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Back Pain Treatment
Back Pain Treatment | Fulham Osteopaths
-
Back Expert Melinda Cotton Spine Examination -
Melinda Examines for Low Back Pain -
Osteopath Melinda Treating the Painful Mid Back
-
Back Expert Melinda Cotton Spine Examination -
Melinda Examines for Low Back Pain -
Osteopath Melinda Treating the Painful Mid Back
Understanding Back Pain
Osteopaths are famous for back pain treatment, but so many people wonder why they get the problems they do with all the different kinds of painful
Andrew Cotton explains back pain, what are it’s causes and what treatment is most appropriate for backpain.
What is back pain?
Back Pain is something most people suffer with at some point in their lives. But why? We don’t all routinely suffer with elbow pain or finger pain, so what is special about the low back?
Any mechanism, including the human low back, is designed for its purpose. We developed over hundreds of thousands of years to hunt, swim, and farm. Our backs are good at that, and research has shown indigenous native peoples suffer very little with chronic low back pain (CLBP). We are perhaps not so well designed to sit all day, look at laptops in bed or spend hours gaming on a PC or Smartphone!
Here the back is in a long curve backwards which comes back level with a shatp kink in the neck.
See how the back is straighter, longer, and the neck is now upright.
As you can see the back can be bent and “strained” by how we use it. Some parts get squashed and compressed, while others get stretched and weakened. The spine is a complex structure, and as it moves off of it’s natural, upright balance, so it acquires strains, stiffnesses and pains, which sow the seeds for further strains elsewhere. The picture becomes chaotic, the spine a map or record of the accidents and maltreatments that we have all had. This process is of increasing “Entropy”, or disorder. This may require an external agent to evaluate and remedy the trouble, as the body’s natural powers of self correction are overwhelmed, or even contribute to the problem through overreaction.
It is the mark of a good treatment for your back, or a series of exercises like Pilates or Yoga, if it starts to smooth out these strains and reverses the process of accumulating trouble, so your back feels free, flexible and right again so you can get on with life.
It is not always obvious, but if your back in strained or injured it has to heal itself. We have a fantastic repair system that mops up damage, lays down support to protect the injury and then gets on with repairs. A treatment for your back must help this repair process, find out why it happened (cause), what it is (effect) and what is to be done (a plan!).
This is the art of the Physical Therapist, to read the situation in all its complexity and set the person on the road to recovery, safely and effectively.
Symptoms of Back Pain
Does the following list sound at all familiar?
- Low back Pain, Mid Back Pain, Neck Pain
- Lumbago, Backache
- Soreness after exercise
- Something “catches” in your back
- Twinges
- Spasms
- Excess tension, Burning, Aching Back Pain
- Shooting pain
- Nondescript, hard to explain or vague Back Pain
Back pain can be vague or quite severe. You may have heard of “Psycho Somatic Pain” and wonder if stress or imagination has a role in what you feel. Actually people are quite accurate in what they feel - you shouldn’t feel any discomfort, and if it does not clear up in a few days it will benefit from a checkover and treatment.
Back Pain Treatment
Treatment for the back will usually involve elements from the following.
- Enquiring how it happened
- Examining to find tenderness, swelling, mis-position etc
- Calming the nervous system to move the body from a state of alarm and action to a state of healing and repair
- Gently balancing and easing the structure to allow circulation and drainage
- Giving advice regarding rest and or exercise
How is back pain treated? The approach of most therapies is similar. First, is the pain due to an injury, where some tissue is damaged, or is the pain due to sensitivity, where the body reports injury as pain but no damage has actually occured. There is often an element of both in many cases.
Back Pain due to hypersensitivity (Neurogenic Pain)
It may be in the person’s interest to overreact to a problem, so that the person takes it seriously and looks after themselves. This is a natural phenomenon, and encourages us to listen to our body and alter what we are doing. If one takes a painkiller in this scenario, the wisdom of the body is ignored, and you run the risk of aggravating the back pain. If the problem is due to hypersensitivity - neurogenic pain which is perhaps an overreaction to an innocuous problem, then sometimes pain relief, if it helps sleep and relaxation, may be helpful. Physical treatment can help more naturally, using techniques which listen and communicate with the body, and calm the nerves down without simply switching them off. This may include discussing stress and diet, as many things often add together to create a state of excitability.
