Best Treatment For Lower Back Pain

Issue 41

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Back pain is such a common occurrence with more or less everyone experiencing it at some point, but for those with repeat episodes of lower back pain or sciatica it would be useful if there was a gold standard for treatment they could aim for. This article will work somewhat as a checklist against which you can grade your current back pain treatment, does it hit some, or all of these points? If so, you’re onto a winner! 

First off, lower back pain is a multifaceted problem. An injury in the first instance, maintained by the simple fact that so many are grossly inadequate in the conditioning department, we do not maintain a healthy body. Granted some will be regular exercisers, perhaps running or cycling, but often in these cases there is next to no full range of motion movement taking place developing the health and function of the joints. We could pick these apart but that’s for another day. The diagnosis remains a lower back injury, where recovery is blocked by numerous lifestyle and wellbeing factors. 

What Does A Back Injury Look Like?

Every so often in the clinic we would hear patients proclaim their back pain was the toughest, and they’d even seen the late Queens doctor who couldn’t help them, this is not hyperbole, more than one person has actually stated this in the opening of a consultation. The problem is that these individuals wear their back pain as an identity, and its permanence a badge, something I would seriously discourage anyone from falling into the practice of, for a whole host of very real psychological reasons.

Our minds are very powerful and our outlook influential in the extreme. A brief look into literature on placebo and nocebo will open your eyes to this.

Back to the topic at hand…

An injury means damage

A back injury, regardless of the diagnosis, is an injury, meaning something got damaged. In the case of the low back, this is nearly always failure to resist compression by the disc, and the associated ligaments on the back of the spine failing under stretch loads.

Damage by compression

Your back is built to bear load and when it fails to bear load things become injured. Granted there will often be muscle and ligament injuries too as everything works together. The primary injury however is done in compression, and as this tissue is recovering, compression will repeat the original insult.

Secondary muscle spasm

As the injury to the back takes place signals will travel to muscles around the low back to create stiffness. This is no different to if you twisted your ankle, your hamstring and hip flexors on that side would tighten up to elevate your ankle slightly, in spite of being nowhere near the injured ankle.

Joint stiffness

Adjacent spinal joints and sections, for example, the upper lumbar spine, the thoracic spine and the hips will all often become stiff from the muscle spasm and any secondary signals that are traveling from the injured site. In addition to this, short term postural changes associated with pain will also result in pockets and regions of stiffness developing.

Weakness in musculature & poor movement

Quite often the individual with low back pain was lacking in muscular development and strength, they have core weakness and general power movements such as a squat or hip hinge are significantly weaker than they should be. Through lack of practice or skill there is often poor movement and technique to go alongside this making an injured structure now more vulnerable. 

Unfavorable daily practices & routines

This injury is all the more maintained by the 9.5 hours a day spent sitting in some form of chair, in the office, in transit or at home. There is nowhere near enough in the way of daily exercise and the flexibility & health of the body in general has been far from acceptable. 

We can all get injured at any time, and many do have minor injuries and recover within a day or two never to be troubled again. However, back pain is one of those injuries that catches out the average person an awful lot more, as it is the average person who suffers from it most, not the sports person injuring an ankle, or shoulder. The average person is not conditioned like the sports person, and does not have the support network that even local rugby clubs in the UK have, with many having team physios at least in some capacity, alongside an understanding of the importance of early intervention and support. 

When it comes to seeking treatment for low back pain, we know a thing or two, having developed our clinic in the past and had real success with the most challenging cases of back pain. Nowadays, when members ask us about treatment to support their hard work in the program, we would always consider these treatments to be the gold standard and ideally all of them together for completeness.This will all become obvious as to why as we move through the rest of the article.

Healing The Damage In Your Lower Back

Traditionally healing takes place at a set pace, the health of the individual will influence this heavily. Healing certainly does take its time with some tissues healing faster than others. We won’t get into the stages of healing specifically other than to say that although it is difficult to speed up healing times, it is very easy to slow them down. 

