Acute or chronic low back pain is one of the most common reason patients consult their Osteopath or Physiotherapist. But what actually happens? Are there preventative measures we can take? Here are the answers to some of your most common questions about lower back pain.
When you come to see us what do we look at?
First we have to establish that it is safe for us to treat you, by taking a detailed case history and, if needed, performing a variety of orthopaedic and neurological tests.
We do this not only to establish whether you are safe to treat but also to understand what specific structure is failing and causing you symptoms. With that information we build your bespoke treatment plan, which will address the factors that have lead to your back pain.
How do we determine what went wrong?
In the case of low back pain, once we are confident that the pain you are experiencing is of a musculoskeletal nature, we look at the joints, intervertebral discs, ligaments and muscles as the structures that might have failed and cause you pain.
Using a variety of specific tests we determine which one of the above it is. Then we look broader in the context of your whole body. This helps us understand why that particular area has started to fail and which areas of your body, your lifestyle and/or habits are causing your symptoms. Generally with spinal pain we need to address areas of restriction (which could for example be in your spine, hips or ankles) while addressing areas of weakness (for example your ankles, pelvic/scapula stabilisers or your core) by working through prescription exercises.
Is there a golden formula approach?
No two bodies are the same, so we don’t have the exact same treatment plan for all patients with low back pain - but over the years a common pattern has emerged with the majority of our low back patients.
Most patients experiencing low back pain will present with:
A decrease of upper back mobility
Poor core strength
Poor pelvic control/stability
So how do I prevent lower back pain?
Work on upper back mobility. Our lifestyle, work posture (particularly desk-bound professions) and habits have limited how much we use our thoracic spine and we often find areas of restriction. That means that the area below and above have to work a lot harder to make up for the lack of movement in the upper back. Great exercises to keep our upper back mobile are seated twists, open books or threading the needle. Taking up swimming is another fantastic thing you can do for your back. Alternate your strokes between front and back crawl as well as breast stroke and try to change sides when you inhale during front crawl to get some lovely rotation mobilisation into your upper back while gently strengthening your back musculature.
Strengthen and engage the core. A lot of us switch the core muscles off when standing or walking, which puts our pelvis into what is called an anterior tilt. That means your whole pelvis is rotated forward. This forward tilt of your pelvis changes the load through your back bones (vertebrae). Rather than weight bearing through the center - the body of the vertebrae - we weight bear through the back - the facet joints - which are not designed for weight bearing. When we do that too much the facet joints can get inflamed and painful and start degenerating. There are many ways to strengthen your core. You could work with a PT, work on strength and conditioning or take up Pilates classes.
Strengthen your pelvic stabilising muscles (ie glutes). If our pelvic stabilisers are weak, rather than having a solid base for translating the flexion/extension movements of our legs into rotational spinal movements, we have an unstable base. This is again causing excessive loading on the lower lumbar spine which needs to cope not only with an excessive extension pattern as described above with a forward tilted pelvis but also excessive side-bending, leading to your facet joints being overloaded via two vectors.
A muscle we particularly like strengthening is gluteus medius. A common exercise is the clam, but there are many better exercises including those that incorporate the core.
What if I need treatment?
We have a great team at Guy Gold’s offering Osteopathy, Physiotherapy and Personal Training, and are very much in tune with each other’s strengths and particular areas of expertise. As a result we regularly cross-refer between each other and you might find that rather than staying with just one practitioner, you’ll be treated by more than one, so that you benefit from the best skills of each of us for your own best personal outcome.
What if I don’t get better?
There are occasions when an injury does not resolve in a manner that we expect. Should we feel that we need some additional input, we might refer you for a scan or to a spinal or neuro consultant. We have excellent relationships with some of the leading consultants in London and pride ourselves on giving you the optimum overall care.
To start treating your lower back pain, book and appointment with one of our Osteopaths or Physiotherapists via our Booking page.