Many of our clients visiting the clinic suffer some form of back pain. Some come to us after trying various treatments from other sources with little relief. In this article I wish to share an insight into the assessment and treatment of a particularly challenging back pain condition.
You don’t find any particular movement makes it worse but things like sitting and standing for long periods leave you feeling stiff and awkward.
Your back muscles feel very tight and are very sensitive to touch – you’ve tried a massage but it makes you feel worse.
Your sleep is not great, you feel grouchy and irritable, maybe a bit depressed and fed up with life wondering if this pain will ever go away.
Your relationships with others might start to suffer as your behaviour becomes more erratic and unpredictable.
You become fearful of movement and feel you are losing fitness and an ability to physically interact with the world.
Finally, you have been to see a physiotherapist who has told you that your spine is unstable and prescribes complex strength and stability exercise which only make the pain worse or have no effect at all! Then in final desperation you see a back specialist who does an MRI and finds no significant structural pathology (cause & effect), leaving you unsure of what to do next.
If you are suffering in this way, you are not alone according to Prof. Peter O’Sullivan of the School of Physiotherapy at Curtin University, Western Australia. He and his team of researchers predict that up to a third of back pain sufferers fit this profile but what can we do about it?
A clinical examination often reveals very tight overactive back muscles which are very sensitive to touch and do not allow for easy, relaxed movement. More often than not clients will be sitting bolt upright because they have been told that there posture is poor – this makes them very rigid and tense, often too around the neck and shoulder area.
Avoid starting with strengthening exercises which add more ‘tension’ to an already wound up, overactive muscular system – what’s the point in trying to make muscles which are already working too hard, work harder?
Instead, exercises should be geared towards helping the muscles relax and wind down – gentle walking or other cardio exercise can be good for this, especially when done outside while listening to some relaxing music. Other techniques may include relaxation and breathing exercises, visualisation or ‘body scanning’ techniques, looking at movement control strategies - how to move well in your environment, as well as receiving guidance on appropriate attitudes and beliefs towards pain and coping strategies.
There is also growing evidence to support cognitive behavioural strategies, that is changing how we ‘think’ about pain. These techniques have been shown to affect how the central nervous system functions which can in turn reduce muscle tension, ease pain and allow people to cope much better.
Surely a good deep tissue massage is all I need to push the pain away?
Well, as mentioned before this can either make you worse, or only temporarily improve your condition for a few hours. There are hands on techniques that can be used to support those mentioned above, but they must be performed very carefully and at the correct ’dose’ to have an impact.
One such approach is referred to as NST (originally and osteopathic technique) which we use here at the clinic to good effect – but it does take time and patience is needed!
Another technique which may also help wind down the central nervous system is medical acupuncture. Read more about the benefits of medical acupuncture.
Occasionally some supplemental medication may be needed to help get the ball rolling. What approach to take is always guided by the assessment findings of a particular individual, no two back management programmes are ever the same.
At the end of the day, our goal is always to try and help alleviate pain, improve a quality of life as well as trying to provide ways to help the back pain sufferer cope well without developing an over reliance on therapy or the medical system.