Back Pain

Back pain is the single biggest problem facing most people today. So – what can you do about it? Most often people are researching this topic AFTER they are sore, and need help.

1. Back Pain Causes

There are so many causes of back pain.

But you can categorise back pain into just a couple of actual causes:

• Structural Causes
• Referred Causes and
• Emotional Causes.

Let’s look at these in a bit more detail, to understand how the brain interprets pain, and tells you it’s “from your back”.

Structural causes of back pain

What this means – is there is an issue with one or several of the structures that make up your spine. The structures are:

• Muscular causes of back pain
• Joint causes of back pain
• Bone causes of back pain
• Ligament causes of back pain
• Disc causes of back pain
• Nerve causes of back pain and
• Lymphatic System

That’s it.

If the cause of your pain is what we call “structural” this means that one or a combination of the above structures are functioning in a way to give you pain. Pain isn’t always BAD.

Pain is simply your brain’s way of saying “change something”…

In each of the above structures there are so many actual possible diagnoses for back pain, depending on the reason it’s there.

For example, you might think you’ve got a “muscle” pain, but really, you might just have a stiff joint between a rib and a vertebrae. But it will FEEL like a muscle pain.

The only true way you can find out is by getting assessed by a professional, who understands all of the above in detail.

You can look up and find some self help videos, or other information, but it’s (usually) so much faster seeing an Osteopath or other allied health practitioner.

Despite what you might have heard, or think…

Your back doesn’t go “out of place” and it can’t be “put back in”.

It’s not that simple, actually.

If your back is stiff, there’s always a reason.

Referred causes of back pain

Your brain can interpret pain as being from the spine, but sometimes, it’s actually referred from somewhere else in your body.

A detailed case history and assessment allows most practitioners to gauge whether or not this is the case.

Referred pain can be felt in the spine or close by from structures such as:

• Reproductive organs (especially in women)
• The stomach/intestines
• Gall bladder
• Heart
• Lungs

If your practitioner only looks at the site of pain, they’re lost

Emotional causes of back pain

This will seem like a strange one, but emotions and stress have an enormous impact on pain states.

It’s very very common for people to be in a state of anxiety, or depression and these can literally affect how your brain interprets pain, potentially making things worse.

There are so many possible individual reasons for stress, but they come down to two main types:

• Stress that’s out of your control
• Stress that’s within your control

It’s very easy for practitioners to miss the signs of stress as being a possible cause, or aggravating factor behind back pain. We see it all the time, and it’s greatly satisfying when someones pain is significantly reduced with correct medication from their Doctor, or dietary and lifestyle advice from other allied healthcare professionals.

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2. Back Pain Assessment

In the presence of a skilled practitioner, back pain assessment should be very thorough.

Put simply, if your practitioner ONLY looks at your back, they’re LOST.

There are so many reasons why your back pain could present – and many times they’re unique to YOU.

Back pain assessment typically revolves around a few simple concepts:

1. Active Range of Motion (i.e. “you” moving)
2. Passive Range of Motion (i.e. “us” moving you)
3. Orthopaedic Tests (special movements that indicate pathology)

Obviously, if you’ve had a specific injury – it makes sense to really assess the spine, as the injury location itself, could have a pain causing structure that’s at fault.

If the cause of the pain you have is “structural” in origin, then you’ll show signs and symptoms that match this.

But this is definitely not always the case.

For example, chronic pain is often completely different to acute pain. There are more “reasons” for that pain to be there.

You’ll “feel” pain in the spine, but the reason it’s there isn’t necessarily from an injury.

That’s the job of a skilled Osteopath or allied healthcare practitioner. To figure this out for you.

Active range of motion assessment

What we’re looking for is simply “how” you move yourself. We’re not helping you. We’re just asking you to do the action.

Can you easily do simple things, like bend forward, bend backward, rotate?

Does your ability to do this match what you mentioned in the history we took?

Usually, if there’s an issue with movement, there’s a related structure that is where you’re feeling the pain or discomfort.

For example, you rotate your back, and you feel pain centrally.

Passive range of motion assessment

When a practitioner takes e.g. your arm through a range of motion, but you’re not helping them, they’re actually trying to assess the structures that don’t contract.

Things that don’t contract like the joint itself and ligaments as opposed to things that contract (like muscles).

This is important – because if something hurts when you contract it, there’s a high chance the problem is muscular or where the muscle inserts onto tendons, or where the tendon inserts onto the bone.

Most of the time, there is a combination of things going on, and they’re all interrelated.

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3. Back Pain Diagnosis

The diagnosis of back pain can actually depend on many factors, including:

1. The history you give the practitioner
2. The practitioners background and experience with back pain
3. The practitioners examination/assessment technique
4. The pathology you have (if any)

The history you give the practitioner

It’s a combination of all the above, that helps the practitioner arrive at a diagnosis for you. Sometimes, a diagnosis isn’t actually truly possible.

Sometimes your back pain may be “non-specific” which means there’s no easy way for us to tell what’s really causing it, other than an educated guess, based on all 4 points above.

A well versed practitioner can ask questions from you to help you give an accurate account of what’s going on, and why.

The practitioners experience

Osteopaths are extremely well trained in taking a very thorough case history. Before they’ve left their 5-year full time training courses, they’ve been extensively examined by various practitioners including GP’s on history taking, and physical examination.

The rigour of the training gives even a newly graduated Osteopath a very good background in a lot of clinical presentations, which gives them a very good “experience” level – even straight out of University.

Experience does of course help, as the practitioner may have seen the same, if not similar presenting complaints in a wider variety of people.

This does not necessarily mean that experienced practitioner will solve your problem any faster though.

The practitioners assessment technique

There are a number of ways that clinicians such as Osteopaths can assess you.

