Low Back Pain
Low back pain is the most common problem I see in clinic and likely the most common condition osteopaths see more generally. It comes in many different forms and affects people in different ways. If you’re suffering from pain in your lower back, then I can assess and put a plan together to help you with it.
What low back pain can feel like
There are many different ways patients describe low back pain and some of the ways it affects people are listed below. You might recognise some of these in yourself:
- A deep ache or stiffness across the low back, often described as a band and spreading from the middle to either or both sides
- Pain or stiffness that is worse in the mornings or after sitting
- A nagging, grumbling type of pain that doesn’t seem to go away
- Pain that is easier with movement and comes back the more you stay in one position
- Pain that gets worse with movement, particularly when you bend, twist or try to lift things
- A feeling of locking in your back or spasms in the muscles
- Feeling fragile when you do certain activities and causing you to avoid certain movements
You may only have one or a few of these and it’s rare to feel all of them at the same time. Low back pain may affect you differently to the next person. My assessment is aimed at figuring out what is going on in your particular case, explaining it to you in plain language, and then deciding how we’ll tackle this so you can get back to your work or activities again.
Why it happens
It can be very tricky to pinpoint exactly why we get low back pain. There is a general ‘catch-all’ term for low back pain without an obvious cause in the medical world: non-specific low-back pain. That might seem like a cop out and that we don’t ‘have a clue’ what’s going on. All that term really means is that after a thorough assessment, all the serious things that would be cause for concern have been ruled out. What is left is the pain coming from ‘something’ in your back, whether that is a joint, muscle, ligament, disc, etc. While I do my best to give you a clear reason as to why your back is hurting, the pain coming from these structures can overlap and it isn’t always possible to be 100% confident in the exact cause.
The good news is, whether it’s muscle, ligament or joint, if it falls under the bucket of ‘non-specific low back pain’, and can be attributed to a general mechanical issue, the treatment approach won’t differ all that much. My ethos is to always be up front with you through the whole process and I’ll explain exactly what I think is happening, including any uncertainty, when you see me and give you a clear plan of how we’re going to tackle it.
Sometimes low back pain might come on after innocuous activities, such as reaching for a mug, picking a sock up off the floor, etc. As well as often being confusing, this is often concerning, as it may feel like your back is vulnerable. The actual event that led to the sudden pain is usually the ‘straw that broke the camel’s back’, to use an analogy, and not necessarily that particular movement or activity being the culprit. The reassurance here is that it’s not that you’re unable to handle such a simple activity. At this particular time, your tolerance for movement has reduced, and this is something we can get back over time.
Does having low back pain mean something is damaged, torn or ‘out of place’?
It’s worth addressing the biggest worry patients have with low back pain, and that is whether it is a sign of something being damaged, torn, or ‘out of place’.
Your back is very robust and it can handle a lot. The structures of your back: your spine, your joints, your disc, are secure, and unless you’ve had a significant injury or congenital issue, things don’t just go ‘out of place’.
Damaged tissues also heal over time. Your body is incredibly adept at fixing itself and healing injuries. Even the discs in our back have been shown over time to have healing capabilities and disc bulges can regress over time1 2.
If you’ve had a scan showing a disc bulge, wear and tear or other types of degeneration, this does not mean you’re damaged beyond repair. A lot of these findings are extremely common in the wider population, including people not experiencing any kind of back pain. Oftentimes, you’ll recover from your symptoms despite some of these things still being visible on a scan. They might mean we have to adapt how we plan your treatment and recovery, and modify how you do certain activities, but they are rarely a block to recovery.
How I assess and treat low back pain
The key to effectively treating low back pain is a thorough assessment and examination. I’ll want to understand how your pain started, what makes it feel worse and what makes it feel better, how it’s affecting your day-to-day life and then get a clear picture of how you’re moving. I’ll be checking for the things that might need looking at by a GP or require further investigations (very rare) and if I find anything like that, I’ll tell you and point you in the right direction.
The vast majority of the time, I can help and will build a treatment plan based around what I’ve found when I’ve examined your movements. I don’t prescribe fixed routines so whatever I suggest will be based on where you’re at and what I think will suit you best. That usually means hands-on treatment to ease pain and improve how you move, alongside specific advice and movement or exercises that you can do between appointments. The best outcomes when treating low back pain come from that mix of hands-on and rehab outside the treatment room.
We’ll also monitor progress as we go along. I’ll give you as clear an idea as I can about expected time frames and if we’re not making progress, we’ll change the plan accordingly. It’s important to me that your recovery is going somewhere and I don’t want you to keep coming back without making meaningful change to your symptoms and quality of life.
If this sounds like what you’ve been experiencing, I can take a proper look and tell you what’s going on.