Back Pain due to injury
Back injury treatment will depend on the tissue involved.
- Muscle Pain - The muscle may be fatigued, tight and stringy. The reason for the overuse must be addressed, and then the muscle relaxed using massage or functional (feedback) approaches
- Joint Pain - whether due to arthritis, sprain or congestion, the joint needs to be carefully brought into normal relations (straightened out) so that and strain is relieved.This is achieved by articulation (gentle movement of the joint) encouraging balance. Normal micro movements of the joints encourage circulation and drainage, swelling is reduced and repair encouraged. Pain should be eased, but can be briefly increased (healing reaction). This represents a rapid acceleration of the healing process, and typically lasts for 12-24 hours.
- Disc Pain - Between our vertebrae (back bones) are rubbery pads filled with jelly, much like an old fashioned jam doughnut. If the spine strains forward too much the jam in the doughnut (jelly in the disc) can squidge backwards and irritate the nerves in your back (sciatica- pain down the back of the leg). The treatment is to decompress and straighten the bones either side of the disc, encourage support of the spine with core exercises etc, and swimming or other supportive exercise to promote recovery. Disc healing can be quite slow, and the injury must be respected. If there is weakness or numbness in the leg or foot a scan (MRI) may be required. The trapped nerve causes the dreaded “sciatica”, pain down the buttock and the back of the leg. Because part of the entrapment of the nerve is swelling around the injury, Osteopathy can help relieve sciatica because our treatment will encourage “micro movements” of the cells and tissues, drastically improving drainage and so relieving swelling and pain.
Stenosis
You may have had a diagnosis of Stenosis, perhaps after an MRI scan or X-Ray.
This rather scary diagnosis just means a bit of nerve pinching from compression in the spine or swelling around a small facet joint.
We usually have good success with this and it’s associated sciatica, if you have that. That is because we try to find normal in your body, and in normal conditions the body can heal itself.
Stenosis
Back Pain, a Reflection by Simon Brocard, Osteopath
Lower Back Pain
Lower back pain can be quite scary, especially if it is sharp or if there doesn’t seem to be any reason for it to have started. There are many small structures that can be affected and become painful, and with the low back in the centre of your body, it can be influenced by many different areas, from the position of the head all the way to how your ankles are moving.It can be dull or sharp, focal or radiating up and down the spine and buttocks, movement can aggravate it or relieve it, each patient is different.
So how does the back work?
Your lower back is formed of a column of 5 lumbar vertebrae stacked up one on top of the other. This column of bone has to bear the weight of your entire thorax, arms and head, as well as absorb and translate forces coming from the ground through the legs. There are a few elements needed to make sure this column of bone behaves normally:work needs to be evenly distributed across all 5 segments — if one segment has to do all the work because the other ones aren’t moving as well as they could, it may strain
it needs a stable base — if the pelvis is lopsided or moving in an odd way, the lower back may have to compensate for it
the muscles around it need to be strong to stabilise it — the core muscles include the buttocks, the “lats“ and the muscles around the abdomen, acting like a corset, or guy ropes around a mast.
your centre of gravity needs to fall in the right place — too far forward and the muscles of the back will have to work harder, too far back and you may need to “drop“ through the low back and compress the spine into a backward arch.
What’s the structure that hurts?
There are roughly 21 joints in the lower back and about 24 main muscles that can pull it in any directions (depending on which textbook you look at). That’s without counting all the tiny muscles between every single vertebrae (that’s roughly another 34) and as many ligaments and tendons holding everything together. Add an extra disc between each vertebrae, a few nerves, the whole lot wrapped in sheets of connective tissue and you have well over 100 different structures that can become painful. Every structure has its role to play and is highly integrated with its environment. They may become painful when stretched (eg. a ligament), when compressed (eg. a joint) or when moving (eg. a muscle) Some have a very good nerve supply (they will be extremely painful very quickly) when others don’t (they may take a while to get irritated and produce a duller ache) so there can be many different manifestations of lower back pain.When should I seek help?
