Lower Back Pain! - What to expect when you come for treatment.

By Cameron Allshorn

Lower back pain is all too familiar, it's far too common and often pushed aside as just a part of day to day life. As osteopaths, we see this presentation daily in both acute and chronic cases. 

Most people know we treat back pain, however we’ve decided to pull back the curtain a bit and tell you HOW! we treat back pain and what to expect from us if you book an appointment due to lower back pain.

There are differences in each case however management and treatment is built off a solid framework including hands on treatment, exercises, stretches and education that we have seen deliver great results.

We will always take a case history before assessing and treating, so that we have the best base of information as to how the pain started, what happened and if this has happened before. (If you are a new patient to Rockhopper all initial appointments include taking your broader medical history so that we are best prepared to help you, which is why we allow for 1hr for new patients.)

During initial assessment we will take you through your available range of motion including forward spinal flexion, side-bending and rotation as well as performing some orthopaedic tests that will help us check the integrity of the overall spinal structure (joint, muscle, disc ect).

The burden from low back pain has reached a tipping point where the condition is growing rapidly, is poorly understood and is being mismanaged medically – at cost both to the patient and to the healthcare system

- Monash University researcher, Professor Rachelle Buchbinder

Acute Back Pain 

Often caused by a joint sprain at one of the lumbar spinal levels  and associated muscular tightening of the lumbar region. This pain is often episodic and short lasting (2-4weeks) It is common to occur after a lift and twist movement, sometimes consistently tight lower back muscles can be a precursor warning sign that a threshold is being reached. 

In the case of acute pain, our first goal is often to reduce symptomatic pain, improve range of motion and delivery initial relief from first appointment. Usually these presentations require 3-4 appointments over 3 weeks give or take, in most cases we will look to have a smaller gap between the first and second appointment (usually 4-7days) 

Treatment will be made up of soft tissue massage of the lumbar region, glutes, and possibly hamstrings, quads or lower limb. Joint mobilisation and articulation of the individual spinal joints, hip, sacrum and pelvis. This will be done in a majority of table positions (lying on front - “prone”, lying on back - “supine” or side lying) however we will always make sure that no one position is too painful. 

Following treatment, we will almost always tape your lower back with rigid strapping tape, this taping provides support for the area post treatment and also helps de-load some highly loaded muscles. This taping can usually stay for 2-3 days.

Follow up appointments will follow a similar framework however we will introduce stretches and exercises as we can that will help further the improvement and recovery process. (check out our resources page for some videos of our favourite lower back stretches) 

Sometimes acute episodic lower back pain can be linked to an underlying structural problem i.e. disc bulge or other disc issue, spinal stenosis or arthritis. If we are already aware of these findings we will adapt our treatment to suit however in the cases where no imaging has previously been done and we are not seeing improvement at the 3rd appointment we may refer off for further imaging (MRI,CT, Xray) to rule in or out any potential underlying pathology.

Across the globe (there is) inappropriately high use of imaging, rest, opioids, spinal injections and surgery. Doing more of the same will not reduce low back pain disability nor its long term consequences.

- Monash University researcher, Professor Rachelle Buchbinder

Chronic Lower Back Pain 

Lower back pain is considered chronic if it has been present for longer than 12 weeks. Now clearly this is on the shorter end as it is not uncommon for us as osteopaths to see a chronic presentation that has been around for years.

Chronic lower back pain is highly variable and is more likely to have associated underlying findings relating to joint, disc and/or spinal canal function.

A common goal when managing chronic lower back pain cases is to maintain and retain the available range of motion and function in the short term while aim to build on to this platform over the long term period to overall reduce symptoms, decrease frequency of flare ups and improving baseline function. 

Management of chronic back pain cases is quite similar to that of the acute back pain initially, this is in part due to the fact that most chronic cases present to us during a flare up of acute symptoms. Once we are able to settle the acute episodic pain, management will shift towards preventing relapse symptoms and associated flare ups. It is quite common that when treating chronic back pain we will have a block of treatment (4-5 appointments over 6 weeks) first and then space out to a regular appointment somewhere between 4-8 week intervals depending on each case. 

We will set up a physitrack program with some stretches, exercises for you. This program may include exercises that target areas other than your lower back such as hips, legs, upper back to help assist our holistic approach.

We see the best overall improvement from patients who are diligent with their rehab exercises and commit to a regular scheduled treatment plan.

Where to next? 

For future care, prevention and management of symptoms Rockhopper recommends an educated approach that suits your lifestyle and current situation. 

Following acute episodic lower back pain and assuming no underlying pathologies a full recovery is expected. This still doesn't not mean that all future management is unrequired. Continuing good spinal care includes 

• reducing high risk loading (using improper gym weights, lifting too much at work) 

• Continued targeted exercise (this can be changing or adding to a gym routine, attending a pilates or yoga class or continuing to do a regular home based program) 

• Being aware of the requirements of your body, seeking treatment if required. 

• Acting sooner rather than later, its much easier to manage and treat that 1-2 day tight back rather than the intense acute pain that could follow. 

In regards to chronic back pain, all of the above still apply however a discussion around your own individual situation may alter the specifics. A scheduled approach to this kind of chronic condition usually leads to improved results rather than waiting to manage an acute flare up and for that reason we recommend to check in with your chosen health practitioner in 2-3 month intervals.   

Hope you have found this insight informative and we’re happy to assist you and answer your questions too!