Regular aggravations and injuries for starters are certainly unhelpful with the healing process being constantly disrupted. Imagine trying to rebuild a house only to come back to site every couple of days with a few doors missing, broken windows and bricks from the supporting wall that have been stolen. When it comes to healing and supporting this, good nutrition and adequate calories and protein are going to go a long way. Reductions in excess sugar intake alongside proper hydration are all simple fundamentals that are so commonly missed by those struggling with back pain. 

Treatment specifically in this department will fall into two categories. The first is the indirect. There are many treatments that will increase circulation to the target area by virtue of things happening in the vicinity which all could be considered to “improve healing” but these are simply helping normal healing take place and one could make the statement that exercise would be an equal vector for increasing circulation compared to a standard osteopathic, chiropractic or massage treatment in this specific department.

There are however other treatments out there that could be used, stem cells and PRP injections are both therapeutic interventions that could be considered as increasing the healing capacity of the injured site, worthy of consideration here. 

In our experience we found Class IV Laser therapy specifically to be a great option that worked very well for patients due to its non-invasive nature and ease of use for anyone in any position. A real life-saver of a treatment for those in such tremendous pain movement is a real challenge. This was one of the 4 core treatment modalities we used in our clinic days. It is worth noting that “Laser therapy” can mean lots of different things and the specifics of the machine being used is important, as well as distinctions between types of Laser, for example, there are many Class III lasers which are so weak it could be considered to be no more effective than standing in the sun for an hour or so – although perhaps if you’re in the UK that might be a worthwhile option considering the absence of the sun!

Unloading Compression Through Your Lower Back

This one sounds simple, just stretch or hang, however control for those with real back pain is important. Simply hanging from a bar is a strong pulling force that is then immediately ceased followed by a spike in compression, not helpful. There are good ways we can offer some decompression to our lower back and the towel exercise is a staple for those in the program, however when it comes to treatment there are some options too! We found the IDD therapy spinal decompression to be the best option for patients, as the forces can be dialled in really nicely, repeatable and reliable as a result. On top of that, the ability to lower a patient to lying down from standing, and then raise them back up after treatment is a wonderful thing.

You could consider that your osteopath or chiropractor with their manual treatments might “decompress your spine” by pulling, but this is like trying to use a carrier pigeon instead of sending a text! It’s not measurable, it’s not repeatable, it’s not sustainable and it’s likely not possible to get up as mentioned above. That is not to knock these treatments, techniques we relied on in years gone by, but we’re talking about the Best treatments for back pain. 

Alleviate Spasm & Stiffness In Your Muscles

Ultimately stretching can be helpful, as can massage, however we have found that the vibration guns, when used correctly offer the best way to interface with these muscles and complement this treatment process. Using the guns, you’re not required to move, there is no need for inordinate amounts of pressure and they can be dialed up or down depending on tolerance at the time. 

Quite often the action of needing to apply direct pressure to a person or use movements to help massage technique can be problematic especially when in a lot of pain. Massage guns are of course ideally used with the patient lying down, however in some instances they must be used in order to help get the patient to lie down! And you simply cannot do that any other way. 

In addition to this, with advances in technology and commerce, the average person can now very easily invest in massage guns to work on their own body at home. Granted there is a big difference between doing it yourself and having a professional do the work, but if faced with a choice of something or nothing, it can be really helpful and a beneficial long term investment.

Joint Stiffness In Your Lower Back

Between the different manual practitioners there are so many different means of mobilizing areas of the body. As mentioned earlier the stiffness in other areas as a consequence of the injury to the lower back only serves to disadvantage you. Having these other areas work as well as possible is always a help in the short to medium term. Your right in thinking it is temporary, however, as you move along the healing and recovery process, the effects of such mobilisations will become more lasting. 

The common spinal mobilisations are the cracking or popping of the joints, termed spinal manipulation. These are great techniques, however they do have their limits and some find them simply too unpleasant as patients. Additionally, when in severe low back pain, it can be difficult to endure the positions required for such adjustments and a stiff uncomfortable patient is one who’s more likely to have a bad reaction. 

