Low back pain affects between 60-80% of people at least once in their lifetime, with many people suffering multiple times and/or for a long period of time. Characteristics of low back pain include but are not limited to pain and tenderness in the area below the ribs and above the sacroiliac region, with or without referral down the legs. Often people come into our Osteopathic clinic saying they have a ‘slipped disc’, ‘sciatica’ or ‘have put their back out’…but what does that really mean?

Due to the holistic nature of Osteopathy and the principle that the ‘body is a functional unit’ an
Osteopathic Practitioner can address the true nature of your back pain, as sometimes the reason it may have started or continued to stick around is not what you think. Back pain can be linked to many different structures in your body, it is important to establish any maintaining and predisposing factors, as well as, rule out any red flags such as cancer, cauda equina syndrome, or even an abdominal aortic aneurysm.

Causes of Lower Back pain

Back pain can be caused by a variety of structures, systems and past events, including:

• Incorrect foot wear, leg length discrepancies, foot alignments (pronation, flat feet, high arches)
• A rotation through the pelvis
• A previous accident in which your body has had to overcompensate (for example… spraining your right ankle, knee, hip and back injuries as well as injuries or compensations further up your body)
• Lifting a heavy item
• Sitting for prolonged periods or poor ergonomic work stations
• Over use of certain muscles, joints, ligaments whether it be from repeating the same movement at work every day, lifting your child or playing a sport as a child
• Incorrect muscle activation patterns, where certain muscles have become tight and others weak
• Referral from other structures, such as your kidneys, ovaries, prostate
• Pregnancy/ hormonal related changes including the oral contraceptive pill or IUD
• Digestive issues such as bloating, constipation, diarrhoea, straining on the toilet
• Fibroids, irritable bowel syndrome, crohn’s disease, celiac disease, endometriosis
• Scaring from surgeries, such as – appendix, gall bladder, hysterectomy, hernia’s, or caesareans (even if the interventions were laparoscopic)
• Incorrect breathing patterns, having the flu – coughing
• Concussions, whiplash.
• Epidurals

Anantomy

The lower back takes on the biggest load with the least amount of structural support of the spine. The lumbar spine consist of 5 vertebrae’s with intervertebral discs between each segment. These discs act as a shock absorber and are often compromised when a large amount of strain is placed on them, particularly through flexing forward and twisting.

The spinal cord runs through the vertebral canal, with nerve roots exiting each level. If a disc is put under too much load it can protrude out and compress the nerve causing pain down the leg(s) and may even result in numbness and or weakness. The nerves can be compressed in many different locations by muscles and other structures over time. For example, a rotation through the pelvis due to weight bearing on one side more than the other can tighten certain muscles causing pain or referring pain to the back. The hip flexors which are often tight can also be the cause of back and refer pain posteriorly.

There are not only nerves which run through the spine and supply the lower extremities but also veins, arteries, and a lymphatic system and a blockage in these systems can directly affect the lower back. Lower back pain is not often caused by only one structure, other areas such as the hips and sacro-iliac joints are often related.

The spinal cord and brain are covered and protected by meninges which are membranes consisting of 3 layers. The inner most layer is referred to as the pia mater, the middle layer the arachnoid mater and the outermost layer the dura mater. Between the pia and arachnoid mater is the subarachnoid space where the cerebral spinal fluid flows (CSF). The CSF is a watery liquid which helps to cushion and protect the spinal cord and brain and also supplies nutrients and removes wastes products from the brain. Any disruption to these meninges and all cerebral spinal fluid can affect the entire body as is why the cranial system is also explored when a person is presenting with back pain.

Many structures in the back have an overlapping nerve supply which can give incorrect signals of which structure may be causing the pain meaning that a muscle strain can feel similar to a herniated disc.

Common Mechanical Causes of Back Pain

Sciatica

Sciatica is any irritation to the larger ‘sciatic nerve’ composed of many nerve fibres originating from the lower back .These nerves join together in the gluteal region and travel down the posterior part of the thigh. There are many ways the sciatic nerve can be irritated including a muscle spasm in the lower back, gluteal area, piriformis or hamstrings, as well as, a disc bulge or prolapse, degeneration/arthritis, pregnancy changes and many more.

