There are a multitude of different treatments available for the treatment of low back pain. Every time that I open one of my social media accounts I’m bombarded with adverts from “experts”claiming to have the “best” treatment for low back pain.
If we left our back pain management to the self-styled, social media experts then I would be forgiven for thinking that we would all be in a much worse position. So, if these gurus aren’t to be believed then who is and what sort of treatment should you be receiving?
The 2 primary options for back pain treatment are conservative management and invasive treatment. Conservative options include hands on treatment and medication, such as from a chiropractor and painkillers. Invasive treatment includes treatments such as steroid injections and surgery.
The majority of low back pain can be managed very well with conservative treatment options. The manual therapy professions, which include physiotherapy, osteopathy and chiropractic, are the three main professions you may well have heard of before. All three professions are regulated by national governing bodies and you must hold the relevant degree to register with these governing bodies.
It is worthwhile stating that treatment from any manual therapist has the potential to help someone with back pain; no one profession is superior to the other. What is more important to consider is whether you are happy to work with the professional that you’re seeing. The relationship between the patient and the therapist, otherwise known as the therapeutic alliance, is the best predictor of whether you will recover. In other words, if you trust your therapist you have a higher chance of getting better.
I think it’s also worthwhile saying that even the worst back pain treatment can sometimes help people to get better, especially if there is a strong therapeutic alliance. However, if a therapist is not following the guidelines laid down by the National Institute of Clinical Excellence (NICE) for the treatment of back pain, then your chance of recovery is lower than if you were to be receiving high quality, research-based advice.
Now, I will concede that it is unlikely that a member of the general public who is experiencing back pain for the first time will know what the NICE guidelines for the treatment of low back pain are. If I am ever faced with a situation where a patient of mine needs to see another therapist, such as when relocating, I like to give some simple advice to help them when choosing the next person to work with on their back pain management.
The first question to ask is ‘Do you feel that the therapist is listening to you?’. You can’t build a therapeutic alliance with a therapist if you don’t feel that they are listening or responding to your requests. For example, if you say that you don’t want a specific form of hands-on treatment and they persist in trying to persuade you to have it, I would recommend not seeing that person because they’re not considering your desires for your treatment.
You also need to ask ‘How long are the sessions?’ (both the Initial Consultation and Follow-Up Treatments). Some treatment sessions can be as short as 5 minutes. It is impossible to deliver treatment that is patient centred (i.e designed around what the patients wants) and scientifically-based in such a short space of time. I have heard many arguments from professionals about why such short treatments are possible, but none of the arguments are plausible.
And finally ‘Have I been given things to work on away from the treatment sessions?’. If you are taking a modern, research-based approach to treating back pain, then there are many facets of a patients life that need to be looked at. For example, poor quality and quantity of sleep are correlated with a higher chance of getting low back pain. Your therapist needs to be looking at this and giving you strategies to improve these areas where necessary. Moreover, any therapist worth their salt will be giving you some sort of physical rehab. This could take the form of specific exercises or asking you to simply increase your daily number of steps.
In summary, to ensure that you receive the most appropriate treatment for your low back pain I would always recommend starting with a regulated manual therapy profession (chiropractic, osteopathy and physiotherapy). Once you have found someone you trust are happy to work with, make sure that they also tick the 3 questions that I have mentioned and you will be giving yourself the best possible chance of recovery.
To read Rob Bailey’s latest column in the Diss Express please click here.
