Lower Back Pain

Lower back pain… Can manual therapy help??

As an Osteopath, we are commonly thought to be back experts, which is probably why most patients we see present with back pain. There are various therapies that can resolve or manage your back pain and the treatment plan will depend on diagnosis. It’s very common for patients to have 3-4 treatments with an Osteopath and feel like they don’t need another session, on the other hand, it’s also very common for a patient to have treatment every 4-6 weeks to manage the pain and maintain optimal function.

60-90% of the population will experience lower back pain in their lifetime, so if you haven’t yet, its likely you are going to at some point. Fortunately, 40% of the time, your back pain will resolve within the week, with the right management. For those not so lucky, around 44% of people will experience chronic lower back pain which can greatly affect daily tasks and is a common cause of days off work. So, who can help?

I’m sure everyone has experienced disappointment when hearing the waiting time to see a doctor is sometime in the next 3 weeks and even then, it is likely that you’ll be prescribed pain killers and may be referred to an NHS physiotherapist, which involves more waiting…

 So why not try an Osteopath? The National Institute for Health and Care Excellence advise “manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage) for managing low back pain with or without sciatica.” This should also be accompanied with prescribed exercises tailored to your needs, all of which an Osteopath is trained to do. I’m not saying avoid pain killers and GPs but waiting times can be avoided and there is strong evidence for manual therapy and the reduction of back pain (Hidalgo et al., 2013).

In my experience, I often find the longer you put up with pain the longer it takes to resolve. I’ve had so many patients put up with the pain for months to years then finally do something about it. After seeking Osteopathy, there’s usually a good improvement within a few sessions. Don’t put up with pain, book in now…

Hidalgo, B., Detrembleur, C., Hall, T., Mahaudens, P. and Nielens, H. (2013). The efficacy of manual therapy and exercise for different stages of non-specific low back pain: an update of systematic reviews. Journal of Manual & Manipulative Therapy, 22(2), pp.59-74.

Does stretching benefit running?

Should you stretch immediately before or after a run? No. Contrary to most beliefs, research suggests that an acute phase of stretching (before or after exercise) does not show any benefits and indicates a possible decrease in performance and increase risk of injury.

Surely that can’t be right??

Muscular stiffness has been considered to cause injury and inhibit performance. However, it appears to be desirable for long-distance runners as stiff muscles around the hip, knee and ankle joints can increase stability and force production during the gait cycle, reducing the required muscle activation to maintain stability. More force production with less energy output = better running economy, better results.

Following this, stretching before a run has been shown to recruit more motor units (coordinate muscle contractions) in a muscle to perform the same work. More motor units = more oxygen consumption + energy expenditure. “No studies were able to suggest that stretching immediately before an endurance running event could improve running economy.” (Shrier, I. 2004).

Don’t be completely put off of stretching. Regular stretching is shown to be beneficial in other sporting disciplines, can improve your flexibility and is often used as part of a rehabilitation programme. Furthermore, stretching regularly (not before or straight after training) is suggested to have no negative impact on your running economy.

Delayed Onset Muscle Soreness (DOMS)

Will stretching help your DOMS? I’m sure everyone has experienced the inability to get off the toilet seat or make their way downstairs for the following days after a hard session running or training legs. This is DOMS. Commonly experienced 24-48 hours after exercise and the leading cause of reduced performance. Depending on the state of the muscle, stretching can actually prolong soreness/injury.

I always see people stretching in between sets or straight after a heavy session. This will not benefit you what so ever and can decrease power and increase risk of injury. There is substantial evidence to show that stretching does not reduce DOMS or improve performance. Instead of stretching, try hot/cold therapy which is shown to aid recovery.

Josh Kelsall (M.Ost)