How Osteopathy Can Treat Your Back Pain: A Complete Guide
When searching for the best treatment for back pain, more and more Australians are turning to Osteopathy. Osteopathy is the fastest growing branch of allied health in Australia and is rapidly becoming recognised as one of the most effective treatments for back pain.
In this guide we will explain:
- Why back pain is such a problem
- How mainstream medicine has failed sufferers of back pain
- Why Osteopathy works so well for back pain treatment and prevention
- Insider tips and tricks to relieve back pain once you have it
- Tips to prevent back pain
WHY IS BACK PAIN SUCH A PROBLEM TODAY?
BACK PAIN – THE WORLD’S NO.1 CAUSE OF DISABILITY
More than 3.7 million Australians experience back pain on any given day. Besides colds and the flu, it is the most common reason for GP consultations and causes more lost days from work than anything else.
For some people, the old saying “once a bad back, always a bad back” rings true. Occasionally lower back pain sufferers never fully recover. They continue to suffer from repeated episodes year after year, and it often gets worse as they get older (i.e more severe pain and frequent attacks).
When it comes to back pain, people complain about various symptoms, ranging from mild pain and stiffness to severe unrelenting pain. For some, the nerves may be irritated and pinched, causing numbness in the legs, while for others it feels like pins and needles, or they may lose control of certain muscles.
Unfortunately, severe back pain can come on without warning. You can be good as gold one minute and then with a simple movement such as bending down to pick something up – bang – your back goes. Often though there are some warning signs that your back is about to play up; feelings of stiffness, tightness or restricted movement can be present in the days weeks or months leading up to a sudden attack of back pain. We are pretty good at ignoring the subtle symptoms that are the body’s early warning signs that something is not right.
Along with the pain, people often have their movement affected. Bending and twisting become more restricted, and sometimes when the pain is severe, any movement at all is difficult. This can be quite scary for someone that just yesterday was feeling pretty good. Amany people report that after a sudden attack of back pain but they feel like they’re 90 and everything becomes 100 times more difficult such as getting up and down out of her chair going to the bathroom walking doing the dishes at the sink. The good news is that often this pain settles down relatively quickly within 7 to 10 days. Most people would take some simple over the counter anti-inflammatories or painkillers.
Some people go on to make a full recovery however other people may be faced with recurring back pain that comes on every few months. So although the savior aspect of pain and disability disappears often the problem doesn’t go away 100% and is working in the background waiting to pop up again.
CAUSES OF BACK PAIN
For the vast majority, it is the result of a strain in the array of bones, discs, ligaments and muscles that make up the spine.
The most common causes of back pain are:
- Muscle strain
- Ligament or joint sprain
- Disc injuries
- Inflammatory arthritis
- Nerve root impingement
There are many theories about why the lower back is particularly susceptible to injury. Poor posture (slouching), not enough activity (sedentary office work) , too much activity (too many sit ups is a classic one we see), “runs in the family”, misalignment of hips, pelvis or feet… the list goes on. The fact is, there is no “one cause” of lower back pain. The series of things that has caused your back pain will be different to someone else’s. Sometimes it’s a trauma (fall, car accident, etc.), sometimes there is no obvious cause – it just started one day and got progressively worse.
There is a list of general things that can contribute to lower back pain:
Sitting for too long
Repetitive bending and lifting
Lack of exercise
Past falls and injuries
Family history or back pain injuries
Fear, anxiety, stress and depression are also linked
Weakness or stiffness in another area of the body that puts more stress on the lower back during movement
THESE THINGS CAN HELP PREVENT BACK PAIN:
You may be able to avoid back pain, or even prevent its recurrence by improving your physical condition, and learning and practising proper body mechanics.
To keep your back healthy and strong:
Exercise. Regular exercise can increase strength and endurance in your back and allow your muscles to function better. Walking, swimming, yoga and pilates are good choices.