What to expect
In time, most episodes of low back pain improve and recent onset will typically get better over the course of a few weeks. If you’ve had low back pain for longer, then it may take more time. It’s important to highlight that recovery is rarely a linear progression. It’s not uncommon to start feeling better and then have some periodic episodes of pain again. This is expected and as long as the general trajectory is upwards, not something to be concerned about. We’ll be working on reducing your pain, allowing you to move more comfortably and confidently and setting realistic goals for where you’re at, with the ultimate aim to get you back to what you want to be doing.
Because there can be so much uncertainty, and with it, fear, around low back pain, I often find that once the condition is understood and you’ve had things explained to you clearly, then recovery isn’t as impeded by fearful movement. This is, at the core, what I’m trying to do when I treat you.
I can never guarantee specific outcomes and it’s important to be up front about that when you put your trust in me to help. What I do promise is that I will give you a thorough assessment and an honest picture of what I think the cause is and work with you to get you back to doing what matters and what you’re currently being prevented from doing.
Most back pain is not serious, but there are a few symptoms to be aware of that would require you to seek urgent medical care right away, either by visiting A&E or calling 999, rather than booking an appointment with me:
- Loss of feeling, tingling, pins and needles in your genitals, back passage or inner thighs
- Numbness, pins and needles or weakness in both legs
- A sudden loss of sexual function
- An inability or difficulty to start, stop or control urination or loss of sensation when passing urine
- Inability to control a bowel movement or not noticing when you need to go
These symptoms can indicate cauda equina syndrome, a medical emergency where the bundle of nerves at the base of the spine becomes compressed. If this is left untreated, it can lead to permanent paralysis, loss of bowel or bladder control and sexual function. This is very rare, with an estimated occurrence in 1-3 people per 100,000 per year.
It is also worth getting an urgent GP appointment, or calling 111, if you experience the following:
- You have fever or feel hot, cold or shivery or generally unwell
- Your pain is severe and came on very quickly, suddenly getting worse, or following a serious accident
Sources: NHS — Back pain · Buckinghamshire Healthcare NHS Trust — Cauda Equina Syndrome
I have pain higher up the back, can you help with this?
Not all back pain I see is in the low back and many patients do see me for mid and upper back pain too. This might be pain across the bra strap level, between the shoulder blades, the back of the ribs, etc. It’s often described as a tight, aching, burning or muscle spasm feeling and can frequently overlap with pain in the neck and/or shoulders. All these areas need to be assessed together to get an accurate idea of what is going on and how best to help.
The principle is the same, whichever part of the back you’re experiencing pain. I’ll assess you comprehensively to figure out what specifically is driving your pain, rule out anything that would require further investigation and then build a treatment plan to address the cause and get you back to your life again.
Written by David Graham, GOsC Registered Osteopath (reg. no. 10852)
Common questions about low back pain
Most of the time, x-ray, MRI and other scans are not necessary. A comprehensive clinical assessment can identify what is going on. Scans are not all that helpful in telling us how much pain you might be experiencing and often show normal changes in the spine we all experience with age. Most importantly, scans often do not change how we manage your pain. The time a scan might be useful is if we’re not getting anywhere or your symptoms are getting worse. If I think you genuinely need a scan, I’ll tell you and refer you.
Yes. Whether you’ve had low back pain for a week or several months, most of the time I can still help. Typically, the longer you’ve had it, the longer it takes to get better. I’ll give you an idea of what I think is a realistic timeframe for your situation after a full assessment. Our goal will be to gradually reduce your pain, improve your comfort and get your function back.
Bed rest for more than a day or two is not recommended, even if this might seem counterintuitive when you’re in pain. Staying active is far more conducive to good recovery. What that activity looks like will depend on your condition, and this might mean gentle movement in the early stages. My job is to help you find movement that is manageable and safe for you. I will advise you of this during treatment so you can continue your recovery at home.
These matter much less than people tend to think. While they can play a part in how comfortable you feel day-to-day, the evidence suggests that they’re rarely the actual ‘cause’ of your back pain. There may be movement modifications to make in your job, or certain postural changes that may help, and I will advise on this after I’ve examined you.
This all depends on what I find and how long you’ve had it. I can’t give an accurate, and more importantly, an honest, estimate until I’ve assessed you. I regularly review progress to make sure we’re going in the right direction. If we’re not making progress within three to six sessions, we’ll look to change the plan or refer if I feel that is necessary.
Osteopathic treatment is usually not painful. Some techniques may feel firm and sometimes symptoms can temporarily flare up after treatment because of the irritation already present. I’ll work within what is comfortable for you and treatment is never compulsory. If something feels uncomfortable, you can let me know and we’ll alter what we do.
My default position is not telling you to stop doing the things you enjoy or need to do. My goal is to find a way to keep you doing the things that matter to you. Sometimes we need to modify or change things slightly while symptoms settle down. Completely stopping is a last resort and if we have to do that, it’s only ever temporary.
Recognise these symptoms and are they holding you back?
Let’s take a look.
If you’re experiencing back pain and it’s getting in the way, book an assessment with me and we’ll work together to create a plan and do something about it.