Herniated disc/disc protrusion

An intervertebral disc sits between the vertebrae of the spine acting as a shock absorber and facilitating movement and flexibility. The discs are various shapes and sizes allowing for different degrees of movement and can be injured in a variety of ways. The disc maintains pressure within itself as it is made up of gelatinous material of complex proteins that hold and absorb water. These discs can be affected in multiple ways including:

• Internal disc disruption
• Bulging – where part of the disc material protrudes out, this can also become a herniated disc
• Dehydration of the disc – where it loses water, this happens naturally as we age causing the disc to become thinner. This contributes to the area of the spine to become increasingly stiff and less stable potentially predisposing the segment to further wear and tear.

Muscle and ligament strain or sprains can also be the cause of low back pain as well as joint friction/impaction on certain movements. As mentioned at the beginning of this article these are not the only causes but are some of the most common reasons people come into see an Osteopathic practitioner. A basic understanding of nerve root irritation and disc pain can be useful in understanding your pain.

Additional Osteopathic Considerations for Back Pain

Your osteopathic practitioner will take a detailed case history to discover any previous accidents, surgeries or procedures that may have contributed to your back pain. Although it may not seem relevant any car accident you may have had, even if 10 years ago, in which you did not have any pain or maybe only neck pain afterwards can be related to your back pain. This is not only due to the effects it may have had on the cerebral spinal fluid and meningeal layers which run from your brain to the end of your spine but also due to compensation patterns that may have developed due to the neck pain and your back having to work harder.

As Anouk spoke about in her blog on scars, any surgery or procedure you may have had regardless of how long ago, or how big can also be contributing to your back pain. This is because without thinking your body would have developed a protective position in which you feel the least amount of pain but over time would have led to weight bearing on one side or holding sustained positions for too long. Any tension build up in one area, causes a change or shift to adjacent and further away structures as the body is interconnected through fascia and other mechanisms.

Fear avoidance and the psychological components of back pain

Lower back pain can also create a negative fear avoidance loop where one is scared to be active and thinks resting for long periods is the best way to recover. This can then cause episodes of depression which in turn can amplify the feeling of pain and prolong its existence. Hence it is always important to address peoples’ beliefs and expectations regarding their pain, to make realistic goals to be able to track their progress and encourage a positive healing journey. This is why an Osteopathic Practitioner may not work on the specific area of pain. Regulating the central nervous system, circulatory system and endocrine system may have a significant impact on the back pain that has been present.

How Osteopathy can help alleviate your Low Back Pain

Osteopathy can help lower back pain in many ways. Treatment may help by encouraging lymphatic drainage, enhancing blood flow to simulate fast healing, improving tissue elasticity, decreasing tissue tension and improving joint mobility.

An Osteopathic Practitioner will assess you as a whole, looking at how you walk, your posture, any joints that maybe hyper or hypo mobile and the patterns you have developed which may be sustaining your back pain. They will work directly and indirectly to decrease your pain, increase your joint range of motion, release tight muscles, take the pressure of your intervertebral discs, investigate any abdominal organs which may be related and provide a calming environment to stimulate your parasympathetic nervous system so the body’s own self-healing mechanisms can be optimized.

As back pain is usually the result of many different structures and our belief systems on how pain is affecting us, sometimes it is necessary to work on other areas of the body which may not be in pain but are related to your back pain. It is important to establish that the correct muscles are firing and being activated whilst doing certain movements for example sitting at work or lifting weights at the gym. If incorrect patterns and habits develop and are continued over time it makes it much harder to change and leads to other areas having to overwork which may ultimately lead to the development of pain.

With back pain it is important to look at the mobility of all joints, for example, a decrease in joint mobility through the ankle leads to compensations in the knee, hip, lower back and further up. The calf muscles are also responsible in blood circulation and help return blood to the heart.
Your Osteopathic Practitioner will also go through what movements/exercises to keep doing, which activities to avoid and look at ways to change current exercises/activities you may have been doing incorrectly.

As you can see, lower back pain can be quite complex with many different systems and structures being involved. Your Osteopathic Practitioner will make sure to address the factors that could be leading to your pain and not only look at your lower back but also at how you are breathing, your posture, and abdominal irritations you have and release any muscular/joint tensions throughout your body as well as work on your cranial –sacral system to ensure your body has all the tools needed to heal.

If you have any queries, don’t hesitate to contact us so that we can help with your lower back pain.