Philip Bayliss, St Albans Osteopathy, Christchurch

Causes of Low Back Pain (Lumbar Pain)

Back pain is a symptom. Pain arising from intra-abdominal disorders, such as appendicitis, aneurysms, kidney diseases, bladder infections, pelvic infections, and ovarian disorders, among others, may also be felt in the back. This is called referred pain. Osteopaths are trained to differentially diagnose these conditions, and will refer you to your GP if one of these conditions is likely to be causing your low back pain (also called lumbar pain). Musculoskeletal causes of low back pain (lumbar pain) include:

Functional disorders of the lumbar spine accounts for 85% of low back pain! Functional disorders of the lumbar spine includes sprains and dysfunction of the facet joints between the lumbar vertebrae, sprains of the spinal ligaments and also sprains and dysfunction of the muscles of the lumbar spine and pelvis. Philip seeks these out by using both observation and a highly developed sense of touch, which enables him to detect the smallest changes in muscular tension and joint mobility. Functional disorders of the lumbar spine usually responds very well to osteopath treatment.
Sacro-iliac joint (SIJ) strain is a common cause of low back pain, with or without sciatica, and responds well to osteopath treatment. Please see the free PDF download at the bottom of this page for details.
Spondylosis is a medical term to describe wear and tear to the spine. The intervertebral discs becomes drier and decreases in height. Fissures or slits can develop. Minor accidents or misalignment can aggravate these slits or fissures which then become inflamed, the pressure of which can press on a nerve root, resulting in pain radiating down the leg or sciatica. Spondylosis usually responds well to osteopath treatment.
A prolapsed intervertebral disc (also called a herniated disc) occurs when a fissure appears in a disc which already has spondylosis, and the gel like nucleus of the disc comes out and presses against a nerve root causing nerve root syndrome. CAT scans show prolapsed discs in one-third of adults over 20 years old, but only 3% of these produce symptoms. Prolapsed discs usually respond well to osteopath treatment. Nerve root syndromes is when there is pressure on a spinal nerve, which can be due to a prolapsed disc, a bone spur caused by degenerative changes, an inflamed facet joint or a rotation between two vertebrae narrowing the space where the nerve comes out. Sciatica is when nerve root impingement causes pain down the leg. The pain tends to be sharp, affecting a specific area, and associated with numbness in the area of the leg that the affected nerve supplies. Nerve root syndromes usually respond well to osteopath treatment.
Myofascial pain can involve muscle and facia in any part of the body, and can produce a large number of different symptoms, according to its location, however there are always trigger points and related areas or referred pain. The pain can vary from mild to severe. Usually knots can be seen under the skin, these can sometimes be felt. Myofasial pain can occur at the same time as fibromyalgia. Myofascial pain can be caused by a connective tissue disease or an emotional disturbance. Myofascial pain usually responds well to osteopath treatment.
Fibromyalgia results in widespread pain and tenderness throughout the body. Generalized stiffness, fatigue, and muscle aches are reported. Fibromyalgia usually responds well to osteopath treatment.
Spinal stenosis can result from spinal disc degeneration coupled with disease in joints of the low back resulting in spinal-canal narrowing. A person with spinal stenosis may have pain radiating down both lower extremities while standing for a long time or walking even short distances. Early stage spinal stenosis can be helped by osteopath treatment. Late stage spinal stenosis requires surgery.
Spondylolisthesis describes the forward displacement of a vertebra in relation to the vertebrae below. There are five different types of spondylolisthesis: isthmic, degenerative, traumatic, and pathologic. Spondylolisthesis is graded by the percentage that the upper vertebral body has slipped in relation to the lower vertebral body: Grade 1 is 0–25%, grade 2 is 25–50%, grade 3 is 50–75%, grade 4 is 75–100%. 90% of spondylolisthesis are grade1 which usually responds well to osteopath treatment. Surgery is usually recommended for the other grades.
Cauda equina syndrome is when the lower part of the spinal cord is directly compressed. Disc material expands into the spinal canal, which compresses the nerves. A person would experience pain, possible loss of sensation, and bowel or bladder dysfunction. This could include inability to control urination causing incontinence or the inability to begin urination. Cauda equina syndrome cannot be helped by osteopath treatment. It is a medical emergency that requires prompt surgery.