We all get aches and pains every now and then, so when is it ok to let it get better on its own? Sometimes it’s tricky to tell when one should seek help.My advice is that if your lower back pain doesn’t start to improve about 3 days after the initial onset, if your symptoms seem to be getting worse rather than better or if the same problem keeps happening over and over again in the same place, it is probably a good idea to seek professional help.
We can tailor our approach to your current state: if the pain is very acute, there are a lot of very gentle techniques we can use to calm the tissues down, before addressing the cause in the background. If the pain is almost gone but you know it keeps happening in the same place and you don’t want it to come back, we can examine the surrounding tissues for clues as to why it keeps happening.
What is my Osteopath going to do?
The Osteopath’s first job is to identify the cause of the problem. Which structure is causing the pain, but most importantly, why did it start in the first place or why is it failing to get better? We will look at your overall posture, see how your spine, pelvis and legs are moving by asking you to do a few simple movements, and we have simple tests that we can use to check different structures (we may ask you to stand on one leg or gently lift your leg up whilst you lie on your back). We may also check your reflexes and muscle power.Once we understand more about what is going on, then we can work out a way forward — this will likely include manual therapy to normalise range of motion in different joints and muscle tone. Treatment may not be isolated to the lower back. We may find that the way your ankle moves is producing a twist through the leg that in turn is upsetting the lower back, or we may find that you are holding your head forward, thus throwing your centre of gravity off balance.
I also like to include lifestyle advice to my treatment — I often give tips on desk setup and posture. I like to talk about activities one can do to strengthen and mobilise the back, be it swimming, yoga, pilates or other. There are often a few simple exercises I can give patients to speed up their recovery and prevent the problem from coming back.
I think educating patients and making them aware of what is going on is a key element of my practice — once you know what is going on, you have the tools to decide how you wish to go forward.
Understanding Back Pain
Osteopaths are famous for back pain treatment, but so many people wonder why they get the problems they do with all the different kinds of back pain.
Principal Fulham Osteopath Andrew Cotton explains back pain, what are it’s causes and what treatment is most appropriate for back pain.
What is back pain?
Back Pain is something most people suffer with at some point in their lives. But why? We don’t all routinely suffer with elbow pain or finger pain, so what is special about the low back?
Any mechanism, including the human low back, is designed for its purpose. We developed over hundreds of thousands of years to hunt, swim, and farm. Our backs are good at that, and research has shown indigenous native peoples suffer very little with chronic low back pain (CLBP). We are perhaps not so well designed to sit all day, look at laptops in bed or spend hours gaming on a PC or Smartphone!
Here the back is in a long curve backwards which comes back level with a shatp kink in the neck.
See how the back is straighter, longer, and the neck is now upright.
As you can see the back can be bent and “strained” by how we use it. Some parts get squashed and compressed, while others get stretched and weakened. The spine is a complex structure, and as it moves off of it’s natural, upright balance, so it acquires strains, stiffnesses and pains, which sow the seeds for further strains elsewhere. The picture becomes chaotic, the spine a map or record of the accidents and maltreatments that we have all had. This process is of increasing “Entropy”, or disorder. This may require an external agent to evaluate and remedy the trouble, as the body’s natural powers of self correction are overwhelmed, or even contribute to the problem through overreaction.
It is the mark of a good treatment for your back, or a series of exercises like Pilates or Yoga, if it starts to smooth out these strains and reverses the process of accumulating trouble, so your back feels free, flexible and right again so you can get on with life.
It is not always obvious, but if your back in strained or injured it has to heal itself. We have a fantastic repair system that mops up damage, lays down support to protect the injury and then gets on with repairs. A treatment for your back must help this repair process, find out why it happened (cause), what it is (effect) and what is to be done (a plan!).