Most often – the practitioner has a movement sequence of some kind that they follow to help guide them towards a diagnosis of some kind.

But overall, who ever you’re seeing for back pain assessment and treatment, they must go through a varied series of movements and tests to try help figure out what’s going on.

Any pathology you have

Every practitioner knows that the incidence of back pain in the general population is incredibly high, and the reasons for it being there are incredibly varied.

Of course, there are several pathologies that can be the real reason for the pain.

It’s in times like this, that your practitioner should know to refer for further examination and tests to exclude these pathologies.

On occasion this might involve blood tests, or diagnostic imaging such as X-Ray or MRI.

Sometimes you need diagnostic imaging

Here’s a fun, but little known fact:

Not all back pain needs imaging, MRI’s or X-Rays

Sometimes yes, but mostly no. In fact, there’s evidence to suggest that your back pain treatment outcomes are made WORSE by having an image.

But again, this is not always the case. We believe the only reason you should have any imaging like X-Rays, Ultrasounds, and MRI’ or CT scans is if it’s going to change what we do, or change what we suggest, which could lead to a better outcome.

You should not have X-Rays as a matter of course.

You do not need X-Rays taken of your spine just to see “how straight” it is.

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4. Back Pain Exercises

The exercises that are given to people with back pain should have several goals:

The first is to not make the back pain worse.

This sounds simple, but time and time again, we see people who’ve been told by another practitioner “do this” – and they comply.

The problem is, the exercise makes them worse, but they keep on doing them – which keeps making them even worse, until they see a practitioner who has some idea of WHY their pain is there…

So there are no one stop generic back pain exercises that will solve all back pain. Life would be easy of this were the case!

Instead, your back pain exercise needs to match what you’ve got going on, and help guide you away from pain, not towards it.

Most people don’t realise that it’s in fact very rare that the actual spine itself needs major strength improvement for back pain to subside.

Very often – the back pain (if related to weakness) is there because of another structure such as the gluteal/butt muscles being weak.

Can Pilates or Yoga help back pain?

The answer is yes it can, but ONLY if the exercises comply with what your brain actually WANTS… and unless this matches, you’re going to have difficulty.

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5. Back Pain Relief

The ultimate question.

How do I get back pain relief?

Relief comes to the brain when it’s allowed to eliminate or reduce what it sees as a “threat”.

If there is a pathology, such as a disc prolapse, your brain sees this as a “threat” and will give you PAIN to try and force you to move differently, or slow down.

Pain is there for a reason.

Your brain is in control folks.

If it’s getting feedback that tells it there’s an injury, it automatically goes to work to help heal that injury by creating pain, inflammation and swelling.

But sometimes the signals get mixed up.

Sometimes the brain doesn’t tell you that things are completely fine, and you still feel pain!

Ask anyone with chronic pain.

You can have a perfect MRI or scan, and be in worlds of pain in the same way that you can have a very ordinary MRI or scan, and have no pain.

In order to get pain relief, it is best done by a practitioner that understands most of the reasons why the pain is there.

Often it’s only when you do a combination of exercise, massage techniques & manipulation, meditation, improving your gut health.

Be wary of the single focus practitioner.

But be wary of the practitioner who ONLY does manipulation.

Or ONLY does exercise. Or ONLY massage.

What if you need multiple angles to get yourself as good as possible?

Very rarely, surgery is a last option in back pain treatment.

This is only is exceptional circumstances, and thankfully, not as common as it used to be.

There’s a growing body of evidence to support non invasive techniques to assist back pain, unfortunately, the scope of how these studies are done is limited.

There are so many variables that go into back pain, that excluding these variables to get reliable, quality test subjects, is something that is very difficult to obtain.

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6. Back Pain Prevention

You don’t realise you need to work on your back, until it starts giving you grief.

People take it for granted.

But you really should look after it… It’s the only one you’ve got!

So how do you do it?

The simple stuff is best, actually. Do the things that make you human.

Things that help your back are:

• Strength exercises
• Mobility exercises
• Good diet
• Good sleep
• Less stress

For most people, the above list is a form of unobtainable utopia.

But most people can obtain a decent degree of the above… It’s just they prioritise one thing over another, at the expense of their back.

But at the time, their back may be completely fine.

Until they lean over and put on a shoe, or something simple that they’ve done a thousand times.

Then and only then do people think they should have looked after themselves

Can you benefit from Pilates? Sure. Possibly.

Can you benefit from Yoga? Sure. Possibly.

Can you benefit from Keiser Physiotherapy? Sure. Possibly.

The main thing you can benefit from is adopting a proactive mindset, and prioritise YOURSELF.

There’s only one you, one spine.

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7. What Can An Osteopath Do For Back Pain

Osteopathy has been around for longer than Chiropractic, and longer than Physiotherapy.

Like Chiropractors and Physiotherapists, Osteopaths have decent training. 5 years of 30+ hour weeks in-fact.

It’s not a 5 minute long course.

So Osteopaths can take a very good holistic view of your body.

You’re not just a spine.

You’re not just someone who is prescribed this exercise or that exercise like everyone with a back problem is.

The reason Osteopathy has become more and more popular over the years is because we must do something different that other allied health professionals do not.

The anatomy is the same.

The physiology is the same.

So what does an Osteopath do that is different?

It’s very hard to describe, and to a degree, we’d hope that there is a a large “overlap” between what we see as normal, and what other practitioners do.

For starters, we don’t see you as a “number”.

You’re an individual.

We listen to you.

We try to gather as much relevant information as we can to assist us in helping you in the fastest way possible.

This means that we can more accurately help guide you out of pain as far as practicable.

Keeping in mind that pain is a very “subjective” experience, something that you and only you feel.

We help guide people away from pain, and towards health.

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