Here at Elementary health, we are fully aware of the large number of people who suffer from lower back pain. Our work in the Cambridge clinic, working with a vast range of physical capabilities, and our athlete work in London, allows us to have very positive contact with such symptom sufferers.
In fact, lower back pain (lumbar spine pain) is currently one of the most common musculoskeletal illnesses for people to suffer from. Musculoskeletal illnesses are believed to generate some of the highest costs to society. Thus lower back pain is one of the largest costs to society!
The most commonly ‘diagnosed’ issues leading to an episode, or multiple episodes, of lower back pain, with or without ‘sciatica’ are:- spinal functional instability, end plate trauma, motor control imbalances, facet joint irritation / dysfunction / locking, discal strain / sprain, muscle strains, muscle spasms, over use syndromes, degeneration, arthritis, ‘slipped discs’, ‘sciatica’, ‘trapped nerve’, ligament sprain, inflammation, ‘lumbago’, ‘nerve root impingement’….. The list goes on!
The quality of some of these diagnosis concepts, and the actual correlation to your pain, are even more fascinating!
How this may affect people
When this doesn’t go well, it often leads to a very dissatisfying outcome. This can manifest itself as: deconditioning, disability development, depression, loss of confidence in yourself and your body, which ultimately often leads to a dependency on pain altering medications, and poorer physical health.
So what are we to do? Are we to:- be immobile?, be mobile?, be active?, or minimally active?, train into pain (‘no pain no gain’)?, or train avoiding pain?, use medication management?, use massage?, use spinal manipulation?, Osteopathy or chiropractic or physiotherapy?, use prescriptive exercise?, regular treatments or minimal treatments?, have imaging or not to have imaging?, should we focus on structure or function?, or is it just age?!!!
Sometimes additional investigations are needed. However, for ‘non-specific lower back pain’, they are rarely needed as a primary input into your assessment and treatment.
Imaging was originally seen by most, as a tool to rule out pathology or disease states, and less to diagnose specific musculoskeletal causes. Often this was due to a poor correlation of images and symptoms.
New imaging approaches have developed, and our dependency on them increased!
However, recent studies show that by performing a thorough clinical case history and physical examination you can often, very effectively decide if MRI or additional imaging or other investigations are needed.
Studies show MRI use, looking at follow up assessments for patients who suffered sciatica, could not distinguish between favourable and unfavourable outcomes.
There are also recent studies that show that MR Imaging (MRI) of the lumbar spine, may actually increase the patient’s likelihood of continuing in pain or disability status, and elongate their symptom picture.
Then there are studies showing that degeneration changes, are just a part of function and use. These however, have no correlation with pain, or perceptions of illness, or illness behaviour i.e. age and degenerative changes have no clear causal link with pain.
In fact studies on some of the most elite athletes, show lower back changes in images, with lumbar degeneration in up to 85 percent of people, and even spinal bony arch fractures or lesions, in 30 percent of people. All had no symptoms of lower back pain.
Does this apply to you
Ah yes, but these are not average people!?!!
Well we also have imaging studies of the average person on the street, with no lower back pain. Interestingly, of this average adult population many will also have degenerative discs, or disc bulge present. Yet no pain!
What can help
Osteopathy has research data that shows that lower back pain is the most common presenting issue, for people seeking osteopathic assistance, showing very positive outcomes and satisfaction levels.
Exercise therapy has been shown in research to reduce lower back pain symptoms, and help restore normal daily activity. More importantly, it seems to have a preventative role.
These positive effects from manual therapy and exercise, may be due to the increasing body of evidence, that pain is a brain interpretation of data, and the local structure itself, cannot consistently be linked with pain or general function.
The point here is there are many opinions and many solutions, to lower back pain. Perhaps some, in our opinion, are more rational than others and some statistically safer than others, and some more empowering than others.
The new updated NICE guideline for lower back pain, includes the guidance to remain as active as normal, seek support and advice at a specialist clinic, for education, management advice, manual therapy including spinal manipulation, mobilisation and soft tissue treatment by an osteopath, hydrotherapy application, increase in muscle strength and specialist exercise therapy for rehabilitation.
At Elementary Health we provide a seamlessly layered combination approach, of education and therapeutic application. This includes education of anatomy and pain theories, manual therapy, osteopathy, posture advice and training, lifestyle advice, hydrotherapy guidance, dietary overviews, and dynamic exercise therapy with motor control training rehabilitation. All of these work together to provide a uniquely structured approach, towards the aim of restoring your brain’s interpretation, or ‘mapping’ of your healthy functioning body, giving you back the control!
Book a consultation to get that pain free control back.
01223 902 433