Firstly, is it serious?
When I’m at work and somebody comes to me with low back pain, the first and most important thing for me to do is to establish whether the pain’s associated with serious or potentially serious causes. Osteopaths are trained to recognise when something should be looked at by a doctor. I’ve had many clients who’ve come to me asking about their back pain and for a number of reasons I’ve asked them to pass straight through my clinic and referred them on up the road to get checked out by their GP. Some of these reasons are what we call ‘red flags’, where I might suspect a serious condition such as cancer, cauda equina syndrome, or even an abdominal aortic aneurysm.
Having ruled out the ‘red flag’ referrals my next aim is to discover the root of the pain, as sometimes the reason it may have started or continued to stick around is not what you might think. People often come into the clinic saying they’ve a ‘slipped disc’, have ‘sciatica’ or ‘have put their back out’. But back pain can be linked to many different structures in your body and that’s what I’d be looking at next.
Detective work (the case history).
My next question is whether the pain we’re dealing with is what’s often called ‘mechanical’, or ‘simple’ low back pain. Alternatively, is the pain caused by other reasons? It’s a bit like being a detective. Welcome to my world!
To find answers I need to think about a whole range of structures, systems and past events.
- Incorrect foot wear, leg length discrepancies or different foot alignments (over-pronation, flat feet, high arches).
- A rotation through the pelvis.
- A previous accident in which your body has had to overcompensate. Examples of simple injuries which can lead to compensation are, spraining your ankle, turning a knee or overstretching your groin or hip.
- Lifting a heavy item awkwardly.
- Sitting for prolonged periods or having a poorly set up work station.
- Over-use of certain muscles, joints or ligaments possibly from repeating the same movement every day, lifting your child or playing a sport.
- Incorrect muscle activation patterns, where certain muscles have become too tight and others too weak.
- Referral from other structures, such as your kidneys, ovaries or prostate (a urine infection is a good example of this).
- Pregnancy/hormone related changes.
- Digestive issues such as bloating, constipation, diarrhoea or straining on the toilet.
- Fibroids, irritable bowel syndrome, Crohn’s disease, coeliac disease, endometriosis.
- Scarring from surgeries. These can include appendix, gall bladder, hysterectomy, hernia, or caesareans (even if the interventions were done by keyhole).
- Incorrect breathing patterns after recovering from flu or a cough.
Creative thinking (it’s not always obvious).
You can see from that list that a bit of lateral thinking’s needed. We have to get a bit creative! That’s why some of my questions may seem to delve into the past a bit, or go in an unexpected direction. For example, although it may not seem relevant now, any car accident or fall you may have had in the past could be related to your current pain. We’ve all ended up ‘moving funny’ because something hurts and these compensation patterns can stick and develop over time, even over many years.
Likewise, surgery or an old procedure you may have had, regardless of how long ago or how big, could also be contributing to the problem. This is because without you thinking about it, your body may have developed a protective position. Any tension built up like this in one area can have an effect on further away structures.
Low back pain can also create a ‘fear avoidance loop’ where we can end up feeling too scared to be active. This can make us feel really low and a low mood can actually amplify the feeling of pain and prolong its existence. It’s a horrible and frightening cycle to experience and can be difficult to break. I always focus my attention to take this into account.
Sherlock is my middle name.
With all these ideas in mind the Osteo Detective (otherwise known as Jane Sherlock Barnett!) will assess you as a whole. I look at your posture and gait and feel for the quality of movement in any joints that may be hypermobile or restricted. I test the strength and tone of your muscles and consider whether any abdominal organs are related to your pain. I provide a calming environment to reduce your body’s fright/fight/flight mechanism so your body’s own self-healing abilities can be optimised.
I take into account your story, how you’re feeling and note any patterns you’ve developed which may be sustaining the problem. Then I treat you directly with my hands and help you indirectly through advice and exercise prescription. I’m aiming to solve the case.
……and that’s just for low back pain. The osteo detective is happy to take on any type of case!