Michael Furlong, Clinic Director, Balance Health Centre, Liverpool, discusses pain management of the lower back
It is rare for someone to get through life without an episode or two of back pain. As a clinician, back pain is by far the number one reason people come to see me. The same applies generally to osteopathy and chiropractic. We see people with back pain who fall into both categories of unresolved pain: unresolved because they have put off doing something about it; or unresolved because despite a number of treatments, pain persists.
Depending on the nature of the problem, in practically all cases something can be done to help people: from manual therapy and exercise to more advanced treatments such as IDD Therapy spinal decompression.
Causes of back pain can include traumatic injuries such as falling off a ladder or a car accident, and these tend to create an instant problem. This is easy for patients to understand, but it can be much more difficult for patients to grasp that the cause of the pain they experience during a small, simple movement—perhaps bending to pick up a pencil—is a result of a weakened condition that has built up over time.
The less we move, the more our muscles weaken. The less we move, the more we lose flexibility in the joints as the tissues around them become stiff or tight. Sitting all day, slouching and generally not moving as much means that when we do stretch or twist or bend over incorrectly to lift something, we can strain our spine or, we can trigger a protective response in our body which causes it to lock up in a spasm; something that is simultaneously protective and painful.
Manual Therapy and Exercise
As a clinician, often the first task we must perform is to gently encourage the body to release the spasm and then work on the stiff joints and tight muscles. When a patient has back pain, logic leads them to think the problem is in their back. It rarely occurs to them that the reason the back has a problem, is often due to problems elsewhere. Few appreciate that their body works as a single unit. Few realise that if they sit for prolonged periods, the muscles in their hips (hip flexors) can become tight or that lack of movement can result in hamstring muscles in the back of their legs losing length and that this combination changes their posture and puts undue strain on their backs.
Patients are usually surprised when they learn that in the time it takes to read some social media posts on a phone, they can do some exercises that will have a dramatic impact on their spinal health. Exercise does not mean drill sergeants and boot camps. And whilst we are interested in spinal health, any exercise and being pain free means we can do so much more besides and live life with a smile on our faces.
But I am still in pain!
“Bulging” or “herniated” disc is a common category of back, neck and nerve pain which can persist and have a significant impact on someone’s life. Patients tend to use the term slipped disc, but that description does very little to convey to the patient what is happening in their body: vertebrae as a stack of cotton reels and the discs between as mini-donuts that can be squashed in all directions usually helps explain why patients can bend to the side, backwards and forwards as well as twist.
These days the number one enemy of the disc is the way we sit and slouch. Poor posture and a lack of activity puts a lot of pressure on the disc, which is unable to stay healthy and recover adequately from this slow bombardment. Over time the discs can weaken and become vulnerable.
Sudden or small movements can cause the toothpaste-like centre of the disc to push out and cause the walls of the disc to bulge. In some cases, the centre of the disc can push out through the disc wall itself. At any given time, we may have slight bulges in our discs and the body has a natural correction and healing mechanisms, so it isn’t a problem. Movement or rather, correct movement, is especially beneficial for disc health.
However, if the bulging disc wall presses against a nerve as it exits the spine, the result can be shooting pain or dull aching pain. If the centre of the disc pushes out through the wall, then the pain can be especially intense and cause additional chemical irritation to the nerves as the area becomes inflamed.
Such a disc bulge usually happens at the bottom of the spine and this is the area where nerves leave the spine and travel down through the buttocks to control the legs. This sciatic nerve is a source of real pain, and even agony, for some people and the pain condition is called sciatica.
When the body picks up a sense that it is injured, it can go into spasm, which is incredibly painful and combined with nerve pain, is doubly bad.
Physical therapy can address most cases of sciatica caused by a bulging or herniated disc. The body has its healing mechanisms, and a skilled practitioner will work to relieve the muscle spasm and then work on tissues to free movement, whilst gentle exercises strengthen supporting muscles.
Over a series of treatments pain can subside and, gradually, normal movement returns.
IDD Therapy Spinal Decompression
When a condition has built up over a long time, the tissues around the spine can become extremely stiff and immobile. The discs in our spine rely on movement to replenish fluid and nutrients but if the joints become compressed, which is compounded by pain, then it can be very challenging to restore mobility and function to help the disc.
IDD Therapy is a computer-controlled spinal decompression treatment which practitioners use to decompress the affected spinal segments. This non-surgical treatment sees patients lie fully clothed on the table of the Accu SPINA machine.
They are connected to the machine by ergonomic pelvis and chest harnesses and then a gentle force pulls the pelvic harness at a precise angle. The way in which the force is applied means that we can take pressure off the affected spinal segment and importantly, gently stretch and work the tissues. This is done through a series of stretching cycles to help release muscle spasm and improve mobility.
Patients have a series of twenty-five minute sessions on the Accu SPINA machine. IDD Therapy treatment is combined with hands on treatment and exercise, again to help address some of the other underlying causes which led to the problem manifesting in the first place.
By decompressing the disc, restoring mobility and taking pressure off nerves, patients can make significant improvement and return to a pain free life.
Pain Management
There are of course many causes of pain. Age-related back pain from conditions like arthritis can lead to restricted movement. Sadly, in some cases we must not set our expectations too high about the degree of improvement that can be achieved.
However, some improvement can usually be obtained with gentle activity and hands-on treatment in order to give relief, and to preserve and maintain function, i.e. to prevent further deterioration.
Pain management is a term to describe where pain persists and, usually, pain medication or injections are given. A pain consultant will discuss the available options depending on the severity of the pain. Pain medication can help ease pain and ideally provide a means to get some improved activity levels.
Whilst not desirable, some conditions are only currently served with pain management through medication.
End Note
When pain persists despite hands-on treatment and exercise, IDD Therapy can make a big difference for patients without the need for surgery or pain management. There are of course those conditions which are best suited to, or require, surgery or careful management with pain medication. The key, is always, to take action and not leave pain untreated.
ABOUT THE AUTHOR
Michael Furlong is the Clinic Director of Balance Health Centre in Liverpool. An Osteopath for over twenty years, Michael is passionate about spine care. When IDD Therapy resolved his own herniated disc, which was threatening to stop him from working, Michael brought IDD Therapy to his clinic to complete a comprehensive non-surgical spine care service.
ABOUT IDD THERAPY
‘Intervertebral Differential Dynamics’ or IDD Therapy is the fastest growing non-surgical spinal treatment for intervertebral discs with over 1,000 clinics worldwide and 34 clinics across the UK. Safe, gentle and non-invasive, IDD Therapy helps patients who need something more for their pain when manual therapy alone is insufficient to achieve lasting pain relief.
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