There are many different causes of back pain, and almost any segment of the spine can be damaged and give rise to pain. Disorders of other parts of the body, particularly the lungs, kidneys and female reproductive organs can also cause backache. Dr Guy Ashburner (on behalf of the osteopathic profession) describes an osteopathic approach to treating this common condition.
Since pain anywhere in the back can be a symptom of a serious disorder, it is important to have an idea of what might be causing your pain, so that you can decide what action to take. Without a diagnosis, effectiveness and safety come into question. This is an important point to note when seeing any therapist or health professional.
The keystone to osteopathic management is diagnosis. Osteopaths offer not only a diagnosis but also the reasons why symptoms started (unless blatantly obvious) and why the pain has kept recurring over a number of years. The length of the initial evaluation allows the osteopath to make such specific diagnosis.
Osteopathy uses a holistic approach to aches and pains. Holistic means that as an osteopath one considers all factors past and present that have had or are having an effect on that patient. This should include psychosocial, spiritual and physical factors. Continuous emotional or psychological stress can produce functional changes in the body, which become structural if they are perpetuated. Osteopaths take a holistic approach with evaluation and treatment. They don’t simply treat the part that hurts, but look at the whole picture.
Holistic does not mean that one has to treat from head to toe, or that one has to use many types of treatment to achieve one’s aim.
In contrast to a holistic approach allopathic medicine takes a reductionist approach to the management of back pain. A reductionist approach zones in on the symptomatic area (there’s the pain rub it, stretch it, ultrasound it, etc.). This approach addresses a part but not the whole of a specific problem.
OSTEOPATHIC PRINCIPLES IN MANAGING BACK PAIN
These are an integral part of the overall evaluation and management of every patient.
The body is a unit. As the osteopath approaches the diagnosis of the patient’s condition, the unity of the body should be kept in mind. It is never good practice to isolate the focus of the examination to a single body part, even though the symptom may seem related to only one area. A clear example is lower back pain. Pain in the lower back may be predisposed to or maintained by flat feet, dysfunction of the knee or hip, sacro-iliac joint dysfunction, pelvic imbalance, muscle imbalances anywhere in the body, or restrictions of the upper back, essentially postural imbalance that has caused compensation from the feet to the head. The osteopath must consider all facets of interrelatedness of the body.
Structure and function are interrelated. The osteopath must recognise that an abnormal structure is likely to result in abnormal functioning of that body part. Likewise, longstanding abnormal function will eventually affect the structure involved by creating a compensatory position or motion pattern, changes in the structure itself, or stresses on the structure that will result in a breakdown of tissue. A treatment plan must focus on improving the structure and function of the patient to the nearest normal possible for that patient, even when those restrictions found do not seem to be related to the problem at hand. The musculoskeletal system is the osteopath’s route to the treatment of many conditions both of that system and other systems connected to it by the nervous and circulatory systems.
The body is self-regulating and self-healing. The osteopath will use the body’s ability to repair and maintain itself. It is then the role of the osteopath to know when and where to intervene to assist the body in its healing process. Osteopathic considerations in doing so include: (1) Maintaining good circulation to involved body parts. (2) Treating all restrictions that interfere with motion of any body part or mobility of the patient in general. (3) Removing any sources of pain or discomfort that are treatable manually. (4) Preventing dysfunction of spinal segments that may send inappropriate feedback to involved structures through the nervous system.
A detailed case history is taken starting with details of the patient’s symptoms, as well as when and how they began. If you are unaware of how your pains started be assured that the osteopath will usually reveal these reasons through analysis of your medical history and physical examination.
Following a careful history (which includes viewing any relevant medical reports) a physical examination is begun of all of the areas the osteopath deems relevant for the individual patient. An osteopathic evaluation is done of the body’s biomechanics, namely structure, posture and physical movements.
In the case of lower back pain an osteopath will examine the whole spine, pelvis, hips, knees, ankles and feet, with orthopaedic testing of these structures. This will be followed by neurological tests. Other clinical examinations may include the respiratory and cardiovascular systems where relevant. Examination leads to diagnosis.
Diagnosis, clinical findings and an appropriate treatment plan with projected recovery will be explained and discussed.
The aim of osteopathy is to correct problems in the body frame, making it easier for the body to function normally and reducing the chance of problems occurring in the future. It is a ‘hands-on’ therapy that restores the normal structure of the musculoskeletal system, which in turn improves the function of the nervous, circulatory and immune systems and allows for faster healing and reduced pain, congestion and restriction within the body. Hands-on treatment ranges from very subtle techniques used for babies through to more robust techniques for athletes.
Osteopathic management of back pain should include advice on the following.
Posture is a vital part of our health. In fact without good posture our health and in particular our back health will suffer.
As most working people are sedentary, correct sitting posture is essential. Correct work station setup is an important part of spinal health.
Hard/firm chairs with a gap at the base of the backrest for one’s bottom to fit through are the best option. Soft seats or sitting reading on a soft bed are the worst options and can contribute significantly to back pain. The best practice for sitting posture is as follows: as you sit bend forward halfway, then wriggle back in your seat as far as possible until you can’t move back further. Then sit up. Your back is now nicely supported and you should have a normal concave curvature to your lumbar spine. If you don’t sit in this position during your working day you will almost be guaranteed back pain now or at a later date.
In your car try the posture described above, and move your seat closer to the steering wheel. This will help those who spend a lot of time driving.
When standing, try to balance in a neutral position so that your weight is distributed on both legs, rather than on just one leg. Then grab hold of your hair on top of your head quite hard. This will bring you into an optimal standing posture, much like our hunter-gatherer ancestors viewing the horizon for danger. Maintain this posture for a couple of months and your nervous system will get used to it and it will eventually become habitual.
Believe it or not water is vital for back health. We are made of 67% water. The more dehydrated you are the faster your back will degenerate. Spinal discs are hydrophilic and absorb water especially when the spine is not loaded, for example as we sleep, lying down. Muscles need to be well hydrated otherwise dehydration will cause shortening of muscle fibres resulting in compression and restriction of spinal joints. So drink plenty of water and avoid diuretics such as coffee and tea.
Take regular aerobic exercise. The more inactive you are the stiffer and more problematic your back will be. Good aerobic options are the step machine (remember not to hold onto the hand rails as in the real world there are none on the mountain and you will get a better workout), cycling, swimming, walking and running depending on your level of fitness and the state of your back. If you have a bad back avoid the cross trainer as this will only aggravate your lumbar spinal joints if they are already under strain.
Always stretch after 5 – 15 minutes of aerobic exercise. Warm muscles are more pliable than cold ones. So if you want better results warm your muscles before your stretches or yoga class. Don’t stretch everything – it will be more productive to stretch what is necessary as recommended by your osteopath. For instance the buttock muscles have a very close relationship with your back. The tighter they are the more problematic your back will be. When you stretch ensure that you feel no more than mild tension, and no pain. The more flexible your muscles are the less pain you should experience. There is a definite correlation between short hamstrings and increased episodes of back pain.
In order to maximise recovery, prevent recurrence and fit each person’s schedule, osteopathic advice and treatment are tailored to the individual.
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