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Manual Therapy
Back Pain
Musculoskeletal Problems
Your First Treatment

Pain Relief

The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with the actual and potential tissue damage, as described in terms of such damage”. Pain is an early warning system to alert us when something is not right in our body. It can be chronic, when the pain lasts more than 3 months, or acute, when the pain comes and goes quickly. When pain becomes a chronic problem, it can have repercussions upon our mental wellbeing. It can lead to depression, anxiety, anger and frustration, which in turn can alter the perception of the pain as being worse than it is. There are many different causes of pain. It can result from an injury or a causative factor, such as an infection. There may be an on-going cause, or it may be as a result of an injury. Sometimes there is no obvious reason.

Person clutching their back Chronic pain can be anywhere on a spectrum from mild to severe, continuous to intermittent. The pain can be felt as a burning, aching, shooting, discomfort, soreness or tightness. It may be linked to other conditions such as a lack of sleep, a restriction on what you are able to do, a weakened immune system and negative moods. When pain is chronic, the pain receptors become activated too easily. There is a change in the neuron pathways and abnormal regrowth after a nerve injury. As pain has an effect on both a psychological and physical level, both aspects need to be addressed. Person sat holding their head in their hands

Different therapies address the treatment of pain in different ways. A physiotherapist can help with chronic pain. They use their hands to put pressure on muscle tissue, and manipulate joints. The pressure helps the muscles to relax, encourages circulation to the area, and helps to break up scar tissue. If a muscle is tense, the joint is unable to work as well. Once joint mobility is restored, muscle spasm can still continue. Soft tissue mobilisation breaks up the muscle tissue (adhesions), encourages the movement of fluids and relaxes the tension in the muscles. A treatment would include stretching and deep pressure, with the problem area concentrated on. There are many different techniques which are used, e.g. traction or strain and counter strain. A course of therapy for the treatment of pain would include lifestyle advice. An exercise programme may be given to be worked on at home. The physiotherapist may use a TENS machine (Transcutaneous electrical nerve stimulation). This is a battery operated device which delivers an electrical current to the painful area, to override the pain signal. Alternatively, ultrasound may be used to target a soft tissue injury with high frequency sound waves. This would stimulate circulation and decrease pain.

Physio and client talking

A chiropractic treatment would involve using spinal manipulation, manual manipulation and thrusts to abnormal vertebra to increase function and decrease pain. The mobilising of a joint involves increasing the movement range by a process of gradually easing and stretching it (and any associated muscles), in a way we are unable to do ourselves. The technique of high velocity low amplitude thrusting allows joints to open and close properly in order to increase mobility and decrease muscle tone around the joint. A study conducted in 2011 demonstrated in a group of chronic lower back pain sufferers that long term outcome was enhanced by them obtaining spinal manipulation after the initial intensive manual therapy.1 diagram showing the spinal vertebra

NICE (National Institute for Health and Care Excellence) have recommended osteopathy for the treatment of low back pain. Treatment can help prevent back pain becoming a chronic long term condition. They also treat many other conditions which give rise to pain, such as headaches, migraines, painful periods, Irritable bowel syndrome, depression and colic in babies. An osteopath detects, treats and prevents health problems by moving, stretching and massaging joints and muscles. The belief is that the body is able to heal itself. Osteo treating a patient

Podiatrists are involved in treating any issues connected to the feet and lower limbs, including any resultant pain issues. They would assess the problem and decide upon a treatment plan to deal with the underlying cause of the pain as well as the obvious symptoms. Among the tools used are stretching exercises, deep heat therapy and steroid injections, as well as the use of padding, insoles, orthotics and strapping. The aim is to decrease pain and discomfort, and increase stability and mobility.

Photo of feet

Acupuncture is part of Traditional Chinese Medicine, and is used to treat many conditions, particularly pain arising from musculoskeletal conditions. Pain is a symptom that the body is out of balance. Treatment is necessary to restore the equilibrium. NICE have recommended it as a treatment for migraines, headaches and back pain. After a consultation, the practitioner would insert fine flexible needles at specific points of the body. The aim is to treat both the root (the cause) of the pain and the branch (the symptom of pain). Treatment involves you relaxing for 20-30 minutes with the needles in situ. Acupuncture has shown to be more effective than a placebo in the treatment of chronic pain.2

Photo of patient relaxing with needles in place

Wherever or whatever type of pain you are experiencing, you will be examined holistically and your treatment plan tailored to your individual needs. Whatever combination of therapies is required to lessen your pain and increase your mobility will be available.

References
  1. 1. Senna M et al ‘Does Maintained Spinal Manipulation Therapy for Chronic Nonspecific Low Back Pain Result in a Better Long Term Outcome?’ Spine 2011 36 (18) 1427-1437.
  2. 2. Vickers A et al ‘Acupuncture for Chronic Pain. An Individual Patient Data Meta-analysis’. Arch Intern Med 2012 172 (19) 1444-1453.

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