This is why we moved to using adjusting instruments alongside movement, a way of helping the spine move more freely without the rapid movements or uncomfortable positions for the patient. 

A Collection Of 4 Of The Best Treatments For Back Pain Combined

When we used to practice in the clinic, we combined these therapies and more, which is what we’ll get onto next, but we firmly believed that helping the back in all four ways simultaneously was what made the difference. All too often you’ll have one or other of these modalities, or inferior alternatives. This is a mistake as by combining all four you can have the greatest influence in someone’s lower back for the better, we coined this approach The Mayfair Method which was featured in the Daily Telegraph in the summer of 2018. 

However, as great as this combined approach is, we cannot ignore these next two. Treatment might make up an hour or two each week, but of the 168 hours each week if you do not work on these next points you will not have long term success – there are no shortcuts!

Weakness In Your Muscles, Joints & Body In General Is Holding Your Back Hostage

Ultimately this is what keeps your back well between treatments and long after you finish your treatments, no matter what they are. This was also an area we covered in the clinic however nowadays the robustness we’re able to offer our members is far superior and funnily enough results seemed to follow this!

It is not negotiable, you should be able to squat completely, have good hip mobility and strength and be able to do simple split squats amongst other exercises, with reasonable weights. Without this ability you will forever be vulnerable, your joints weak and you’ll fulfill that prophecy of having bad knees and hips to compliment your bad back.

The reason they’re bad is because you don’t look after them, and that doesn’t mean protect them by not using them, that means working them properly, over your lifetime with good form!

Too many struggle with recovering from back pain whilst simultaneously being unable to squat with reasonable form to the level of the everyday dining chair. This is shocking.

With this in mind an imperative adjunct to treatment would be the partaking in a proper resistance based rehabilitation program to rebuild your body, this is what members of the Back In Shape Program are doing. 

Given our experience in both a clinical setting, and an exercise only setting, one thing is clear, you can do exercise without treatment and get results, but you cannot get results that last with treatment and no rehabilitation exercises. 

Daily Habits & Movements Are Stopping Your Back Pain From Recovering

We’ve discussed treatment and we’ve discussed exercise, both can be hugely impactful for your lower back pain, or any injury for that matter. However, when it comes to back pain you are the problem and how you use your body on a daily basis, what’s more, you probably don’t even know what you’re doing, but that needs to change.

Ultimately education and guidance are the real keys for this part as you don’t know what you don’t know. However, I’ll tell you now, doing something about that 9.5 hours (average) you spend sitting – reinforcing the back injury – is a good starting point! The fact is, as you start to understand your back more, and progress through your rehab exercises, you will begin to apply the lessons, skills and strength from your rehab exercises, to your daily life. When loading the dishwasher, you’ll be more mindful of how you do it, lifting things will be done more ergonomically and so on. 

You might think this all sounds quite boring, surely I can just carry on and be fine? WRONG! This is no different to the child that is told to stop skidding every time they break on their bike, or stop scuffing their heels. Sure you can do it if you want, but you are being inefficient and sooner rather than later, someone is going to have to pay for it in the form of new shoes or a new bike tire.  Don’t be stubborn or childish like this example, change the way you do things and within no time the old habits will be gone, and new back friendly ones will have taken their place!

The education side of back pain, or more appropriately, back health is so important and it is often ignored. This is one of the major areas of the Back In Shape Program that we’re proud of. These days, we’re able to support the ongoing education of our members, as well as their rehabilitation in ways we never could have in our clinic days. Granted the use of those amazing therapies and our “Mayfair Method” was, and from what we’ve heard, still is, the best treatment for back pain out there, you really cannot go without the rehabilitation and support that should go alongside any clinical therapeutic visits. 

If you’re interested in learning more about becoming a member of The Back In Shape Program, check it out below.

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