Lower back pain
This is one of the main areas of osteopathic work and makes up a good 50% of patients; we specialize in getting them back to normal and pain free. The osteopathic assessment and diagnosis process are subtle assessing through touch and observation how a body moves and the different parts interact with one another. In most cases pain originates from the small facet joints of the back and or the pelvic joints which can become restricted causing muscle guarding and inflammation. Occasionally there is ligament damage or a pulled muscle. Frequently there is a postural issue or habitual posture or activity that can sets things off; most frequently there exists a combination of all these elements.
Lower back pain is really very common, with 8 out of 10 adults suffering at some point in their lives. In many cases the cause is not clear and advice about anti-inflammatory drugs, analgesics and keeping moving makes sense; in most cases the problem will resolve spontaneously in a week or two.
The lower back is made up of the lumbar spine and the extensive network of muscles enveloping the region and forming the abdominal cavity, attaching to the ribs above and the pelvis below. Between each vertebral body (the big round bit) there are discs that act as shock absorbers and allow movements between the vertebra. At the most posterior part of the back sit the spinal facet joints which control the movements between these vertebral structures.
‘Non-specific or Simple lower back pain’ is a common diagnostic phrase used by GP’s, hospitals and NICE guidance to describe your bog-standard lower back pain patients’ symptoms. The diagnostic logic assumes that if there is pain there is probably a disease process or structural damage that is causing this to occur and this is ‘testable’. Over many years and in most cases, on medical examination and testing nothing is found that might obviously induce the symptoms. It is very difficult for the doctor to identify the exact cause, hence the generic title. The advice normally goes along the lines of….‘if it is painful, but we don’t know why, it will probably resolve pretty quickly anyway, follow the advice in the second paragraph, go away and only come back if it is no better in 6 weeks. Now saying all that, many patients find that the osteopathic intervention at an early stage speeds their recovery, reduces pain and improves movement. The occasional treatments every few months stop them having a recurrence, so simply put ‘prevention is better than cure’.
In quite rare cases (you may find that a bit difficult to believe but it is true) structural things can happen to lumbar spines which cause not only ‘back pain’ but also the trapping or squashing of one or more of the nerves of the back. These nerves supply various structures in the legs with motor power signals and in turn carry sensation signals from the legs thereby providing feedback to the spinal cord and brain about what’s going on in that limb. A diagnosis used widely is that of ‘sciatica’. This is applied to describe leg pain associated with compressed nerves in the back. It is however, a rare event commonly ‘misdiagnosed’ by medical practitioners, osteopaths, chiropractors etc all of whom should know better about reaching this diagnosis with little or no evidence to support it. They carry on regardless however, even though this scares patients completely unnecessarily. There are many other causes of referred pain into the buttocks, thigh, calf and most are relatively simple to remedy, do not come from trapped nerves, but other truncal structures which refer pain. Everyone likes a bit of drama in their life but having this gloomy diagnosis would not be my personal choice or way to fill the dramatic void.