What works best for back pain – Medicines or Non-invasive techniques (Physiotherapy and Chiropractic)?
Substantiating evidence for non-invasive management
A recent publication by the American College of Physicians strongly favours non-medicinal approaches for dealing with non-specific back pain. The report encourages doing away with unnecessary investigations and medicines that are likely to do more harm than good and instead look towards structured physiotherapy guided exercise as a solution.
The latest 2016 NICE guidelines are also in sync with the American College of Physicians in recommending non-invasive procedures for the management of non-specific low back pain. The treatment protocol is patient centred and includes
- Motor control exercises for efficient recruitment of the core muscles
- Localised deep soft tissue massage and manual therapy techniques
- Spinal manipulation technique in cases of impaired mobility of the vertebral joints
- Structured exercise program: strengthening and stretching of affected muscles
- Use of behavioral therapy to resolve people’s fears regarding their back pain
Do you know your back pain type – Interesting facts
Non-specific or mechanical back pain arises from injury to muscles, ligaments and facet joints and may extend from low back to the buttock or thighs. The cause could be anything from poor ergonomics at work, road traffic accidents, incorrect postural habits or increased weight.
Radicular pain occurs due to compression of one or more spinal nerves due to disc prolapse or any other space occupying condition in the spinal canal. Pain radiates up to the great toe and may be unilateral or bilateral.
What’s techniques would a Physiotherapist’s/Chiropractor use?
Physiotherapists are experienced in manual therapy, massage, mobilisation, manipulation, stretching and strengthening techniques which they use according to patient condition.
- Spinal Mobilisation/Manipulation (Thrust)
Essentially belonging to the Chiropractic toolkit. A very handy procedure when there is restricted (unequal) vertebral movement due to a facet lock.
- Localised soft tissue massage
An excellent way to relax the muscles, increase blood supply and flush away the pain causing toxins.
- Stretching and Strengthening
Short muscles are essentially weak muscles. They need be stretched to normal length for effective function. On the same lines weaker muscles require strengthening for correct recruitment patterns during movement. If a muscle is recruited early or late in the movement, pain is imminent.
- Core strengthening/ Motor Control Exercises
I consider this the most important intervention in preventing the recurrence of back pain. The abdominals and short muscles between the vertebrae act as a guy rope to hold the spine in neutral
All these interventions when used individually or in combination customised to patient’s needs go a long way in relieving back pain. Long lasting, No side effects
A pioneering project carried out by one NHS trust says it all:
“East Lancashire trust NHS was one of the first to begin a drop-in physiotherapy service for acute low back pain in 2011. This early intervention physiotherapy service helped to:
- Rreduce reliance on drugs
- Lessen time off work
- Reduced years lived with disability
- Reduced susceptibility to depression
Over the last few years physicians have started looking outside the realm of medicine and surgery while treating mechanical (non-specific) back pain.
Listen to your Physio
Physiotherapists are now using a multidisciplinary rehab approach while dealing with back pain cases in order to limit disability.
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