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When and how to treat back pain

Susannah Makram

By Susannah Makram

Susannah Makram is a registered Osteopath with a wealth of knowledge and experience in the pathophysiology of the ageing spine and optimising tissue health. She is a specialist at BVLGARI Hotels London and practices at the Chelsea Private Clinic. Susannah also works with athletes and families around the world.

A large majority of people will experience back pain at some point in their lives. It is estimated that 540 million people globally are affected by low back pain and it is the main cause of disability worldwide. A peer-reviewed research study concluded that the highest prevalence of low back pain is in Western Europe, followed by the MENA region (Middle East North Africa), and the lowest is in the Caribbean and Latin America.1

What is pain exactly?

An acute pain, “usually comes on suddenly and is caused by something specific… Chronic pain is pain that is ongoing and usually lasts longer than six months,” states experts from The Cleveland Clinic.2

The therapy of acute pain is aimed at treating the underlying cause and interrupting the nociceptive signals. The therapy of chronic pain must rely on a multidisciplinary approach and should involve more than one therapeutic modality.3

Any of these sensations is still subjective in the way we describe it but we usually use words like “shooting”, “sharp”, “dull ache” to try to understand where it might be coming from.

What is back pain?

Back pain is a pain sensation in or around the spine (our vertebral joints). Associated with back pain is usually a muscle ache and a shooting pain that can travel down the leg. The pain may improve with reclining and worsen with bending forwards or standing for long period of time. Noting what is aggravating and relieving your back pain helps to manage pain if it’s not severe as well as provides information as to what’s causing the pain.

When to seek medical attention

Although most back pain is not serious the time to address the pain, without hesitation is when you experience back pain in conjunction with a fever or sudden weight-loss.
Other times to seek medical attention are when you feel a weakness or numbness or tingling in one or both legs; when the pain is persistent, with no alleviating positions or movements, loss of control of bowel or bladder, numbness around the groin (saddle) area.

Tips on self-care and managing occasional back pain

If you suffer occasional back pain, then here are some self-care tips to manage the pain once you have got the right treatment:

  • Outside exerciseExercise outdoors when you can, taking advantage of good weather. Vitamin D from the sunshine and the breath of oxygen outside, can help the mind greater than being indoors.
  • If you have no history of injuring your ankles, try a trigger point ball on the soles of your feet. Try to aim for the spot in front of the heel, pressing your body weight back in towards you heel, rather than pushing straight down. Roll the ball then gently up and down the foot from this point to the toes and back.
  • Hot and cold showers or baths (ice baths if the body is hot) can help. Rule of thumb is to do what feels right for the body. If there’s inflammation it’s usually best to end this hot/cold water routine on cold.
  • Try a magnesium salt bath or Epsom salt bath at night before sleeping. This is best undertaken at night as it can leave you feeling drowsy afterwards.
  • Sleep with a pillow in between your legs alternating from the left to right side so as not to stick to one side habitually. This is usually the hardest thing as it’s not easy to change sleeping habits.

Tips and treatments

  • If you are already exercising, then it is important to make smart exercise choices to protect yourself from back pain.
  • Include different types of exercise, prescribed by a physical therapy expert whose analysis of your dynamic posture (posture whilst moving/exercising), is a great place to start.
  • Suitable pain medication(s), prescribed movement work or exercise, changes in lifestyle and diet are likely to offer the most relief. Surgery is useful in a minority of people (indicated more so if medical attention is required as per above).
  • Complementary therapies such as osteopathy, physiotherapy, chiropractic care, acupuncture, cupping, TCM, and massage are popular these days. However, making an informed decision with your health practitioner is advisable.

The backpain patient’s health journey

Once it’s established that you have acute/chronic back pain that’s not a medical emergency in its origin, then you will need to visit your Medical Doctor who will undertake a medical case history as part of the consultation procedure. Followed by a physical exam of active movements to screen whether you will be safe to treat via physical therapy modalities / NSAIDS vs. steroidal/other specific pharmaceutical therapy, or whether you need further investigation in the form or x-ray or MRI.

Physical therapy is defined as therapy for the preservation, enhancement, or restoration of movement and physical function impaired or threatened by disease, injury, or disability that utilises therapeutic exercise, physical modalities (such as massage and electrotherapy), assistive devices, and patient education and training.

Chiropractor palpationWhat’s the difference between physiotherapy, osteopathy, and chiropractic?

There are many similarities between all three professions, i.e. they all:

  • Treat musculoskeletal pain conditions.
  • Use manual therapy or physical therapy, i.e. touch, to varying degrees.
  • Require University degrees.
  • Have protected titles.

In terms of differences:

  • The skill of an Osteopath is high in palpation.
  • The physiotherapist focuses on exercise prescription and is less hands on compared to osteopathy/chiropractic treatment.
  • Each use different hands-on treatment technique differs somewhat. HVT or HVLAT – High velocity, low amplitude thrust techniques – are unique to the profession.
  • Type and length of University qualifications: Osteopaths complete a four to five-year honours degree programme (bachelor’s or master’s), which involves at least 1,000 hours of clinical training. Some osteopaths are qualified to PhD level. Chiropractors’ 4-year Chiropractic Degree programme ensures completion of bachelor of human science degree completion. Physiotherapists complete a three-year full-time BSc (Hons) programme.

NICE Guidelines:

The National Institute for Health and Care Excellence (NICE) recommends:

  • Osteopathy as an effective for the treatment of persistent lower back pain.
  • Manual therapy that might include spinal manipulation (as practised by chiropractors).

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