THE PHYSICAL TREATMENT OF BACK PAIN

Physiotherapy, osteopathy and chiropractic treatment can all help to relieve back pain. All of these techniques involve manipulating parts of the backbone and some can involve exercise, massage and ultrasound therapy. All must be carried out by a suitably qualified professional. By correcting any underlying mechanical disturbances in the musculoskeletal system, manipulation can effectively relieve the pain and distress of back pain and minimise the need for drug treatment and the risks associated with this. However, manipulation is not recommended in some people, including pregnant women and people with osteoarthritis of the neck or osteoporosis of the spine. If manipulation is inappropriate for you then your GP will let you know.

It is important that you choose a physiotherapist, osteopath or a chiropractor who is suitably qualified. The first time you visit a therapist they will take a full medical history and ask you about your general health, lifestyle, emotional state and family history. This may take an hour or so. Subsequent consultations will usually last about half an hour.

Physiotherapy
Physiotherapy uses physical means (such as massage, exercise, heat or electricity) to maintain and restore your physical and mental well-being. It is an active rather than a passive treatment and is usually concerned with keeping your joints and muscles moving. As well as relieving back pain, physiotherapy can also be used to treat a large number of other common ailments like muscle sprains, sports injuries, incontinence, osteoporosis, depression and asthma.

Physiotherapy is heavily based on the basic principles of medical science, and is therefore generally regarded as a conventional rather than a complementary kind of therapy. Physiotherapists work in all areas of the hospital, private healthcare, industry and education, and physiotherapy is the fourth largest healthcare profession in the country.

OSTEOPATHY
Osteopathy uses the manipulation of the body and the spine to cure disease. Over half of people who go to an osteopath do so for back pain. Osteopath use their hands and fingers to feel the patient's body and identify damaged areas. These areas may have a slighly different temperature or tone, or respond differently to movement than normal healthy areas of the body. Once the injured area has been found, a variety of manual techniques are used to correct the problem. Osteopathy usually also involves a special form of massage that helps muscles relax and lets joints move more easily.

Osteopathy is not recommended for some people with back pain, including people with brittle bone conditions or inflammed joints and women in the early stages of pregnancy.


CHIROPRACTIC TREATMENT
Like osteopaths, chiropractors aim to diagnose and correct joint disorders. Although at first glance the two techniques may appear to be very similar, they are in fact quite different. Osteopathy uses more soft tissue massage and osteopaths suggest that the benefits of their therapy are related to the improved circulation of the blood. In contrast, chiropractors suggest that their treatment improves nervous function and relieves pain in this way. Around half of all chiropractic consultations are for low-back pain, including hip problems. The technique was developed in the late nineteenth century by a Canadian called Daniel David Palmer.

After examining you, chiropractors are able to identify whether the contraction of the muscles surrounding the spinal column has pulled the spine out of the line slightly, and is thus causing your pain. Once it has been identified, chiropractors try to rectify the problem by reducing the tension in these muscles so that the spinal column becomes straighter and exerts less pressure on your joints, thereby lessening your pain. Chiropractic treatment is not suitable for people with inflammed joints, spinal infections or cancer. Treatment can be specially adapted to suit those people with osteoporosis or fractures.


ALTERNATIVE WAYS TO MANAGE BACK PAIN
Transcutaneous Electrical Nerve Stimulation (TENS)

TENS is a type of pain relief that is centred around using small electrical currents to 'block out' the nerves that are transmitting the feelings of pain you are experiencing. Instead of pain, you will feel more tolerable tingling sensations. Small pads are placed above or to either side of the area that is giving pain, and the results are felt straight away. TENS can be used to manage both acute and chronic pain but may not work for everyone. For people with pacemakers, women in the first 3 months of pregnancy and people who operate heavy machinery, TENS is not appropriate form of pain relief.

If it is appropriate for you, your GP can refer you to a hospital physiotherapy department or a physiotherapist who will be able to loan you a TENS machine for several weeks. If TENS is effective in reducing your pain, you may wish to buy your own machine.

ACUPUNCTURE

Acupuncture is an ancient Chinese medical treatment that relieves pain and cures disease through the insertion of very fine needles into the body specific points. There are around 500 acupuncture points all over the body. By mapping 'energy pathways' throughout the body, acupuncture affects the functioning of certain organs in the body. However, the area that is stimulated by the needle may not necessarily be close to the part of the body where you are experiencing pain. For example, even though you are suffering from headaches, needles may be inserted in your foot or hand.

At your first consultation, an acupunturist will ask you about your symptoms, your medical history and your health in general. They may also feel the quality, rhythm and strength of the pulses on both of your wrists. It is important that you choose an acupuncturist who is suitably qualified.

BACK SURGERY
Surgery is only appropriate for a very small proportion of patients with back pain. Rarely, back pain may worsen to the extent that other functions or organs of the body (eg. bladder or bowel) are affected. In the most severe cases, some patients may become paralysed. Your doctor will use surgery as a last resort, when all other attempts at relieving your pain have failed. If you have been referred for back surgery, you should carefully considered your options before consenting.

As well as requiring weeks of convalescence, success is never guaranteed and even after surgery the pain may not go away. It is important that you discuss the surgery and all the possible outcomes with your surgeon.

There are three general types of back surgery:

• discectomy - involves the removal of part of a vertebral disc to reduce pressure on a nerve root
• decompression - involves the removal of tissue that is compressing a nerve and disturbing major functions like the control of the bladder and bowels
• stabilisation/fusion - involves fixing together two or more adjacent vertebrae with bone taken elsewhere in the body.
  
  
  

BACK PAIN AND PREGNANCY

Back pain during pregnancy is relatively common problem. The growing foetus may cause postural problems and, toward the end of the pregnancy, the position of the baby can compress nerves and cause back pain this way.

The hormones you produce whilst you are pregnant can also affect your back. Some pregnancy hormones cause the ligaments between the pelvic bones to soften and your joints to loosen in preparation for the birth. As the structures that support your pelvic organs become more flexible, you may feel considerable discomfort on either bside of your lower back.

There are a number of steps that women can take avoid back pain whilst they are pregnant:

• wear low-heeled shoes with good arch support
• sleep on your side with a pillow between your legs
• use a support belt to take some of the weight of your baby away from your back
• avoid slouching wherever possible
• avoid bending over with your legs straight (and placing excessive strain on your lower back)
• do pelvic tilts to strengthen the pelvis and reduce lower back pain
• take warm baths or use a warm jet of water from a shower head
• exercise regularly (but always consult your doctor before starting any exercise routine).