Build muscle strength and flexibility. General muscles strength and flexibility work will help your muscles to protect your spine. Flexibility in your hips and upper legs aligns your pelvic bones to improve how your back feels.
Maintain a healthy weight. Being overweight strains back muscles. If you’re overweight, trimming down can prevent back pain.
Use proper body mechanics:
Stand smart. Maintain a neutral pelvic position. Good posture can reduce the stress on back muscles. Break up periods of standing with walking and sitting if you can.
Sit smart. Choose a seat with good lower back support, armrests and a swivel base. Consider placing a pillow or rolled towel in the small of your back to maintain its normal curve. Keep your knees and hips level. Change your position frequently, at least every half-hour.
Lift smart. Avoid heavy lifting, if possible, but if you must lift something heavy, let your legs do the work. Keep your back straight — no twisting — and bend only at the knees. Hold the load close to your body. Find a lifting partner if the object is heavy or awkward.
CAN BACK PAIN MEAN THERE IS SOMETHING SERIOUS GOING ON?
As primary health-care practitioners, osteopaths are trained to differentiate between back pain from a common cause (i.e. joint sprain) and back pain that is due to a more serious pathology (such as infection, fracture or a tumour), and refer when required.
Back pain can also be due to a viscerosomatic referral. Examples of this kind of back pain include; back pain during your period or pain in your right shoulder with associated irritation to your gallbladder. A thorough case history and osteopathic examination will enable your osteopath to differentiate between back pain with a musculoskeletal origin or a visceral referral.
WHEN TO SEE A MEDICAL DOCTOR:
Most back pain gradually improves with home treatment and self-care, usually within two weeks. If not, see your doctor.
In rare cases, back pain can signal a serious medical problem. Seek immediate care if your back pain:
Causes new bowel or bladder problems such as difficulty stopping or starting urination
Is accompanied by fever
Follows a fall, blow to your back or other injuries
Severe pain at night
Contact a doctor if your back pain:
Is severe and doesn’t improve with rest
Spreads down one or both legs, especially if the pain extends below the knee
Causes weakness, numbness or tingling in one or both legs
Is accompanied by unexplained weight loss
Also, see your doctor if you start having back pain for the first time after age 50, or if you have a history of cancer, osteoporosis, steroid use, or drug or alcohol abuse.
HOW MAINSTREAM MEDICINE HAS FAILED BACK PAIN SUFFERERS
As technology has advanced, we have put more and more emphasis on what we can see and do with this technology. Take MRI scans for example. Before we had these, we could only see the bones with an x-ray. But as MRI’s developed we could see the discs that sit in between bones. So, those with back pain started to get MRI’s for a better idea of the problem. When they saw something they thought was abnormal (such as a disc bulge), they automatically linked the disc bulge to the person’s pain. This makes sense that this would happen – a normal disc does not bulge. Or so we thought…
Pic of normal discs vs bulging
30 years later. We know that healthy people with no back pain can have disc bulges. There is no link or evidence that disc bulges cause back pain in every person. In fact, if you are over 30 there is a good chance that you have at least one or two disc bulges in your spine and no pain.
Unfortunately, for 30 years, advanced imaging from the MRI actually distracted us from the true cause of back pain, and thousands of people had useless and unnecessary surgery because of it. Research has now shown that the outcomes of surgery for lower back pain are no better than having no surgery at all.
When we have pain, we want it gone as quickly as possible, we want relief. Medication can be a fast and effective way to relieve pain in the short term. Unfortunately for many people, the use of medication to control their pain became the only treatment that they were getting. In some cases, their addiction led to more serious consequences and actually made their back pain worse. This is one of the reasons that we have seen codeine removed from over the counter sales here in Australia. In short, painkillers are very useful when you have back pain and take them in for a very short period of time (2-3 days). If you perceive that your back pain is bad enough to take time off work, take medication (besides simple analgesics or anti-inflammatories such as panadol/paracetamol/ibuprofen), and see a back pain expert for an assessment and advice on treatment.