This is the art of the Physical Therapist, to read the situation in all its complexity and set the person on the road to recovery, safely and effectively.
Symptoms of Back Pain
Does the following list sound at all familiar?
- Low back Pain, Mid Back Pain, Neck Pain
- Lumbago, Backache
- Soreness after exercise
- Something “catches” in your back
- Twinges
- Spasms
- Excess tension, Burning, Aching Back Pain
- Shooting pain
- Nondescript, hard to explain or vague Back Pain
Back pain can be vague or quite severe. You may have heard of “Psycho Somatic Pain” and wonder if stress or imagination has a role in what you feel. Actually people are quite accurate in what they feel - you shouldn’t feel any discomfort, and if it does not clear up in a few days it will benefit from a checkover and treatment.
Back Pain Treatment
Treatment for the back will usually involve elements from the following.
- Enquiring how it happened
- Examining to find tenderness, swelling, mis-position etc
- Calming the nervous system to move the body from a state of alarm and action to a state of healing and repair
- Gently balancing and easing the structure to allow circulation and drainage
- Giving advice regarding rest and or exercise
How is back pain treated? The approach of most therapies is similar. First, is the pain due to an injury, where some tissue is damaged, or is the pain due to sensitivity, where the body reports injury as pain but no damage has actually occurred. There is often an element of both in many cases.
Back Pain due to hypersensitivity (Neurogenic Pain)
It may be in the person’s interest to overreact to a problem, so that the person takes it seriously and looks after themselves. This is a natural phenomenon, and encourages us to listen to our body and alter what we are doing. If one takes a painkiller in this scenario, the wisdom of the body is ignored, and you run the risk of aggravating the back pain. If the problem is due to hypersensitivity - “neurogenic” or nerve created pain which is perhaps an overreaction to an innocuous problem, then sometimes pain relief, if it helps sleep and relaxation, may be helpful. Physical treatment can help more naturally, using techniques which listen and communicate with the body, and calm the nerves down without simply switching them off. This may include discussing stress and diet, as many things often add together to create a state of excitability.
Back Pain and Sciatica due to injury
Back injury treatment will depend on the tissue involved.
- Muscle Pain - The muscle may be fatigued, tight and stringy. The reason for the overuse must be addressed, and then the muscle relaxed using massage or functional (feedback) approaches
- Joint Pain - whether due to arthritis, sprain or congestion, the joint needs to be carefully brought into normal relations (straightened out) so that and strain is relieved.This is achieved by articulation (gentle movement of the joint) encouraging balance. Normal micro movements of the joints encourage circulation and drainage, swelling is reduced and repair encouraged. Pain should be eased, but can be briefly increased (healing reaction). This represents a rapid acceleration of the healing process, and typically lasts for 12-24 hours.
- Disc Pain - Between our vertebrae (back bones) are rubbery pads filled with jelly, much like an old fashioned jam doughnut. If the spine strains forward too much the jam in the doughnut (jelly in the disc) can squidge backwards and irritate the nerves in your back (sciatica- pain down the back of the leg). The treatment is to decompress and straighten the bones either side of the disc, encourage support of the spine with core exercises etc, and swimming or other supportive exercise to promote recovery. Disc healing can be quite slow, and the injury must be respected. If there is weakness or numbness in the leg or foot a scan (MRI) may be required. The trapped nerve causes the dreaded “sciatica”, pain down the buttock and the back of the leg. Because part of the entrapment of the nerve is swelling around the injury, Osteopathy can help relieve sciatica because our treatment will encourage “micro movements” of the cells and tissues, drastically improving drainage and so relieving swelling and pain.
Stenosis
You may have had a diagnosis of Stenosis, perhaps after an MRI scan or X-Ray.
This rather scary diagnosis just means a bit of nerve pinching from compression in the spine or swelling around a small facet joint.
We usually have good success with this and it’s associated sciatica, if you have that. That is because we try to find normal in your body, and in normal conditions the body can heal itself.
