What is Back Pain?
According to the Australian Government 16% of the Australian population experience back pain. Back pain can contribute to psychological distress, chronic pain other comorbidities such as arthritis (AIHW, 2023). Back pain is reported at an increased rate as you age and can interfere with activities of daily living (AIHW, 2023).
Common conditions that may cause back pain include sprains and strains, herniated discs, spinal stenosis, scoliosis, joint degeneration, inflammatory back pain and osteoporosis (Casiano et. al., 2023).
Causes of low back pain can include heavy physical work, frequent twisting, bending or lifting, weak musculature and more. It is important to see your doctor if there are any changed to bowl and bladder movements or incontinence, no improvement or worsening in pain levels as well as numbness, tingling or weakness in the lower limb or groin (Casiano et. al., 2023).
Osteopathy is targeted towards the improvement of physiological function and support of homeostasis when altered by impaired somatic dysfunction of the musculoskeletal system (TFLBPCG, 2016). The American Osteopathic Association analysed studies on both acute and chronic non-specific low back pain and found that osteopathic manipulative treatment was effective at reducing pain and increasing functional status.
A study by Rehman et. al. (2020) found significant evidence that OMT was effective in reducing pain and disability. It focused not only on muscular treatment but also visceral osteopathy – a more indirect modality. It showed that 8 weeks of osteopathic treatment when compared to standard care was shown to have significant improvement in return to work.
Another study by Licciardone et. al. (2014) investigated osteopathic manual therapy in regard to pain reduction and biomechanical dysfunction. The study looked at 230 patients receiving treatment for 15 minutes every week. In the study a low back pain response was considered a decrease of pain of 30% or greater between the initial appointment and the 12 week follow up. The study focused on various anatomical landmarks and their position to determine biomechanical dysfunction and used 3 different outcome measures to assess results.
A range of techniques were found to be effective in decreasing pain including HVLA manipulation (High Velocity Low Amplitude), soft tissue, myofascial release, positional release, muscle energy technique. In addition, the study highlighted the importance of the psoas muscle due and its contribution to low back pain in the increased likelihood of low back pain returning if the psoas was not focused on.
Economically, Verhaeghe et. al. (2018) found OMT (Osteopathic Manipulative Treatment) to be a cost-effective treatment option for low back pain with improved health outcomes (measured as quality adjusted life years) when compared with usual care.
While osteopathy is a manual therapy there are also aspects that patients can do at home to improve their health. Owen et. al. (2019) used a variety of exercise types and criteria to identify the most effective form of exercise. Pain is best modified through exercise such a pilates, aerobic exercise and stabilisation/control exercise.
Physical function an capability is best improved using stabilisation/control exercise and resistance training. These were followed by water exercise, pilates and yoga. Mental health greatly contributes to physical health and healing and as such is an important fact to consider in both hands on and exercise therapy. Resistance and aerobic training were most beneficial for mental health and muscle strength.
In addition to strengthening you can also stretch to relieve muscle tension. Some stretches that you may find helpful include the “Cat Cow”, “Thread the Needle” and “Lumbar rotation”.
Instructions for Cat Cow:
Start on your hands and knees with your back in a neutral position. Make sure your hands are under your shoulders and knees under your hips. Arch your back while lifting your head up and tailbone out. This will make a dish like shape with your spine. Hold this position for 5 seconds. Bend your back, tuck your head and tail bone making a sad face shape with your spine. HINT: pull your bellybutton to the ceiling. Hold this position for 5 seconds and then repeat.
Instructions for Lumbar Rotation:
Start lying on your back with arms outstretched palms facing the floor. Keeping one leg flat on the floor bring the other to 90 degrees. Roll the bent leg over the straight as far as is comfortable. You will feel a stretch in your back and opposite armpit. Repeat on both sides. This can be done as a static stretch or as a fluid side to side movement.
Instructions for Thread the Needle:
Start facing the floor with hands and knees equal distance apart, hands under shoulders and knees under hips. Bring one hand off the floor and reach between your other hand and leg. Follow with your shoulder and head moving towards the floor taking the hand towards the opposite wall and allowing your back to twist and stabilising elbow to bend. A stretch should be felt down the side, shoulder blade and neck. Hold and then return to the starting position. Repeat.
References:
Australian Institute of Health and Welfare. (December 14, 2023). Back Problems. Chronic musculoskeletal conditions : Back problems – Australian Institute of Health and Welfare (aihw.gov.au)
Casiano, V.E., Sarwan, G., Dydyk, A.M., Varacallo, M. (2023). Baack Pain. StatPearls. Back Pain – StatPearls – NCBI Bookshelf (nih.gov)
Licciardone, J.C., Kearns, C.M., Crow, W.T. (2014). Changes in biomechanical dysfunction and low back pain reduction with osteopathic manual treatment: Results from the osteopathic trial. Manual Therapy 19 (4), 324-330. https://doi.org/10.1016/j.math.2014.03.004
Owen, P.J., Miller, C.T., Mundell, N.L., Verswijveren, S.J.J.M., Tagliaferri, S.D., Brisby, H., Bowe, S.J., Belavy, D.L. (2019). Which specific modes of exercise training are most effective for treating low back pain? Netwrk meta-analysis. British Medical Journal, 1-12. https://doi.org/10.1136/bjsports-2019-100886
Rehman, Y., Ferguson, H., Bozek, A., Blair, J., Allison, A., Johnston, R. (2020). Osteopathic manual treatment for pain severity, functional improvement, and return to work in patients with chronic pain. Journal of Osteopathic Medicine 120 (12). https://doi.org/10.7556/jaoa.2020.128
Task Force on the Low Back Pain Clinical Practice Guidelines. (2016). American Osteopathic Association Guidelines for Osteopathic Manipulative Treatment (OMT) for Patients With Low Back Pain. Journal of Osteopathic Medicine 116 (8), 536-549. https://doi.org/10.7556/jaoa.2016.107
Vergaeghe, N., Schepers, J., Van Dun, P., Annemans, L. (2018). Osteopathic care for low back pain and neck pain: A cost-utility analysis. Complementary Therapies in Medicine 40 207-213. https://doi.org/10.1016/j.ctim.2018.06.001