RELYING ON A GENERALIST VS A BACK PAIN EXPERT
Doctors are wonderful, and their job is incredibly difficult. But, they are general practitioners, not back pain experts. If a patient perceives their back pain to be severe enough to visit their GP, the GP should refer the patient to an allied health practitioner, such as a physiotherapist, osteopath or chiropractor for an accurate diagnosis, advice and follow up. We see so many patients who have seen a GP for a mild to moderate back injury. Often, they had no follow up beyond the initial consult with the GP and their back problem plagued them for months. All they needed was simple advice and treatment beyond the very acute and painful stage. This is no attack on GP’s, but perhaps the patients get lost in the system, or the patients themselves fail to make a follow-up appointment because the severe pain that they were in at the start has lessened, but the problem has not fully resolved.
What’s important is for people to get an early diagnosis to find out what is wrong and how best to manage it:
Effective treatment to reduce pain and restore mobility
Advice on simple pain relief
Self-management advice to get you better faster and prevent re-occurrences
This approach can mean the difference between a quickly resolving episode of back pain or the development of a more chronic back pain condition.
Additionally, each individual’s recovery from back pain is going to be different. Some cases of extreme pain get better in 2 days and others with moderate pain can take months.
WHY OSTEOPATHY WORKS SO WELL FOR BACK PAIN
History Of Osteopathy
In 1874, Andrew Taylor Still MD DO (1828-1917), a medical doctor, discovered that optimal health is possible only when all of the tissues and cells of the body function together in harmonious motion. He reasoned that disease could have its origins in slight anatomical deviation from normal. He then proved he could restore health by treating the body with his hands.
He understood that the human body is composed of many parts, all intimately related as a functional and holistic whole. He not only understood that but also that this holistic whole is more than just a physical body. He envisioned a totally new medical system, that acknowledges the relationships of the body, mind, emotions and spirit.
Today, more and more evidence is emerging of the importance of looking at the body as a whole. Scientists have found that gut bacteria can affect your mood and brain function, and your thoughts and emotions. This works both ways, as fear and anxiety can affect how your back functions.
As a practising physician, Dr Still diligently researched and developed osteopathy. He developed a very practical way of treating people using just his hands. Today, osteopaths continue to use their hands to treat their patients in this same tradition.
Osteopathy recognises that the body has an amazing ability to heal. Do you ever wonder why some people recover so much faster than others when they have a similar injury? Some people with back pain get better in 2-7 days, others still have pain after 2 years. The body can heal itself. It just sometimes get stuck and doesn’t know quite what to do. Osteopaths unlock that barrier and allow the body to heal and recover from pain and injury.
Osteopathy has been practised in Australia for over 100 years and has been taught in universities since the early 1980’s. Now, osteopathy has grown as a recognised allied health, with a combination of traditional methods and modern scientific philosophies. Doctors and specialists alike are referring patients to osteopaths for the treatment of back pain.
Osteopathic training in Australia is a 5-year program with major studies in anatomy, physiology, pathology, research methods, and osteopathic philosophy and technique. There are similarities with other manual therapies, such as chiropractic and manipulative physiotherapy, but the differences in underlying philosophy, approach to diagnosis and treatment based on the above principles.
RESEARCH AND OSTEOPATHY
There is growing evidence in support for treatment of lower back pain.
A number of comprehensive studies have found that osteopathy was:
more effective than placebo for chronic LBP interventions,
more effective than usual medical care for acute LBP, and
helpful for LBP in pregnant women.4
One of the major benefits of osteopathy treatment is the wide selection of treatment techniques that are available.
As you know, we all come in different shapes and sizes. The same goes for our experience of back pain, it can come in a variety of intensities, locations, and sensations. So, treating all cases of back pain in the same way, such as only with manipulation, is not going to be the most effective means to help you. With the wide range of technique now recognised and available, there are options to suit everyone. These range from very gentle techniques that are suitable for the very young or elderly, to stronger and more direct techniques, such as deep soft tissue massage and manipulation, which are more beneficial for the athletic population. Of course, the treatment selected will depend on the patient’s diagnosis age, overall fitness and what’s appropriate for their specific condition. Osteopaths are also very adept at exercise rehabilitation for back pain, and this is especially important when people have had back pain for more than 6 weeks. Osteopaths will advise on the right posture, stretching, and other activities that can help relieve pain but also help with an effective rehabilitation and prevention program.