Osteopath Treatment

An osteopath will take your history, examine your body and bio-mechanics and use differential diagnosis to determine the tissues causing your symptoms and the underlying bio-mechanical factors that underlie or cause your symptoms. Every osteopath treatment is different and is designed specifically to address these factors.

Philip is based in Christchurch and uses a wide range of techniques, including gentle manipulation, cranial osteopathy (cranio-sacral therapy), and soft tissue techniques such as massage, fascial release and muscle-energy, in order to optimise the functioning of the body and enable the innate self-healing ability of the body to do its work. All the osteopath techniques that Philip uses are gentle and are never painful or frightening. Philip may give advice on exercises, posture, diet and home remedies to help you manage pain, speed recovery and to avoid future problems. ACC research shows that osteopathic treatment is more effective that all other treatment modalities (including physiotherapy, chiropractic and acupuncture). Please see the free PDF download at the bottom of the page which uses ACC data to compare osteopath treatment with other modalities.

Self-Care at Home

Be positive. You will make a full recovery and be able to work and practice your hobbies. Only a tiny proportion of low back pain sufferers who consult Philip Bayliss fail to make a complete recovery. If necessary, ask for help and support from your family and friends. If you have severe low back (lumbar) pain you may need some time off work. You will probably be able to return to work before you are completely better. Your osteopath can advise you on this, though you will need to see your GP for certification. Long periods off work are associated with longer recovery times and the development of chronic pain.
Osteopaths don't recommend complete bed rest, as it can delay recovery. Activity helps the healing process, but must be geared to the severity of the injury. In severe cases it may be necessary to rest lying or relining most of the day, getting up every hour for a short walk, which can be gradually lengthened in duration. Osteopaths generally recommend resuming normal, or near normal, activity as soon as possible. However, bending, lifting or activities that place additional strain on the back are discouraged in the early stages of recovery from severe lumbar pain, especially if accompanied by sciatica.
For sitting, use a padded but firm chair which has lumbar support. If necessary put a small cushion in the small of your back. Sit on your 'sitting bones', with your bottom at the back of the seat. If sitting causes an aggravation of your low back pain, or it is difficult to straighten up afterwards, then it is best to avoid sitting and to relax by lying or reclining with your knees slightly bent (a cushion can be placed beneath them). You can eat or use a computer etc. while standing.
Sleeping with a pillow between the knees while lying on one side may increase comfort. Sometimes lying on your back with a pillow under your knees may help.
Ice is not recommended for low back pain. Although ice can help reduce inflammation, it also increases muscle tone, which is not helpful.
Heat, such as a hot water bottle, heat pad or wheat bag, can be useful to help relieve tight painful muscles, but it should not be too hot, or applied for too long, as heat can increase inflammation, causing an aggravation of the underlying injury. As a guide, the temperature should not be over 55 degrees, and should not be applied for more than 30 minutes, with a two hour break between applications. Alternating hot and cold has been proven to be ineffective. A warm bath with a handful of Epsom salts is very relaxing and can give relief from back or neck pain. Epsom salts can be purchased from a pharmacy. They are magnesium sulphate. Some of the magnesium is absorbed into your muscle and helps relax them. A few drops of essential oil of lavender or rosemary added to the bath water can also help relaxation and soothe tight muscles.
Osteopaths do not recommend the continuous use of lumbar support belts. It can be useful for workers who perform heavy lifting to wear these belts just when lifting and to avoid wearing them at other times.
The recent meta-analysis of research into exercise and low back pain found that physiotherapist prescribed exercises do not improve pain or increased functional ability in people with acute back pain. Exercise, however, may be useful for people with chronic back pain to help them return to normal activities and work. Your osteopath may prescribe you specific exercises based on your personal bio-mechanics and injured tissues. A good exercise progam can help prevent a re-occurance of low back pain. At the bottom of this page are two free PDF downloads of Pilates exercises that you can do at home. Core Stability - a Pilates workout is a full program to develop your core stability and prevent low back pain. Pilates Exercises for Back Pain has a shorter selection of Pilates exercises that are usually OK to practice while you are suffering from back pain. If you prefer a more gym style of exercises, please see the PDF download: Exercises to prevent back pain.
The following exercise usually gives some relief to low back pain:

The following exercise can be useful if you find that you are standing bent to one side because of your injury:

Herbs, enzymes and lipids

The following herbs, enzymes and oils taken orally may help reduce inflammation, and can be taken at the same time as having osteopath treatment:

Curcuma longa (Tumeric extract)

