Lower back pain is one of the leading causes of disability in the world. As Osteopathic Therapists, we are well versed in diagnosing and treating lower back pain. Research has shown that Osteopathic treatment can improve pain and function in people with chronic lower back pain.
The vast majority of lower back pain cases are due to non sinister problems with the joints, ligaments, nerves and muscles of the lower back, interacting with things such as stress, sleep, diet and our pain processing systems. However, as Osteopathic Therapists our first job is to make sure that we screen our patients for what we refer to as “red flags”. Red flags are things such as cancers, rheumatological and autoimmune conditions that could be causing lower back pain and would lead us to referring our patients to be investigated by other health care professionals.
Osteopathic diagnosis considers the whole person. What does this mean for lower back pain? We will assess, diagnose and treat the lower back specifically, but with a consideration to a range of factors such as;
- Biomechanics: we will consider if for example, upper back, hip or ankle stiffness is causing you to over use your lower back.
- Physiological: whether poor sleep, poor nutrition or too much of a specific exercise is creating a situation where your lower back cannot recover.
- Psychological: whether stress, anxiety and false believes such as “my spine is out of place” or fear of movement (thinking that movement will lead to further damage of your spine) are contributing to the pain symptoms.
Osteopathic treatment typically involves a wide range of manual therapy techniques that are designed to restore joint mobility and soft tissue flexibility, and will typically involve the site of pain and sometimes areas further from the pain such as the ankle or neck.
One thing that is very relevant in lower back pain, is that spines are a lot stronger than you think. Research has clearly demonstrated that back pain is not due to something being out of place and has identified that chronic lower back pain is rarely due to one thing and is often multifactorial and influenced by a vast range of biological, psychological and sociological factors.
How can back pain be influenced by psychological and sociological factors? When back pain is chronic we now have a lot of research to show that the level of pain we experience is rarely related to the level of tissue damage. We now understand pain to be generated by the brain as a mechanism to protect us, in comparison to our historic understanding of pain where we thought that the level of pain correlated to the level of tissue damage. This is why research has shown that if you believe your back is “out of place”, you will experience more pain with movement, your body will produce more pain to stop you moving to protect itself, or if you’re super stressed you’re likely to experience more pain. Most people seem to appreciate this when it comes to headaches; they understand that fatigue, poor diet, lack of water, stress and worry can lead to a headache or pain, it’s the same in chronic lower back pain.
What fascinates me is that early Osteopathic researchers had started to consider the psychological and sociological factors, and understood that descending information (brain downwards) had the ability to intensify or cause pain, here is a quote from a paper published in 1947: “This does not mean, of course, that every osteopathic physician should become a psychiatrist, but he certainly must take into consideration the home factors, family relations, emotional adjustments, tensions, etc.” (Korr, 1947).
However, in some cases the biggest driver and cause of lower back pain can be biological factors e.g a recent traumatic injury, biomechanics, daily movement habits, the way you’re exercising or a finding from an x-ray or MRI. But to highlight how our levels of “tissue damage” and structure does not always relate to pain, table 2 from a large study that included 3,110 CT and MRI results. These are results from people who do not have any pain (1). As you can see, as we age our spines demonstrate more imaging findings even in the absence of pain. We consider these “wrinkles on the inside” and a normal part of the ageing process.
As an Osteopathic Therapist, we use our manual therapy skills to restore mobility and teach the body that it can move in a pain free way. We also search and investigate other areas in your life that may be contributing to the level of pain you’re experiencing or might be a blocking factor to your recovery.
Early diagnosis and treatment can aid recovery and get you back to normal activities quickly. Back pain is rarely due to any serious disease, and the long-term outlook is typically good but in some people it can lead to long term disability.
Tips for managing lower back pain:
- Our backs require movement to be healthy. If you’re unsure take advice from a professional to learn where to start and how to progress with exercise.
- Keeping active can help with most back pain, prolonged bed rest is very rarely the answer and typically delays recovery.
- Try to trust that it will get better, just think how quickly broken bones, muscle tears and cuts heal, the same principles apply to the spine.
- Understand that just like a headache, you may experience more pain when your are tired, stressed or have been eating unhealthy. The pain is not alway related to the level of tissue damage.
- Trust that the joints of your spine are robust and do not slip of place or out of alignment, changes in posture associated with a new episode of back pain are usually your bodies attempt to move away from irritated tissue and muscle spams.
References:
1. Brinjikji, W., Luetmer, P.H., Comstock, B., Bresnahan, B.W., Chen, L.E., Deyo, R.A., Halabi, S., Turner, J.A., Avins, A.L., James, K. and Wald, J.T., 2015. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American journal of neuroradiology, 36(4), pp.811-816. [Online]. Available at: http://www.ajnr.org/content/ajnr/36/4/811.full.pdf
Dal Farra et al., (2021) ‘Effectiveness of osteopathic interventions in chronic non-specific low back pain: A systematic review and meta-analysis’, Complementary Therapies in Medicine, 56, p.102616. [Online]. Available at: https://doi.org/10.1016/j.ctim.2020.102616
Hartvigsen, J., Hancock, M.J., Kongsted, A., Louw, Q., Ferreira, M.L., Genevay, S., Hoy, D., Karppinen, J., Pransky, G., Sieper, J. and Smeets, R.J., 2018. What low back pain is and why we need to pay attention. The Lancet, 391(10137), pp.2356-2367. [Online] Available at: https://doi.org/10.1016/S0140-6736(18)30480-X
IM, K., 1947. The neural basis of the osteopathic lesion. The Journal of the American Osteopathic Association, 47(4), pp.191-198. [Online]. Available at: https://www.jiscs.it/corsi/pluginAppObj/pluginAppObj_244_36/Irvin-Korr-The-Neural-Basis-of-the-Osteopathic-Lesion_eng.pdf