Osteopathy provides a holistic treatment for back pain, using diverse techniques to relieve pain and treat a variety of problems. These techniques include:
Massage – achieved by freeing restrictions within joints and muscles, massage addresses the whole body so to restore its vitality. The osteopath also uses traction, where your head, feet, and hands are slightly lifted and pulled to relieve stress.
Spinal manipulation – used to help restore movement to a joint or threat asymmetry in a facet joint.
Muscle energy technique – with this technique, the patient uses his or her muscles in a specific direction and from a precise position against a counterforce applied by the osteopath.
Counterstrain technique – this technique implies the patient being moved away from a position where movement is restricted to one of greater comfort.
Osteopathic medicine provides drug-free non-invasive manual treatment that focuses on strengthening the musculoskeletal frameworks to:
Increase or restore joint mobility;
Relieve muscle tension;
Reduce pain and stiffness in muscles and joints;
Improve blood flow;
Enhance tissue elasticity.
OSTEOPATHIC MEDICINE AND BACK PAIN
Types of back pain that osteopathy can help with
Simple muscle strain or muscle spasm
Dull, achy lower back pain. Strained muscles usually feel sore, tight, or achy. lower back strain typically worsens with specific movements that activate the affected muscles. Pain is usually concentrated in the lower back. It may also be felt in the buttocks and/or hips, as these muscles help support the lower back. Typical movements may be limited when a lower back muscle is strained, making it difficult to bend, shift positions, or walk or stand for extended periods. A muscle strain may become inflamed and feel tender to the touch. Briefly resting the lower back muscles allows them to relax, alleviating tension and spasms.
Osteopathy uses a combination of techniques to help settle muscles that have been strained or are is spasm such as massage, MET, Inhibition, counterstrain, PNF stretching and dry needling
A sprain to the joint of the lower back (commonly called Facet Joint sprain) is very common and is often caused by sustained poor posture, lifting something heavy or repeatedly, or by trauma such as a fall or knock.
A back facet joint injury will cause lower back pain and potentially pain referred to your buttock or thigh.
When a facet joint is sprained and becomes stiff or “locks”, you may not be able to move in the direction away from where it’s locked. For example, if the joint is locked in a bending forward position, you will probably have difficulty arching backwards. In acute phases, muscle spasm will attempt to protect the injured facet joint.
Often a facet joint sprain and muscle spasm will occur together.
The osteopathic treatment of this is a combination of techniques addressing the joint stiffness, such as manipulation, or mobilisation, or Muscle energy techniques.
Disc Injuries ( bulges, strains, prolapses, slipped disc)
Although these injuries do occur, they are a much less common cause of pain than a muscle spasm or joint sprain.
The disc is the little cushion or shock absorber that sits between your vertebrae. Over time through repetitive strain or overuse, the disc can start to bulge a little. This is often what is seen on MRI’s and is not always the cause of your pain.
For some people, there is a clear link between their disc bulge and their back pain. This can only be ascertained by completing a full assessment of the individual by a back expert along with their MRI. Just because you have a disc bulge doesn’t mean that bulge is causing your pain. It may be coming from a simple muscle spasm or facet sprain.
If it is a disc bulge you will have similar symptoms as a muscle spasm or joint sprain with or without pain going into your legs. Pain will go into your legs if the disc bulge is pressing on a nerve in your spine. Sometimes you get leg pain, other times pins and needles or altered sensation or a lack of strength in the muscles of your leg.