Boswellia serrate (Shallaki)

Zinzibar officianale (Ginger)

Harpagophytum procumbens (Devil’s claw)

Enzymes such as papain and bromelain

Omega 3 fatty acids (fish oil/marine lipids)

Philip can give you advice on these herbs and help you obtain them

Herbal Rubs

Massaging the painful area with a cream that containing some or all of the following may be helpful:

Common rue (ruta graveolens)

Poison ivy (rhus toxicodendron)

Chickweed (stellaria media)

Leopard's bane (arnica montana)

Comfrey (symphytum officinale)

Lavender oil (lavendula angustafolia)

Nutritional Supplements

The following nutritional supplements may help repair damaged joints in the lumbar spine, and can be taken at the same time as having osteopath treatment:

Chondroitin sulfate

Glucosamine sulfate

Manganese picolinate

MSM (Methyl sulfonyl methane)

There is some anecdotal evidence that freeze dried porcine or bovine intervertebral disc tissue and liquefied bovine tracheal cartilage taken orally can help speed up the healing of intervertebral disc problems.

Magnesium is a natural muscle relaxant. Although Epsom salts are magnesium sulphate, it is not a good idea to take them orally as they are poorly absorbed and often cause diarrhoea. Magnesium is best taken in a chelated form for good absorption and bio-availability. Magnesium citrate is a very good form. You should take about 150 mg of magnesium (elemental weight), twice a day. Long term supplementation of just magnesium can lead to calcium depletion and osteopenia or osteoporosis (different degrees of low bone density). Do not take magnesium for more than three months unless part of a comprehensive nutritional programme formulated by an expert such as Philip Bayliss.

Philip can give you advice on these nutritional supplements and can obtain high quality supplements for you (Thorne Research and Metagenics).

Vibrational Remedies

If you have a sudden onset of severe pain, you could try taking the homoeopathic remedy arnica 6X or the Bach Flower Remedy: Rescue Remedy as soon as possible after the onset. If taking arnica, let 2 tablets disolve under the tongue, and avoid coffee or mints. If taking Rescue Remedy, drop a couple of drops under the tongue every 2 hours. Please note that Dr Bach was Welsh, not German, so the name Bach should be pronounced the same way as that of a New Zealand holiday home.

Non-Prescription Medicines (general sales and pharmacy only)

Pain relief can be taken at the same time as having osteopath treatment. Some traditional nonsteroidal anti-inflammatory drugs (NSAID) such as ibuprofen (Nurofen, I-Profen), diclofenac (Voltaren), naproxen (Naprogesic) and menfenamic acid (Ponstan) are available over the counter. Naprogesic and Pontsan are marketed in New Zealand for the treatment of period pain, though they are effective NSAD's for reducing musculoskeletal inflammation. Nurofen Zavance Liquid capsules and Act-3 Liquid Ibuprofen are claimed to be absorbed twice as fast as standard ibuprofen. Ibuprofen lysine is more soluble in water than apo-ibuprofen. Do not take more than one type of NSAID at the same time (aspirin is also a NSAID). NSAID's do not address the root cause of inflammation, but they do temporarily reduce inflammation and give some relief of symptoms while the body's self healing process takes place. There is no evidence that they decrease recovery time of back pain. Osteopathy does address the underlying causes of back pain, and does decrease the recovery time. Because of the risk of ulcers and gastrointestinal bleeding, do not exceed the recommended dose, and talk with your doctor or osteopath about using this medication for a long time. Ibuprofen is less likely to cause side effects than diclofenec. The application of topical agents such as a NZAI gel (i.e. Voltaren Emugel, Nurofen Gel, Oruvail Gel, Powergel, Feldene P Gel) can help reduce inflammation without risk of side-effects. Deep heat has been shown to be ineffective.

