Back

You can count yourself extremely lucky if you manage to get through life without experiencing back pain at some time or another.  Very often we can trace the cause to our own over-enthusiasm – perhaps working too hard in the back yard in the first warms days of spring, or lifting a heavy chest of drawers to clean behind it.  In the main, these back aches and pains get better of their own accord after a relaxing bath, some rest and, on occasion, a couple of analgesic tablets for pain relief.  The medical profession refers to such cases as “non-specific back pain”, one of the largest single causes of working days lost through sick leave in the Western world.

In cases where non-specific back pain is not the result of over-ambitious exertion, there are a few categories of people who are more prone to it than most: Those who are overweight and those – like nurses and factory workers, for example – whose work involves lifting and carrying.  Non-specific back pain is thought to occur as a result of ligament strain, a muscle tear, damage to a spinal joint, or prolapse of an intervertebral disk (slipped disk).  This is often coupled with spasm in the surrounding back muscles, which causes additional pain and tenderness over a wide area and, in some cases, can lead to temporary scoliosis (abnormal sideways curvature of the spine).  A slipped disc and damage to the facet joints of the spine can both cause sciatica (pain in the buttocks and down the back of the leg into the foot). Sciatica is painful enough at the best of times, but if you cough, sneeze, or strain in any way during a bout, the pain is excruciating.

Those who suffer from osteoarthritis in the joints of the spine often complain of never being free from pain and, as with sufferers from ankylosing spondylitis (arthritis affecting the spine, they frequently experience stiffness and a loss of back mobility which prevents them from performing many of the simplest tasks, such as tying a shoe lace.

The condition fibrositis (pain and tenderness in the muscles) can sometimes affect the back without there being any problems of the bones or joints.

THE ORTHODOX APPROACH

An examination of the back may reveal tenderness or a lack of mobility which could indicate several of the non-specific back pains mentioned above.  To confirm structural damage, an x-ray would be arranged and there are several specialized forms of x-ray or scanning which may be employed if pressure on a nerve root is suspected.  If a specific cause can be found, then the treatment will be appropriate to the situation. Acute non-specific back pain is treated by analgesics and a short period of restriction, if necessary.

Chronic back pain is more difficult – the treatment could include a course of aspirin and related drugs, non-steroidal anti-inflammatory drugs or muscle-relaxants; acupuncture or spinal injections; exercise, spinal manipulation, the wearing of a surgical corset or even spinal surgery.  Fibrositis often improves with the use of non-steroidal anti-inflammatory drugs.

THE HALE APPROACH

Most physicians, except those who have taken a specific interest in the subject of back pain, will agree that osteopaths and chiropractors have far more training in the field. Any back injury or back pain is therefore best assessed by either of these specialists, who can make a referral to an orthodox specialist if required.

The causes of back pain are very diverse and I would recommend some patients to see a consultant in complementary medicine to be advised about the most appropriate form of treatment. Where this is not practical, try to choose the most suitable treatment on the basis of the information given here.

The most usual treatments for back pain are manipulative therapies such as osteopathy and chiropractic, which aim to bring the vertebrae back into line, but working either directly or through the muscular system. In cases of muscle spasm or sciatica, however, acupuncture, aromatherapy, massage, or reflexology may be more appropriate.

If the back pain keeps recurring, it may be that the treatment should be focussed more on the muscles.  Osteopathy or chiropractic may still be appropriate, but homeopathy can also be effective in strengthening the muscles in order to keep the vertebrae in place.  Equally, working on the muscles with Marma massage or tuina massage can be very helpful.

For chronic back pain postural treatments such as the Alexander Technique, Hellerwork or G.D.S. may be more appropriate than constant manipulation.  If a patient is receptive to the idea of energy healing, this can be effective, particularly with very serious cases.

The self-care aspect is also important in the treatment and prevention of back pain – try gentle exercises like T’ai Chi, Chi Kung, and yoga. 

Finally, the possibility of a psychological aspect to back pain cannot be ignored. We once had a patient who suffered from neck pain.  Every “standard” treatment had been ineffective and eventually he saw a psychologist, who asked him which person in his life was “a pain in the neck”.  The patient immediately recognized who that person was, and the pain disappeared within a few hours. Homeopathy can also be of great assistance if there is a strong psychological basis for back pain.

OSTEOPATHY

After taking a medical history and carrying out a detailed physical examination, an osteopath will plan a course of treatment. Each session, which usually lasts about thirty minutes, may involve soft-tissue massage, gentle, repetitive movement of joints, and rapid guiding of the joints through their normal range of movements (producing the characteristic clicking that most people associate with osteopathy). There may also be advice on posture, exercise, and relaxation techniques. A short spell of perhaps three or four treatments should sort out the majority of back problems.  More about osteopathy...