Osteopathic Treatment for a disc injury will be dependant on how severe you are when you first present to the osteopath. If you are in acute pain, the treatment will be gentle to encourage the body to start healing. It will emphasise encouraging normal alignment of the hips, pelvis and spine, and to increase blood flow. Specific exercises which will relieve the pressure on the disc will be given. Typically these are backwards bending exercises, but again it will depend on how severe the pain is and how limited your movements are.
OSTEOPATHIC EXAMINATION OF LOWER BACK PAIN
The aim of the osteopath is to relieve or reduce the pain and to help you get back to normal or improved movement and function.
The osteopath will take a detailed case history to understand if there has been any previous injury, repetitive strain, surgery, illness or emotional stress that can have an impact on the biomechanics of the spine, pelvis and hips.
Initial osteopathic consultations are up to 60 minutes in duration. The consultation includes obtaining a case history and other relevant medical and health information,9 assessment of red flags 10 and gaining patient consent for treatment. If a red flag is identified, patients are immediately referred to their GP for assessment, and in more urgent cases (eg. cauda equina syndrome) referred directly to hospital emergency units. The patient completes a self-report pain questionnaire (eg. visual analogue pain scale) and assessment of changes in activities of daily living (ADLs) to assess pain and functional disability.
The information provided in this case scenario suggests differential diagnoses of lumbar facet joint sprain, lumbar disc pathology or sacroiliac joint (SIJ) sprain. The osteopathic physical examination is informed by the case history and aims to support or exclude differential diagnoses.
Physical examination for the case presented.
A physical examination would include the following:
observation of standing posture
active and passive range of motion of lumbopelvic, hip and thoracic regions
occupation and ADL-oriented functional movement testing
assessment of lumbar and thoracic segmental mobility and tenderness
palpation of lumbar spine, abdomen and hip soft tissues
orthopaedic tests, including straight leg raise, active straight leg raise test and SIJ pain provocation tests.
Osteopaths take a whole body, or holistic approach, so they also look at other regions of the body and determine whether they are impacting on the spinal dysfunction. This usually involves examining how the pelvis is working with the spine ( i.e. your hips and tailbone), how the leg is working with your spine, and even how your upper body is contributing to the movement in your spine.
OSTEOPATHIC TREATMENT OF LOWER BACK PAIN
Research shows that osteopathic treatment for lower back pain is effective. All of our osteopaths at Premier Sports and Spinal Medicine have many, many years of clinical experience in treating and managing lower back pain.
If you are in severe pain, osteopaths tend to use very gentle techniques to improve movement, reduce pain, and calm the nervous system – which is propagating the pain signals.
As back pain is the main reason that people present to osteopaths, they generally have seen thousands of cases of back pain, from severe 10/10 pain to mild muscle strain. Osteopaths will assess the presentation and apply the most appropriate treatment technique to provide the best result.
As the pain lessens and your mobility improves, different techniques may be used to further improve the response and outcomes. This may include rehabilitation for prevention of further episodes.
MANAGING LOWER BACK PAIN
In conjunction with osteopathic treatment, the osteopath may recommend some things that can be done to help manage pain. This may include rest, heat packs, gentle exercise and stretching, supplements and improved postural changes to reduce repetitive strain e.g. how someone might sit at work.
WHY CHOOSE AN OSTEOPATH
Osteopaths look at spinal or lower back pain issues differently to other manual therapists. They look at spinal pain in conjunction with a holistic approach to the body. By looking at how the spine is being influenced biomechanically from other body regions, the osteopath may be able to reduce pain and improve mobility more efficiently. Osteopaths can treat acute lower back pain or chronic lower back pain, which make up the vast majority of osteopathy treatments.
Today’s osteopaths incorporate rehabilitation exercises, which used to be the domain of physiotherapists. Osteopaths understand that although traditional osteopathy treatment using their hands can be incredibly effective in the early stages of back pain, it will not help to make your back stronger and more resilient. This can only be done through rehabilitation exercises.
The best outcomes are achieved by osteopaths who incorporate rehabilitation exercises with hands-on treatment.