Paracetamol (Panadol, Paracare) helps relieve mild to moderate pain. Panadol Extra contains 500 mg paracetemol and 65 mg caffeine. Panadeine, Panadeine Extra, Panafen Plus and Paracode are over the counter medications that contains paracetamol and codeine and therefore give stronger pain relief than paracetamol alone. Panadeine and Paracode both contain 500 mg paracetamol and 8 mg of codeine, Panafen Plus contains 500 mg paracetemol and 12.5 mg codeine and Panadeine Extra contains 500 mg paracetamol and 16 mg of codeine. With Panadol, Panadol Extra, Panadeine, Panadeine Extra, Paracode and Panafen Plus an adult or children over 12 should take two tablets every 4-6 hours, with a maximum of 8 tablets in 24 hours. Children 7 to 12 should take half to one tablet every 4-6 hours, with a maximum of 4 tablets in 24 hours. Childern under 7 should not take paracetamol or codeine except under medical advice. The higher dose of codeine in Panadeine Plus may cause drowsiness and/or constipation. Constipation can be avoided by taking lactulose syrup. Do not take codeine for more than three days without medical advice. Do not take with another medication containing paracetamol or codeine. A stronger effect may be obtained by combining a pain killer such as Panadeine, Paracode, Panafen Plus or Panadeine Extra with a NSAID such as Nurofen. Nuromol contains 500 mg paracetemol and 200 mg ibuprofen and Maxigesic contains 500 mg paracetemol and 150 mg ibuprofen, making them good all-in-ones. Nurofen Plus and Ibucode Plus both contain 200 mg ibuprofen and 12.8 mg codeine. Nurofen Plus and Ibucode Plus can be taken at the same time as paracetemol.

Pain relief when pregnant. Any type or amount of NSAID (including ibuprofen and diclofenac) increases the risk of miscarriage by 2.4%. Opiates (including codeine) are best avoided in pregnancy. In the first trimester there is a small risk of opiates causing miscarriage or malformations. In the third trimester they may cause fetal physical dependance and withdrawal. Paracetemol has an extremely small risk of liver damage and death, but is probably the safest analgesic to take when pregnant. However it is not very effective on it's own in relieving moderate to severe back pain. Please take the advice of your doctor before taking any medicine if you are pregnant.

Prescription Only Medicines

There are two categories of nonsteroidal anti-inflammatory drugs (NSAID's). Tradititional NSAID's are nonselective COX inhibitors, that is they inhihibit two isoforms of the enzyme cycloxygenese, COX-1 and COX-2. Examples are ibuprofen (Nurofen), diclofenac (Voltaren), naproxen (Noflam), ketoprofen (Oruvail), sunlidac (Daclin), tenoxicam (Tilcotil), peroxicam (Candyl-D), tiaprofenic acid (Suram) and indomethacin (Rheumacin). Examples of COX-2 inhibitors are celecoxib (Celebrex), and etoricoxib (Arcoxia). COX-2 is found at the site of inflammation, while COX-1 is found in most tissues and helps maintain the normal lining of the stomach. Inhibiting COX-1 can cause gastic irritation, ulcers, prolonged bleeding time and kidney problems. However some COX-2 inhibitors (Vioxx and Bextra) have been withdrawn because of a small increase in the risk of a heart attack or stroke, and all of them can produce side effects such as GI upsets, though the incidence is less than with conventional NSAID's. Meloxicam (Mobic) is claimed by its manufacturer to be COX-2 selective, but it is an oxicam (other COX-2 inhibitors coxibs) and in reality inhibits both COX-1 and COX-2. It is found at higher levels in synovial joints than other body fluids, making it particularly effective for treating sprained joints and arthritis. Meloxicam and COX-2 inhibitors are unfunded by the New Zealand government, though most tradititional NSAD's are funded. For Meloxicam or COX-2 inhibitors to be funded by ACC, your doctor will need to apply for advance consent using an ACC1171 form.

Strong analgesics (pain killers) such as codeine, tramadol (Tramal), dihydrocodeine (DHC Continus), pethidine, morphine, and oxycodone (OxyContin) are helpful in managing severe back pain. They are all addictive and have side effects such as drowsiness and constipation. Ask your doctor if you can drive a motor vehicle or use machinery if you are taking strong analgesics. Codeine is effective for the relief of mild to moderate pain, and is often taken with paracetemol. Tramadol is a synthetic analog of codeine and is between codeine and morphine in potency, but causes fewer side effects than opioids due to it's dual opioid and monoaminergic actions. It is unfunded by the New Zealand government (all the other drugs listed above are funded), though it is the most used centrally-acting analgesic worldwide. For tramadol to be funded by ACC, your doctor will need to apply for advance consent using an ACC1171 form. Dihydrocodeine is similar in potency to Tramadol but with typical opioid side effects (it is also an effective cough suppressant). It is sometimes used for the management of chronic severe pain. Pethidine is sometimes used clinically for the short term relief of moderate to severe acute pain. Oxycontin is used for more severe acute pain and similar in analgesic and adverse effects to morphine. In New Zealand oxycontin is sometimes used to relieve the pain of bone fractures, but not usually for back pain. Oral liquid morphine is more often used to relieve acute severe back pain (on a controlled drug prescription). Due to their constipating effects of opioids, it is a good idea to take a laxative such as lactulose syrup with them. Contrary to popular belief strong analgesics do not simply mask pain and cause people to do things they shouldn't and make their condition worse. They enable people with severe pain to move, which helps them lead a normal life and speed up recovery and helps to prevent chronic pain. Strong analgesics should not be used for prolonged periods unless all other therapies such as osteopath treatment have been tried, and then only as part of a pain management program. If you suffer from severe pain your osteopath will tell you what activities you can do and what you should avoid.

