Back pain is a major health issue costing the country and the health service billions of pounds every year. Musculoskeletal disorders are one of the leading causes of sickness absence, which it is estimated costs the UK economy £15bn annually.
Approaches in treating back pain have changed radically in the 34 years that I have been practicing, both from a surgical medical and manual therapy perspective.
Hopefully as further research progresses, we can make further inroads and further refine management of this, affecting people on not just a physical level but affecting their mental and social health having huge effects on quality of life.
During my time as an osteopath, I have seen approaches to back pain change in both the medical and manual therapy world, from bed rest and plaster casts and bed rest to sclerosant injections, steroid injections and epidurals to the current models such as chronic pain injection – spinal blocks, denervations and botulinum injections.
Similarly manual therapeutic approaches have changed. Physiotherapists several decades ago were renowned for electrotherapy (interferential and ultrasound and exercises), osteopaths and. chiropractors were still using predominantly showy ‘adjustment’ techniques to pop or click joints on the basis of ‘putting joints back’.
How things have changed. I feel now that the spectrum of techniques by all manual therapists is so much broader, often with much overlap between the different disciplines, making differentiation between them increasingly hard to define. Many physios, on the whole, are more hands on, whilst osteopaths and chiropractors have embraced the role of rehabilitation and exercises as part of an exercise programme. Both are now using devices such as shockwave therapy and laser, along with using western medical acupuncture.
For me one of the most significant changes in the last decade is the movement away from concepts like ‘joints out of place’ and ‘strengthening the core’ for the majority of back pain sufferers. The emphasis is now placed on the stage before strengthening to focus on how the relevant parts of the body function in relation to a patient’s lifestyle and activities. Subtle changes in movement patterns can have significant impact on reducing pain, while improving function without, in some cases, even having to use strength training.
I always remember Roy Palmer our Alexander Technique teacher saying to me…. ‘the problem with training for strength is that if the muscles are not being utilised correctly in the first place, then rehabilitation to increase strength just gives the patient a stronger set of muscles to carry out the same function even more inappropriately.’
How right he was! My own personal experience of running the marathon the first time in 2015 left me shortly after completing it (not with back pain) but with a reactive tendinopathy in my achilles. We’ll look more at this in another post.
But for now, it’s worth remembering the line from Bananarama and Fun Boy Three song – ‘It ain't what you do, it's the way that you do it.’ If you spend hours a week either running, training at the gym, or playing your sport, ask yourself, ‘How am I moving?’ You could be using your muscles in a way that makes your movement inefficient and places undue stress on your body. But the million-dollar question is… how do I know?
Watch this space :0)