Stenosis
Back Pain, a Reflection by Simon Brocard, Osteopath
Lower Back Pain
Lower back pain can be quite scary, especially if it is sharp or if there doesn’t seem to be any reason for it to have started. There are many small structures that can be affected and become painful, and with the low back in the centre of your body, it can be influenced by many different areas, from the position of the head all the way to how your ankles are moving.It can be dull or sharp, focal or radiating up and down the spine and buttocks, movement can aggravate it or relieve it, each patient is different.
So how does the back work?
Your lower back is formed of a column of 5 lumbar vertebrae stacked up one on top of the other. This column of bone has to bear the weight of your entire thorax, arms and head, as well as absorb and translate forces coming from the ground through the legs. There are a few elements needed to make sure this column of bone behaves normally:work needs to be evenly distributed across all 5 segments — if one segment has to do all the work because the other ones aren’t moving as well as they could, it may strain
it needs a stable base — if the pelvis is lopsided or moving in an odd way, the lower back may have to compensate for it
the muscles around it need to be strong to stabilise it — the core muscles include the buttocks, the “lats“ and the muscles around the abdomen, acting like a corset, or guy ropes around a mast.
your centre of gravity needs to fall in the right place — too far forward and the muscles of the back will have to work harder, too far back and you may need to “drop“ through the low back and compress the spine into a backward arch.
What’s the structure that hurts?
There are roughly 21 joints in the lower back and about 24 main muscles that can pull it in any directions (depending on which textbook you look at). That’s without counting all the tiny muscles between every single vertebrae (that’s roughly another 34) and as many ligaments and tendons holding everything together. Add an extra disc between each vertebrae, a few nerves, the whole lot wrapped in sheets of connective tissue and you have well over 100 different structures that can become painful. Every structure has its role to play and is highly integrated with its environment. They may become painful when stretched (eg. a ligament), when compressed (eg. a joint) or when moving (eg. a muscle) Some have a very good nerve supply (they will be extremely painful very quickly) when others don’t (they may take a while to get irritated and produce a duller ache) so there can be many different manifestations of lower back pain.When should I seek help?
We all get aches and pains every now and then, so when is it ok to let it get better on its own? Sometimes it’s tricky to tell when one should seek help.My advice is that if your lower back pain doesn’t start to improve about 3 days after the initial onset, if your symptoms seem to be getting worse rather than better or if the same problem keeps happening over and over again in the same place, it is probably a good idea to seek professional help.
We can tailor our approach to your current state: if the pain is very acute, there are a lot of very gentle techniques we can use to calm the tissues down, before addressing the cause in the background. If the pain is almost gone but you know it keeps happening in the same place and you don’t want it to come back, we can examine the surrounding tissues for clues as to why it keeps happening.
What is my Osteopath going to do?
The Osteopath’s first job is to identify the cause of the problem. Which structure is causing the pain, but most importantly, why did it start in the first place or why is it failing to get better? We will look at your overall posture, see how your spine, pelvis and legs are moving by asking you to do a few simple movements, and we have simple tests that we can use to check different structures (we may ask you to stand on one leg or gently lift your leg up whilst you lie on your back). We may also check your reflexes and muscle power.Once we understand more about what is going on, then we can work out a way forward — this will likely include manual therapy to normalise range of motion in different joints and muscle tone. Treatment may not be isolated to the lower back. We may find that the way your ankle moves is producing a twist through the leg that in turn is upsetting the lower back, or we may find that you are holding your head forward, thus throwing your centre of gravity off balance.
I also like to include lifestyle advice to my treatment — I often give tips on desk setup and posture. I like to talk about activities one can do to strengthen and mobilise the back, be it swimming, yoga, pilates or other. There are often a few simple exercises I can give patients to speed up their recovery and prevent the problem from coming back.
I think educating patients and making them aware of what is going on is a key element of my practice — once you know what is going on, you have the tools to decide how you wish to go forward.
Back Pain, You are not the only one…
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