Amitryptyline (Amitrip) is a older type of tricylic antidepressant that, in low doses, can be useful in treating chronic pain. It is more effective in treating fibromyalgia and chronic back pain of neuropathic origin than musculoskeletal injuries. It is best taken at night as it can cause drowsiness. It can also cause a dry mouth. It is funded in New Zealand. Never stop taking amtryptyline without talking to your doctor first as you may experience withdrawal symptoms such as headaches, nausea or low energy.

Muscle relaxants: back muscles do not usually get injured, but muscle spasm can be a consequence of a back injury, and may contribute to pain. Muscle relaxants such as orhenadrine citrate (Norflex), dantrolene (Dantrium), baclofen (Alpha-Baclofen) and diazepam (Valium) can help people with severe back pain move around, which can speed up the healing process. All are funded by the New Zealand government. Baclofen and diazepam can cause drowsiness and are addictive. Do not drive a motor vehicle or use machinery if taking baclofen or diazepam. Orhenadrine citrate is an anticholinergic drug that is both a muscle relaxant and an analgesic. Muscle relaxants can result in a loss of a protective posture and gait, which can sometimes lead to the aggravation of an injury. For example, a small disc bulge could fully prolapse and press on a nerve root, causing sciatica. Muscle relaxants are usually used in conjunction with analgesics and sometimes NSAI's. Muscle relaxants are of no help for less severe back pain.

Steroids: oral steroids (Prednisolone) can help reduce the symptoms of acute sciatica, but are rarely used as they can cause serious side effects. Stopping steroids must be done carefully under medical supervision. Steroid injections (hydocortisone) into the epidural space have not been found to decrease duration of symptoms or improve function and are not currently recommended for the treatment of acute back pain without sciatica. Injections of hydrocortisone with a local anaesthetic into the facets joints or intervertebral discs may be beneficial for people with severe low back pain associated with sciatica, though symptoms tend to reoccur some months later. In New Zealand these injections are usually preformed by musculoskeletal specialists. Facet joint and disc injections by musculoskeletal specialists are not funded by Public Health but they are available on ACC, though they they are not fully funded, so a co-payment is payable. You will need a referral from your osteopath or GP. Steroids reduce inflammation but also kill the cells that renew damaged connective tissue, and damaged connective tissue is usually part of the problem. Osteopaths doesn't recommend more than one steroid injection into one specific site within one year. It is recommended to also have osteopath treatment to correct the underlying biomechanical dysfunction that has led to the presenting symptoms. Trigger point injections have not been proven helpful in acute back pain. Trigger point injections with a steroid and a local anaesthetic are sometimes used to treat chronic back pain. Their benefit is unproven and their use remains controversial.

Street Drugs and Alcohol

Please do not use illegal drugs or excessive alcohol for self management of low back pain. This osteopath does not believe that marijuana (cannabis) helps relieve low back pain caused by common causes, though as part of medical management it may be useful to alleviate neuropathic pain and pain due to spacticity caused by cerebral palsy (CP), stroke and spinal cord injury. Narcotics such as opioids are powerful but highly dangerous analgesics and must only be used under medical supervision. There is anectotal evidence that psychedelic drugs and ecstasy (MDMA) can be powerful analgesics, but their powerful consciousness altering effects means that they can't be used for that purpose. Amphetamines and cocaine do not have analgesic qualities. Alcohol only has an analgesic effect in very large quantities, which has unfortunate negative effects including the possibility of further injury. It is acceptable for an adult suffering from low back pain to imbibe a couple of units in the evening to help induce relaxation.

