chronic Lower Back Pain. A Randomized Controlled Trial’. Arch Inter Med vol 166 2006 (4) 450-457.
- Sol, N ‘When Orthotics Can Treat Low Back Pain’. Podiatry Today vol 16 2003 (155) 4.