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Back Pain Treatment

Joint mobilizations,..
With this in mind, my approach here would be to firstly use some passive care, such as spinal manipulation, mobilisation or various soft tissue therapies, secondly move into some specific rehabilitation and finally find something which the patient enjoys that will ultimately help them maintain the back health in the long term

Lumbago, General low back pain and non-specific low back pain.

Can we tell the difference between these or has the terminology just changed? Like spondylosis, osteoarthritis of the spine, degenerative joint and disc disease and age-related changes in the spine, the way we as professionals describe, explain and diagnose our patients has changed with time. Our terminology has become more descriptive so that hopefully our patients have a better understanding of what is causing their complaint.

Let’s define some terms,
Lumbago – pain in the muscles and joints of the low back (Google dictionary),
Non-specific low back pain – low back pain not attributable to a recognizable, known specific pathology (https://www.physio-pedia.com/Non_Specific_Low_Back_Pain)

General low back pain
When we talk about specific pathology, we are ruling out anything which would be considered more sinister, such as disc problems leading to nerve root irritation or sciatica. For this reason, when a patient comes to see us, we take a comprehensive case history about the presenting complaint as well as performing a number of physical tests, our goal at this point is take any pathology off the table as well as trying to build a clinical picture and try to identify what structures are involved. We will bend you, twist you, get you to bend and twist as well as a bit of prodding and poking, using neurological, orthopaedic and chiropractic tests. However even after all this it is still virtually impossible for us to say exactly what is causing your low back pain, hence the term non-specific low back pain. As a side note here imaging such as x-ray or MRI’s are not much better at identifying what anatomical structures are involved as a lot of the ‘abnormalities’ which are seen on these are part of the normal aging process (Brinjikji, Luetmer et al, 2015).

Time frame is also worth discussing at this junction, acute being short term, up to 12 weeks and chronic, long term beyond 12 weeks, however this may vary depending on what definition you read and please note these have no relevance to severity of the complaint. It is worth noting that how we approach acute problems and chronic problems may vary considerably, this is because a number of changes happen when pain has been present for long period beyond the time tissue healing usually takes and is a whole other blog topic!

With all these factors in mind, can we still help you? Yes, is the short answer and we have a number of options for this, firstly as the study below concludes we can use a combination of manual therapies, and exercise, or, one or the other,

Stabilization exercises were as efficacious as manual therapy in decreasing pain and disability and should be encouraged as part of musculoskeletal rehabilitation for low back pain. (https://www.sciencedirect.com/science/article/pii/S1466853X16300712)

Alternatively, as this article suggests exercise alone can be effective and that exercise does not need to be anything specific.
The authors conclude that evidence from randomised controlled trials demonstrated that exercise therapy is effective at reducing pain and function in the treatment of chronic low back pain. There is no evidence that one particular type of exercise therapy is clearly more effective than others. However, effects are small and it remains unclear which subgroups of patients benefit most from a specific type of treatment. (https://www.sciencedirect.com/science/article/pii/S1521694210000033)

With this in mind, my approach here would be to firstly use some passive care, such as spinal manipulation, mobilisation or various soft tissue therapies, secondly move into some specific rehabilitation and finally find something which the patient enjoys that will ultimately help them maintain the back health in the long term (see ‘what we are trying to achieve with our patients’). This is an important point as we do not want to create chronic rehabbers, those people who do the same ‘rehabilitation’ day in day out, which gets boring and so they eventually stop, so finding something you enjoy, and it can be anything from rock climbing to wrestling to ball room dancing will help keep you moving, active and strong!

Brinjikji, Luetmer et al, (2015) Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 36(4):811-6. doi: 10.3174/ajnr.A4173. Epub 2014 Nov 27