Back pain is a common cause of work absenteeism and is as common among active populations as it is in sedentary folks.
The causes of back pain are multifaceted and there is a lot more to it than just tissue damage.
The current guidelines point to a more encompassing Biopsychosocial model. This quite literally means Biological reasons, Psychological reasons and Sociological reasons, because any number of things from any or all of these aspects could be a contributing factor in your pain.
Dueñas et al (2016)
I have already covered the complexities of diagnosis in detail here, so if you haven’t read that blog, I suggest you do so now!
It’s likely to bring a lot of things into question for you regarding how you think about your pain but let’s just say that, because the diagnosis is a lot more complex than most people realise, it’s not uncommon to be misdiagnosed.
You should ALWAYS get the advice of your GP or Primary Care Physician if you are suffering with chronic pain, but if you are unsatisfied with their diagnosis (if in deed they give you a proper diagnosis) then do consider getting a second opinion.
A GP might need a little persuasion to refer you to a more specialist unit within the NHS but even then, there’s no guarantee that you will receive the correct advice!
Medical institutes often take a ‘see symptom, treat symptom’ approach and, as you can see from the above schematic that’s not always correct.
Maybe you could even share these articles with your doctor before they decide to fob you off with a prescription for ibuprofen!
First off, let me clarify that I am referring here to what is often referred to as ‘non-specific low back pain.’
This is a recurrent or ongoing pain that is often disabling but that isn’t necessarily the direct result of an injury.
I mean, if you threw a much larger person in the Dojo using poor technique and felt or heard something rip, it’s safe to say that your pain has a pretty specific cause! Not that I’m speaking from personal experience or anything…. OK I am.
The British Medical Journal have a Best Practice section on their website. They describe chronic back pain as lasting for 4-12 weeks and outline clear guidelines for diagnosis.
An exclusion diagnosis is made by eliminating specific causes of lower back pain arising from neurological compromise, neoplasia, inflammatory arthritis, fracture, and referred pain from other locations or organ systems.
This means that your GP is not in the best position to give you a diagnosis but, so long as they are up to date with current medical guidelines for chronic back pain and they don’t suspect anything more serious, they ought to be recommending exercise not pain meds or surgery!
Even the NHS recommend exercise as a primary intervention as these bullets from the NHS website show:
Do regular back exercises and stretches – a GP or physiotherapist may be able to advise you about exercises to try.
Stay active – doing regular exercise can help keep your back strong; adults are advised to do 150 minutes of exercise a week.
Avoid sitting for too long when driving or at work.
Take care when lifting – read some safe lifting tips.
Check your posture when sitting, using computers and watching television – find out how to sit correctly and get tips for laptop users.
Ensure the mattress on your bed supports you properly.
Lose weight through a combination of a healthy diet and regular exercise if you’re overweight – being overweight can increase your risk of developing back pain.
Of course, your GP is not an exercise expert and may not have very much personal experience with exercise, so they won’t always recommend exercise or appreciate which types of exercise are best suited to you.
Fortunately, I am an exercise professional and have already written a blog for My Home Vitality on that very topic, go check it out.
If you are unsure of the doctor’s diagnosis, or want more hands-on treatment then you will probably need to go private and seek advice from a bodywork therapist of some kind.
Chiropractor or Physiotherapist
Many people are confused by the differences between physios and chiros, often using the terms interchangeably; although, the way a bodyworker operates will be down to their level of education, their attention to scientific literature and also their own life experiences and beliefs.
In an ideal world, they should both be using evidence-based passive (exercise) treatment protocols and you wouldn’t tell the difference; however, that, unfortunately, is often not the case.
Chiropractic Medicine isn’t a clinical or medical discipline and is officially regarded as an alternative therapy along with naturopathic medicine, acupuncture and various massage therapies.
Alternative treatments are NOT medical and there are many controversies surrounding chiropractic medicine (4).
The main intervention chiropractors use are spine and joint manipulations and although the sense of having your back clicked may feel like it’s doing something useful it’s not affecting anything on a cellular level.
It’s a placebo, which is not necessarily a bad thing but it’s important for the practitioner to explain the rationale for what they are doing to you.
There is a time and a place for manipulations, but it shouldn’t be a primary intervention or form the basis for all practice.
Chiropractic medicine is underpinned by the theory that Subluxations (partial dislocation) cause pain and that “releasing” a subluxation dispels negative energy, the build-up of which may cause disease.
This was devised by Danial D. Palmer in 1895.
According to the National Council Against Health Fraud, Palmer’s “subluxations” supposedly interfered with the body’s expression of the Universal Intelligence (God) which Palmer dubbed the “Innate Intelligence” (spark of life or spirit).
Fortunately, newer science-based chiropractors have long since moved away from such quackery. A science-based chiropractor should adhere to hippocratic practises in accordance with the following list:
Advance only methods of diagnosis, and treatments, which have a scientific basis.
Openly disclaim the non-scientific ‘subluxation theory’.
Restrict the scope of practice to neuromusculoskeletal problems loosely defined as “Type M” conditions (i.e. muscle spasms, strains, sprains, fatigue, imbalance of strength and flexibility, stretched or irritated nerve tissue, and so forth) recognizing that some Type M problems will fall outside the scope of even a scientific chiropractor.
Work closely with medical practitioners, consulting with them on cases involving possible pathology and readily referring when reasonable and prudent.
Use conservative methods of manipulative therapy.
Avoid exposing patients to unnecessary radiation.
Work to increase public awareness about abuses by non-scientific chiropractors.
Help other chiropractors become more scientific in their approaches to health care delivery.
Work to prohibit unqualified practitioners of all kinds from performing manipulation.
Aid in the prosecution of alleged malpractice.
Not all chiropractors are created equal and some still align themselves with Naturopathy and other non-scientific alternative practices which, at best, do nothing and, at worst, could do you harm!
If your chiro believes in the subluxation theory, prescribes natural herbal “remedies” or other unproven supplements or tells you that rubbing ginger on your joints will cure you of type 2 diabetes, take my advice: run away very quickly and then return sometime later with a maddening mob wielding pitchforks and flaming torches, because they might be a witch!
A physiotherapist in the UK would be a member of the Chartered Society of Physiotherapy and will have the letters MCSP after their name or, if they are involved in contributing to research in the field, they may have a PhD and be a Doctor of Physiotherapy (DiPT).
Therefore, Physiotherapy is far more likely to be evidence-based and ethical but, like a say, the practitioner maketh the practice and there are still bad physios out there!
In short, if you trust your chiro and they aren’t a vocal anti-vaxer or advocate of sensational claims such as “joint manipulations cure Cancer,” they’re probably OK. In either case, a chiro or physio ought to be using exercise-based interventions as their main treatment for your back pain but will likely support that with massage or occasional manipulations if they feel this will help desensitise an area under intense pain.
Remember, being stronger and more muscular (that doesn’t have to mean big by the way) will mean that your body moves more efficiently!
A combination of stronger muscles, denser bones and better motor patterning will almost always lead to less joint pain and better athletic performance; therefore, if you are suffering with back pain, once your physio has you back on your feet, your priority should be to get stronger!
To sum all this up let me put it into bullet points for you:
- Get a proper MEDICAL diagnosis!
- See a CLINICAL specialist!
- Get a specific exercise intervention prescription!
- See an exercise professional who specialises in strength, conditioning and injury rehab for sports to be sure of safe practice!
If you feel you are ready to learn how to take a systems-based approach to beating chronic back pain then look no further than my online program The Back-Pain Solution.