Low Back Pain
Article by Steven Goodacre
Matt Roberts City
November 2011
A functional and modern approach to dealing with low back pain.
Low back pain can be defined as ‘pain, tension or stiffness, localised below the costal margin and above the inferior gluteal folds, with or without referred or radicular leg pain (sciatica). 1 According to research low back pain is suffered by 80% of the adult population at some point in their life and at any one time, 14-49% of the adult population will be suffering from back pain. In 85% of cases there is no clear pathology for the injury either. Of the people that have suffered low back pain only 7% will develop chronic pains, however this minority group accounts for 80% of social and health care costs. The NHS spends over £1 billion a year on back pain, whilst the private sector outlays £565 million a year, bringing the total expenditure to around £1.6 billion. These figures do not account for the indirect costs which rise to between £590 - £624 million, the 5 million lost work days and the fact that on any one day 1% of the population are absent from work due to back pain. As we can see lower back pain is a very big issue. That considered we must assume that either we are naturally predisposed to spinal problems or alternatively we are, on a large scale, doing something to cause these problems. In less resourceful and less affluent countries than the UK, the incidence of low back pain is far lower. Is this just coincidence or is there something we can take from that?
So what causes so many of us to suffer from low back pain? When we look at the causes for injury it is a good idea to search for some common linking factors that can be seen amongst the majority of sufferers. This is what we find:
If we work through these common factors we can see that individually they do not seem particularly likely to damage the lower back, all of these activities or situations have been encountered before. We need to get to the root of why such a seemingly unharmful situation can cause this injury. Before we get there let us have a look at how we commonly treat this injury. The most common process is to visit our doctor where the most likely outcome is to be told to rest and be given a prescription for some anti-inflammatory or pain killers. This will have the effect of reducing or removing the pain, however it is only masking the pain. So ask yourself, ‘do I have a bad back due to a lack of anti-inflammatory or pain killers’ the answer is a definite NO. Other treatment methods include the use of a weights belt or a lumbar support. Whilst there is an argument for the use of both of these treatments, again ask yourself if you are injured due to a lack of a weights belt? The answer is a definite NO. We need to look deeper into what exactly is causing the low back pain on such a large scale, we can do this by assessing the body on a biomechanical level and seeing just how well equipped it is to deal with the demands of our everyday activities. This assessment can be performed by the widely accessible collection of specialist practitioners. The specialist practitioner will set you back a minor sum of money, less than you would spend in a restaurant on a meal, but what you get in return will far surpass your outlay.
A functional approach to treating low back pain requires finding the root cause of the injury. We are able to do this by taking logical, methodical steps backwards from the injury itself. Assessing the body physically from top to bottom, we use a few specialist examinations. Firstly a plumb line assessment should be performed. This will show us how well balanced the musco-skeletal system is at rest. By comparing the results as deviations from ‘ideal’ posture we can see which muscles are short/overactive and which are long/weak and where there is undue stress being placed on the skeleton. A further biomechanical assessment in the form of a ‘movement screening’ will test the integrated functionality of the musculoskeletal system through primal movements such as squats, lunges, pushes, pulls, bends, twists and gait. The movement screen will tell us how the muscles work with each other, allowing us to see any biomechanical deficiencies that can be the cause of the low back pain.
A final physical examination can give us a more detailed insight into what stresses are being placed through the thoracic, lumbar and cervical spine and pelvis. By performing specific joint measurements on the lumbar and thoracic spine, measuring head carriage and pelvic tilt we obtain some detailed information as to what pressures are being placed on the intervertebral discs, the respiratory system and the inner and outer unit core musculature.
With the body in ‘ideal’ posture all of the muscle systems, joints and dynamic functions will be optimally balanced. This means that all of the body’s joints will be in optimal alignment, reducing the stress placed on them and on the articular surfaces that surround them. The incidence of muscle injury is far reduced as there will be no undue lengthening or shortening of the muscle. Having performed these physical assessments we will be in a position to know how far the body is away from ideal posture. A programme will be devised that will bring the low back pain sufferer closer to, or to ideal posture, thus reducing undue stresses on the skeleton. This programme will involve a few basic tasks:
Once the correctional programme is designed, the low back pain sufferer is expected to experience far reduced levels of discomfort that continue to improve the closer they get to optimal posture. This is only one aspect of a programme that also looks into lifestyle and nutrition. A lifestyle assessment is particularly important. It assesses a variety of areas including, stress levels, sleep patterns, nutritional practices, occupational and recreational habits, all of which can hold the key to why the body’s posture has deviated in the first place. For example if somebody is seated for long periods of time on a regular basis they can experience a shortening of the hip flexors combined with a lengthening of the hamstrings. If somebody works at a checkout counter where they continually turn to their left they can experience an imbalance of the muscles in the core and lumbar spine. These situations occur all day long, however if you are not educated to look out for them you would never anticipate that they could be so detrimental to the health of your lumbar spine. With the information regarding lifestyle very simple suggestions can be made to prevent the onset of pain or continued pain. Something as simple as sitting differently in your chair, flipping your mattress or changing checkout desks every shift can have a real and positive impact. Nutritional assessment examines what types of food are being eaten, when and in what volume and how all of this can impact on the body. An allergy or an intolerance can cause abdominal bloating that can have a huge effect on the functionality of the core musculature and in turn affect the condition of the low back. Simple changes to nutrition can remedy these problems and reduce or remove the low back pain.
In summary we can see that by assessing the body to ascertain the root cause of low back pain, we can build a programme that will provide instant and continued improvement. In most cases there is no reason why a low back pain sufferer cannot be restored to a pain free level of functionality that allows them to comfortably perform the tasks that their lifestyle requires of them.
Time spent with a specialist practitioner is an investment in yourself and your future.
