Osteopathy and Low Back Pain

spinal stenosis

Over the course of our lifetime more than 80% of us will suffer at least one episode of low back pain that will last for more than 2 weeks. When this occurs we are often at a loss regarding what we should do and how we can regain our health. This article will identify structures that cause pain and advise on what we can do to prevent it worsening or reoccurring.

I graduated as an osteopath in 1999 from the British School of Osteopathy in London following a 4 year full time degree in osteopathy. I'm currently in practice in downtown Vancouver. During my training and subsequent practice I have observed that osteopathic treatment can be very beneficial in the management of low back pain. In fact I often describe it to my patients as the bread and butter of my business as it is such a common presentation.

When a patient presents with low back pain I will be considering the following structures that may be causing the pain:- muscle, ligament, disc, nerve, bone or joint.

Muscle pain may be due to local injury or trauma caused by overstrain whilst exercising or lifting. Muscle pain can also be caused by chronic hypertonicity of the intrinsic and extrinsic muscles of the spine as they compensate and protect another injured structure.

The posterior spinal ligaments can often be strained due to poor lifting technique or damaged in the long term by poor posture and prolonged slouching whilst sitting.

Our intervertebral discs take an enormous amount of trauma over the course of our lives and they can be damaged leading to mild injuries such as a disc bulge to the more serious, a full herniation. The intervertebral discs are commonly injured whilst lifting poorly when we combine spinal flexion and rotation which causes a shearing force on the disc fibres causing them to tear. At different times of our lives we are prone to different types of disc injuries from the late teens and early twenties when our discs are at their healthiest to gradual degeneration and wear as we age.

Nerve fibres are often damaged by surrounding structures such as the disc and bone. There is a very limited space in the intervertebral foramina where the nerve exits and any space occupying lesion can lead to nerve root irritation and pain. Most commonly a herniating disc will protrude and touch the nerve causing pain. As we age and our discs naturally degenerate this can lead to spondylosis a decrease in disc space which in turn allows the spinal joints to proximate which leads to wear and tear which may impinge the nerve. When a lower lumbar nerve root is impinged typically we will get pain into the posterior part of our lower extremity and into our foot. Typically when the L5 disc herniates it impinges on the L5/S1 nerve root giving pain into the lower extremity. When the nerve is injured it can produce pain, altered sensation such as numbness or pins and needles, muscle fatigue or weakness. In more serious cases a serious complication known as cauda equina can develop which causes pain in the lumbar spine, saddle anaesthesia (numbness around the groin and genital area) and urinary incontinence. This requires immediate surgical decompression as prolonged pressure on the nerve that supplies the bladder can lead to permanent incontinence.

As we age there can also be a narrowing of the spinal canal which leads to spinal stenosis. This can restrict the spinal cord and cause symptoms usually bilaterally into the lower extremity.

Bone can produce pain in a variety of ways. There can be fracture pain from either trauma or perhaps in old age pathological fracture due to osteoporotic change. There can also be congenital malformations of the spine such as spondolisthesis or spina bifidae which typically affect the lumbar spine. Finally and most seriously bone pain in the spine can be caused by metastatic growth or secondary spinal cancers, this however is rarely a presenting symptom.

Lumbar spinal joints can also cause pain locally and referred pain into the lower extremity. Joint pain is caused when the joints are forced together in hyperextension or in old age when due to disc narrowing they proximate. As the apophyseal joints between each vertebrae are pain sensitive pain and discomfort occurs when they are forced together. This is a major cause of arthritic pain in the elderly.

So that's the bad news, what about some good?

Well osteopathy can help most of the conditions above. On your first visit to an osteopath they will take a detailed case history regarding your low back pain and general medical history. This will help to form a diagnosis and also exclude the possibility of any serious pathology. In a small number of cases an osteopath may refer you to another specialist if indicated for further testing.

After the initial assessment an osteopath will usually examine your posture to determine any areas that may be causing strain on the low back. They will also use a highly developed sense of touch known as palpation to assess tissue health. The next step is to examine a patients range of active movement to see if there are any restrictions.

Once a diagnosis has been made the treatment begins. This will usually involve a variety of hands on massage techniques along with spinal mobilization and manipulation if indicated. The treatment is not usually painful but there may be some discomfort during and after as the tissues are mobilized. Osteopathic treatment will focus on improving the blood supply to tissues to help them heal and also releasing the surrounding structures which may be preventing effective functioning.

Following treatment to the lumbar spine an osteopath will usually give advice on exercise and ergonomics. I usually give my patients the following advise following treatment:-

1). If there is pain and discomfort following treatment do not be alarmed as this is normal. In some cases anti-inflammatory or pain killing medication may be beneficial.

2). If there is pain icing is beneficial in the first 48 hours following treatment or injury. After this time I usually recommend contrast bathing (5mins hot, 5 mins cold, 5 mins hot, 5 mins cold, 5 mins hot) on the affected area to improve fluid drainage.

3). Keep up and mobile don't go home and lie down or sit for too prolonged periods.

4). Gentle exercise such as lying flat and bringing the knees up to the chest and gently rocking can help mobilize the spine.

In the long term I will be looking to improve my patients overall health by encouraging them to exercise more. By working on our abdominal muscles and improving core stability some back pain can be relieved. I will also spend a great deal of time discussing ergonomics with them, how they relate to their environment be it at work or at home, and how they can maintain their pain free state. Periodic treatments may also be beneficial in certain circumstances.

In conclusion should you find yourself suffering from low back pain consider osteopathy with a well qualified practitioner as it is safe, simple and effective.