Surgery

Surgery is seldom considered for acute back pain except for cauda equina syndrome, spondylolisthesis or a prolapsed intervertebral disc causing severe sciatica with numbness and muscle wasting. Surgery for prolapsed discs has a 70% success rate, though longitudinal studies show no benefit over osteopath treatment.

Prolotherapy

Prolotherapy (PROLiferative injection therapy) involves the injection of an irritant solution such as dexrose (sugar) into an area where connective tissue has been weakened or damaged through injury or strain. The injection is given into joints or tendons where they connect to bone. It is thought to re-initiate the inflammatory process, depositing new additional fibers to repair an injury. Once strengthened, the tissue no longer send pain signals. Prolotherapy treatment sessions are generally given every three to six weeks. A temporary increase in pain and stiffness may follow each treatment. Many patients receive treatment at less and less frequent intervals until treatments are rarely required, if at all. In New Zealand prolotherapy is usually practiced by musculoskeletal specialists. Prolotherapy by musculoskeletal specialists is not funded by Public Health but is available on ACC, though it is not fully funded, so a co-payment is payable. You will need a referral from your osteopath or GP. Evidence of its effectiveness is inconclusive, with some trials showing no difference to placebo injections. It is probably most effective in cases of joint instability caused by lax ligaments, and then after other options such as osteopath treatment have been explored.

Other Therapies

The Alexander Technique is usually learned by one-on-one lessons, and can help you become aware of your bodies posture, movement and balance. You need to practice it regularly and apply it to your daily life. The Feldenkrais method is usually learned in classes and helps you increase your awareness of how your body is put together and how it moves.

Chiropractic was started in the US in the 1890's by a layman called D.D. Palmer, who may have been a student of Dr. A.T. Still, the founder of osteopathy. In the US chiropractic has remained an alternative therapy, while osteopathy integrated into the conventional health care system a century ago. Osteopathy went from the US to the UK in 1917, where it developed as a distinctive British primary health care profession. The first full time training in New Zealand started in 1999 (there was a previous part-time training by ISOP). Chiropractic went more recently from the US to Australia and New Zealand, and tends to have more American ethics and practice management. In the nineteenth century osteopaths specialised in 'long-lever' manipulative techniques, and chiropractors in 'short-lever' techniques, but neither profession can claim exclusivity of a technique, and it is now common for osteopaths to use techniques that were once exclusively chiropractic, and for chiropractors to use techniques that were exclusively osteopathic. It is illegal in New Zealand for anyone other than an osteopath, chiropractor, physiotherapists or medical doctor to perform a high velocity manipulative technique to anyone's neck (Philip Bayliss very rarely uses these type of manipulations). In the nineteenth century both professions were quite dogmatic, with osteopaths proclaiming that the rule of the artery reigns supreme and chiropractors that the rule of the nerve reigns supreme. Present day osteopaths recognise that both the nerve supply and circulation are vitally important, though modern chiropractic literature puts the emphasis almost entirely on nerves. Chiropractors have a greater emphasis on alignment than osteopaths (who concentate more on restoring normal function to all tissues and joints, including the spine). Chiropractors base their diagnosis on X-rays (while osteopaths base their diagnosis on palpation or feeling the body and observation), and chiropractors treat mainly (and often only) by high velocity joint manipulation, while osteopaths usually use a combination of manipulation and a variety of soft tissue techniques. Chiropractors will often see their patients more frequently than osteopaths, with shorter appointments. There are exceptions, if you are not sure, please ask your practitioner.

Physiotherapy has had a long association with the medical profession. Until relatively recently physiotherapists worked under the direction of doctors, though today many are independent practitioners. This close historical association is the reason that some GP's favour referring to physiotherapists. Physiotherapists are trained to treat a wider range of conditions than osteopaths (who specialise mainly in pain in the musculoskeletal system), such as rehabilitation following surgery or spinal cord injury, rehabilitation following stroke, rehabilitation for those with congenital anomalies, draining thick secretions or pus out of the chests of those with cystic fibrosis or bronchietasis etc. Consequently their basic training does not go into such depth in diagnosing the underlying causes of musculoskeletal pain as does that of osteopaths. Frequently musculoskeletal pain sufferers visiting a physiotherapist may have no hands-on treatment at all. Soft tissue techniques may be limited to the basic massage moves and many physiotherapists never manipulate. Those that do, may manipulate only the 'painful spot', unlike osteopaths who treat the underlying causes and may avoid the 'painful spot' if it is contraindicated by their differential diagnosis. Instead a physiotherapist may give generic exercises, tape or splint the affected part and/or use ultrasound.

