Back pain is common…really common. In the UK, the National Institute for Health and Care Excellence (NICE) estimates that LBP affects about a quarter of us each year costing the UK over £12 billion annually. With lots of bad advice and claims of instant fixes, lets clear a few things up:
Q. What’s the best treatment for back pain?
For back pain (with or without sciatica- read more about sciatica here) conservative treatment options are varied and range from rehabilitative exercise, acupuncture, anti-inflammatory/pain relieving medication, and manual therapy/spinal manipulation (e.g. by an osteopath). More medically invasive treatments include injections of pain relieving/anti-inflammatory medication in and around the spinal structures, and finally in a minority of cases surgery may be an option. Research shows that all of these different treatments can be somewhat effective at relieving pain and restoring function in specific case, but its difficult to generalise as individual people respond differently. Hence, there isn’t a ‘one size fits all’ approach to treating back pain and research suggests that a combination of different treatments appears to be most effective. However, in the vast majority of cases, back pain and sciatica can be treated successfully with conservative approaches.
Q. Can I exercise with back pain?
A resounding yes. It’s now accepted by all healthcare professionals, that exercise should be a core part of any effective treatment plan for back pain and sciatica. Research shows that exercise is vastly more effective than other stand-alone conservative treatments (e.g. using manual therapy, acupuncture and medication alone). As a result, the most recent NICE guidelines for back pain and sciatica recommend combining exercise with manual therapy as a ‘multi-modal’ treatment package.
Q. Is it dangerous to exercise with back pain?
No. When exercising with non-specific back pain/sciatica, movements might feel sore and stiff at first, but this doesn’t mean that you’re damaging or harming your back. Over time the pain will ease and relaxed movement will help your pain settle, and with continued exercise, movement will become effortless and more confident. Avoiding movement and exercise is shown to delay recovery of back pain in the long term.
Q. What type of exercise is best for back pain?
Research is also showing that the specific type of exercise doesn’t seem to matter; but rather any dedicated exercise is beneficial. So, whether you go to the gym, play tennis, play golf, swim or do yoga- it’s engaging the body (and mind) in movement and activity that’s important rather than the specific exercise itself. If you can choose and exercise that you enjoy, then that’s even better. With that said, beliefs and fears about back pain influence recovery; therefore the beliefs and language underpinning a particular approach to exercise are also likely to influence it’s overall effectiveness. For example, an exercise approach which ‘believes’ it is stabilising/coordinating/strengthening a damaged, weak, fragile and vulnerable spine is likely to be less effective compared to exercise which emphasises the inherent strength of the spine and looks to enhance resilience, reduce sensitivity and promote free and confident movement.
Q. But I think I have a ‘weak core’. What about ‘core stability’ exercises?
The theory of weak ‘core muscles’ as a possible cause for back pain is not supported by research. If anything, people experiencing back pain appear to exhibit spinal and trunk muscles which are excessively active and co-contracted. This results in more cautious, slower and less-efficient movement during day-to-day tasks such as bending and lifting. Therefore, adding ‘core stability’ exercises to such a maladaptive ‘contracted’ movement pattern makes little sense, and may actually perpetuate back pain by overloading pain sensitive structures in the back. Furthermore, research studies do not show specific motor control exercises (e.g. core stability training) be more superior than other more general forms of exercise for treating back pain. The research concludes that the choice of exercise for back pain should probably depend on patient and therapist preferences.
Q. How can osteopathy help my back pain?
Spinal manipulation and manual therapy combined with exercise and appropriate advice and reassurance is recommended by NICE for the management of back pain and sciatica. Like any good health professional, performing a thorough clinical assessment of your clinical symptoms and exploring with you the other factors which have been shown to effect the recovery or back pain (e.g. pain-related fear/beliefs, anxiety, stress/emotions and expectations), I can provide you with a diagnosis and discuss with you the possible treatment options or whether referral to a specialist is necessary (note, x-rays and MRi scan are rarely needed in most cases of back pain and sciatica- read more here). For most cases of back pain/sciatica, the aim of osteopathy treatment is to ‘settle down’ the acute pain and encourage normal movement of the body using manual therapy techniques, such as soft tissue stretching and manipulation of joints. I will also help you learn positive ways to think about your back pain and advise you on exercises and self-management strategies, so that you’re able to move confidently and painlessly as quickly as possible. This approach is shown to be the most effective method of treating most cases of back pain and sciatica.
Q. How can you help me?
I don’t have any magical spinal manipulation techniques, nor do I have any Jedi powers to provide an instant ‘fix’. However, I do have extensive experience in helping people with back pain and sciatica, using an honest evidence-based approach. Back pain and sciatica can be a highly distressing and disabling experience, and using the best available research I will support you throughout, and provide treatment to help relieve pain and advise you on exercise for longer term management. Musculoskeletal pain can be complex and challenging to treat effectively, and it often involves a range of factors (beyond ‘bad’ posture, stiffness and ‘slipped discs- read more here); therefore simple ‘magic bullet’ treatments don’t exist. Research into the most effective way of treating back pain and sciatica is ongoing, however I’ve created some ‘top tips’ based on the current evidence here.
If you’re experiencing back pain, sciatica or another musculoskeletal problem, osteopath Dr Oliver Thomson can provide effective evidence-based treatment and advice to relieve your pain as quickly as possible. To book an appointment click here.