Back pain and Low Back pain

Back pain and low back pain does not always arise immediately after an injury because the body is very good at adapting to injuries and accommodating strains and stresses. However, the disruption to spinal mechanics brought about by injury can cause strain to build up over a period of time and symptoms begin.

Episodes of low back pain may be triggered by events such as physical exertion, emotional stress, illness or pregnancy. Sometimes a minor strain may give more pain and take longer to heal than expected. This may be because the body has reached the limits of its ability to cope with the combined effects of past injuries, and any new demand is 'the final straw'.

In treatment, it is often necessary to release retained stresses from past injuries and trauma in order to relieve the current back pain, and reduce the chances of it recurring.

Biodynamic or Cranial osteopaths are skilled in assessing the mechanics of the whole body, and in particular the spine. The gentle techniques of cranial osteopathy are particularly useful for feeling deeply into the body, locating where the body might be carrying the effects of stresses and strains, and helping the body release these tensions. This may relieve pain and discomfort, and helps restore the normal ease of movement of the spine. 

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Research:

J. C. Licciardone, D. E. Minotti, R. J. Gatchel, C. M. Kearns, K. P. Singh

Published in The Annals of Family Medicine, 2013; 11 (2): 122 DOI: 10.1370/afm.1468

OMT patients did see significant improvement in pain, used less prescription medication and were more satisfied with their care.

Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW.

Published in Spine

High-quality evidence suggests that there is no clinically relevant difference between spinal manipulative therapy and other interventions for reducing pain and improving function in patients with chronic low-back pain. Determining cost-effectiveness of care has high priority.

Vaughan B, Morrison T, Buttigieg S, Macfarlane C, Fryer G. 

Published in Australian Family Physician 2014, Vol43, No.4, April 2014 Pages 197-198

This article forms part of our allied health series for 2014, which aims to provide information about the management approach of different allied health professionals, using the case example of uncomplicated, mechanical low back pain.

Cruser dA, Maurer D, Hensel K, Brown SK, White K, Stoll ST.

Published in the Journal of Manual and Manipulative Therapy, 2012 Feb; 20(1):5-15.

This study supports the effectiveness of osteopathic manipulative treatment in reducing acute low back pain in active duty military personnel.

Licciardone JC, Minotti DE, Gatchel RJ, Kearns CM, Singh KP.

Published in Annals of Family Medicine

The osteopathic manipulative treatment regimen met or exceeded the Cochrane Back Review Group criterion for a medium effect size in relieving chronic low back pain. It was safe, parsimonious, and well accepted by patients.

JC Licciardone, AK Brimhall and LN King

OMT significantly reduces low back pain. The level of pain reduction is greater than expected from placebo effects alone and persists for at least three months. Additional research is warranted to elucidate mechanistically how OMT exerts its effects, to determine if OMT benefits are long lasting, and to assess the cost-effectiveness of OMT as a complementary treatment for low back pain.

Licciardone JC, Kearns CM, Minotti DE.

The large effect size for OMT in providing substantial pain reduction in patients with chronic LBP of high severity was associated with clinically important improvement in back-specific functioning. Thus, OMT may be an attractive option in such patients before proceeding to more invasive and costly treatments.

Helge Franke, Jan-David Franke and Gary Fryer

Published in BMC Musculoskeletal Disorders 2014

Clinically relevant effects of osteopathic manipulative treatment were found for reducing pain and improving functional status in patients with acute and chronic nonspecific low back pain and for low back pain in pregnant and postpartum women at 3 months posttreatment. However, larger, high-quality randomized controlled trials with robust comparison groups are recommended.

Vismara L, Cimolin V, Menegoni F, Zaina F, Galli M, Negrini S, Villa V, Capodaglio P.

Published in Manual Therapy

Combined rehabilitation treatment including osteopathic manipulative treatment showed to be effective in improving biomechanical parameters of the thoracic spine in obese patients with chronic low back pain.

Williams NH, Wilkinson C, Russell I, Edwards RT, Hibbs R, Linck P, Muntz R.

Published in Family Practice

Aim: was to assess the effectiveness and health care costs of a practice-based osteopathy clinic for subacute spinal pain. A primary care osteopathy clinic improved short-term physical and longer term psychological outcomes, at little extra cost. Rigorous multicentre studies are now needed to assess the generalizability of this approach.

de Oliveira RF, Liebano RE, Costa Lda C, Rissato LL, Costa LO.

Published in Physical Therapy

The immediate changes in pain intensity and pressure pain threshold after a single high-velocity manipulation do not differ by region-specific versus non-region-specific manipulation techniques in patients with chronic low back pain.

Downie A, Williams CM, Henschke N, Hancock MJ, Ostelo RW, de Vet HC, Macaskill P, Irwig L, van Tulder MW, Koes BW, Maher CG.

Published in BMJ

While several red flags are endorsed in guidelines to screen for fracture or malignancy, only a small subset of these have evidence that they are indeed informative. These findings suggest a need for revision of many current guidelines.

Paul J Orrock and Stephen P Myers

One trial concluded similarity of effect between osteopathic intervention, exercise and physiotherap and the other was similar in effect to a sham intervention. Further clinical trials into this subject are required that have consistent and rigorous methods.

Roger Chou, MD; and Laurie Hoyt Huffman, MS

Therapies with good evidence of moderate efficacy for chronic or subacute low back pain are cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation.In 1 study of primary care clinicians, 65% reported recommending massage therapy and 22% recommended, prescribed, or performed spinal manipulation.

 

Licciardone JC, Buchanan S, Hensel KL, King HH, Fulda KG, Stoll ST

Published in American Journal of Obstetrics and Gynaecology, 2010 Jan;202(1):43.e1-8.

Osteopathic manipulative treatment slows or halts the deterioration of back-specific functioning during the third trimester of pregnancy.

Pennick V, Liddle SD.

Published in Cochrane Database Syst Rev. 2013 Aug 1;8:CD001139. doi: 10.1002/14651858.CD001139.pub3.

Physiotherapy, OMT, acupuncture, a multi-modal intervention, or the addition of a rigid pelvic belt to exercise seemed to relieve pelvic or back pain more than usual care alone.