Acupuncture: current evidence shows that acupuncture can give pain relief, but does not decrease recovery time. Acupuncture can be used at the same time as osteopath treatment.

Transcutaneous electric nerve stimulation (TENS): TENS provides pulses of electrical stimulation through surface electrodes. For acute back pain, there is no proven benefit. Two small studies produced inconclusive results, with a trend toward improvement with TENS. In chronic back pain, there is conflicting evidence regarding its ability to help relieve pain. One study showed a slight advantage at one week for TENS but no difference at three months and beyond. Other studies showed no benefit for TENS at any time. There is no known benefit for sciatica. TENS can be used at the same time as osteopath treatment.

ACC data proves that osteopath treatment is more effective than physiotherapy, chiropractic and acupuncture in treating low back pain. Please see the free PDF download "ACC research - osteopath treatment vs other modalities" at the bottom of this page.

Prevention

The prevention of back pain is somewhat controversial. It has long been thought that exercise and an all-around healthy lifestyle would prevent back pain. This is not necessarily true. What some people consider exercise is little more than repetitive abuse of the body. Nonetheless, exercise is important for overall health - your osteopath can advise you on helpful exercises and good usage of your body. Low-impact activities such as yoga, Pilates, swimming, walking, and bicycling can increase overall fitness without straining the low back. PDF downloads of exercise programs are at the botom of this page.

These tips can help to prevent back pain, talk to your osteopath about how to perform them correctly:

Standing: Stand tall, with your stomach tight, your knees very slightly bent and your tail bone slightly pulled in. Women, please avoid high heels.
Sitting: Chairs should allow your knees should be slightly lower than your hips and have good lumbar support, and sit with your buttocks far back on the seat with the weight on your ‘sitting bones’. Keep both feet flat on the floor. If you need to turn often when sitting, use a chair that swivels. Car seats should also have adequate low-back support. If not, a small pillow or rolled towel behind the lumbar area will provide adequate support.
Computers: The top of the screen should be level with the eyes. Ergonomic keyboards and mice are best. The keyboard should be close to the body and slightly below elbow height. If you use a laptop, either place it on a stand or pile of books so that the screen is at the correct height and use a separate keyboard connected by cable or bluetooth, or use a separate monitor and keep the laptop close to you for keyboard use. Do not use a laptop on your lap!
Sleeping: Individual needs vary. If the mattress is too soft or too hard, many people will experience backache. A mattress needs to allow the more prominent parts of the body to sink in and support the more hollow parts. If the mattress is too hard the person will have to sleep twisted in order to present a flat surface to the mattress. A worn or poor quality mattress will sag. A firm base is preferable. If you have a box spring base, a piece of plywood between the base and mattress help. A mattress pad will help soften a mattress that is too firm.
Lifting: Don't lift objects that are too heavy for you. If you attempt to lift something, bend your knees and your hips, keeping your back straight, and lift with your knees and your hips. Keep the object close to you, don't stoop over to lift. Don’t twist while lifting. Tighten your stomach muscles to keep your back in balance.
Yoga has been shown to decrease the incidence of low back pain. A supple spine is less likely to be strained. Stiff joints will degenerate more quickly. Stretchable hamstring muscle give good hip movements, which save the back when bending and lifting. Classes are available at a number of locations in Christchurch.
Exercising on an unstable surface helps strengthen the stabiliser muscles, which are also the muscles that help prevent injury. Examples are exercise balls, skateboards, surfboards, snowboards and skis. Care must be taken not to fall and injure oneself as that would be counter-productive. If resistance training in a gym, it is best to sit or lie on an exercise ball rather than be supported by a bench, and to use free weights, or to move weights via a cable, such as with a Paul Check machine, as then the stabiliser muscle will be used. To strengthen large muscles without also strengthening the stabilisers is to invite injury.

To get an excercise program tailor made for you, please visit the ACC ActiveSmart website.

Below are links to free PDF downloads on sacro-iliac joint strain and piriformis sydrome, ACC research comparing osteopath treatment with other modalities and seven free PDF download on exercise programs. 'Pilates Exercises for Back Pain' is recommended if you are suffering from back pain, and 'Core Stability - A Pilates Workout' is recommended as a program to avoid back pain. Pilates classes are available at several locations in Christchurch.