CHIROPRACTIC

Spinal manipulation (chiropractic) is one of the most well-documented complementary therapies in terms of effectiveness and cost effectiveness. Studies suggest that with manipulation the stimulation of nerves (reflexes) can cause the muscles to relax and possibly also have an effect on the vascular system via these nervous reflexes.  The majority of cases need an average of five to eight treatments, but chronic back pain will often need more than 10, spread over several weeks or months, in conjunction with exercises, ergonomic advice, stress management, and so on.

A first consultation would entail a full physical examination, treatment and explanation of the patient’s symptoms; subsequent sessions would comprise treatment and exercises with continuous monitoring of progress.  Provided the patient follows the advice and exercises, chiropractic claims a success rate of over 95 percent in most (uncomplicated) cases. In the case of chronic back pain, patients could hope for a significant reduction in pain medication, and increased mobility and social function.  A maintenance program whereby you might attend a treatment every one to three months may well be recommended following the more intensive course of treatment.  More about chiropractor...

ACUPUNCTURE/CHINESE HERBS

Depending on a patient’s condition, a combination of acupuncture and Chinese herbs may be used to regulate the energy balance and get through any blockage in the body’s meridians, particularly the bladder and kidney meridians.  Most patients will experience some improvement and some will achieve a complete cure after a course of this treatment.  Acupuncture has been particularly successful in the treatment of back pain caused by muscular spasm of sciatica. More about acupuncture...

HOMEOPATHY

Although each case has to be judged individually, there a number of homeopathic remedies that is commonly associated with the treatment of back pain.  The first step is to find the origin of the back pain. Rhus tox is a very common remedy when there is stiffness in the back and particularly if there is a stiffness after the first movement of the day which then disappears.  Arnica is also useful, especially when there is a sensation of bruising in the back, and after mental or physical trauma.  Sometimes the problem is weakness in the back rather than pain, and then phosphoric acid is used.  Ruta grav and Hypericum are often indicated when nerve damage is involved. More about homeopathy...

MARMA MASSAGE

Marma is a form of deep-tissue which is used together with yoga and Ayurveda to eradicate muscle spasm and inflammation, and to correct mechanical and pathological conditions of the back.  This integrated physical therapy has been very effective with back pain. The duration of treatment varies with the severity of the case, but as a rule of thumb two or three sessions should be enough to eradicate acute pain; between 6 and 20 sessions may be needed to relieve chronic pain completely.

According to one Ayurvedic physician and Marma therapist, “The back maintains a unique pressure. If there is an imbalance of pressure for mechanical or pathological reasons, muscle spasms and inflammation will be created and this results in back pain.  Marma therapy can help the back to maintain pressure.  In terms of lifestyle changes, diet and exercise are very important for the prevention of back pain. I also recommend no acidic food.   More about marma massage...

ALEXANDER TECHNIQUE

The Alexander Technique improves posture, allowing the body to work in a more natural, relaxed, and efficient manner.  To treat back pain, the therapist begins by watching how you use your body.  He or she will then guide you to correct any harmful postures you may have acquired over the years and help you regain the habit of using your muscles with minimum effort and maximum efficiency.   Good posture and correct use of the body will release tension, alleviate symptoms and prevent further pain.  More about Alexander Technique...

SHIATSU

Shiatsu and its associated maintenance advice (such as corrective chi yoga/exercise) focus on the underlying causes of the back pain.  Therapy aims to support and energize the weak areas and relax the tense areas of the back (and indeed the whole body). 

Following a series of treatments the individual may not only expect relief from pain, but will also be equipped actively to prevent further attacks.  More about Shiatsu….

REFLEXOLOGY

Whatever the complaint, reflexologists will give a full reflexology treatment, based on treating the whole body, before moving on to specific areas relating to the particular problems.  With back pain, a full treatment would be followed by extra treatment specific to the area where the pain was being experienced, such as the lower back, and to the neck, adrenal glands, and solar plexus.

The duration of treatment depends on how long the problem has been present.  Some people who are sensitive and react very quickly may need only three treatments.  Others need a longer time, particularly if the problem is deep seated.

You can treat yourself by working along the inner side of both feet, but only after you have been instructed by your practitioner and have a clear understanding of what you are doing.  Inexpert treatment can overwork a reflex area, possibly upsetting the balance in the body, with unpleasant results.  More about reflexology...

TUINA

Tuina (meaning “push” and “squeeze”) is traditional Chinese massage working over acupoints and meridians, using deep pressure, tapping, clapping or friction to alleviate pain (caused by the stagnation of chi energy in the body). This stimulates the flow of blood and is helpful in the treatment of chronic and acute back pain, and sports injuries.  The treatment is normally very deep tissue massage, leaving the patient alert and balanced.  Chi Kung exercises are also normally prescribed.  More about Tuina...

NUTRITION

In general terms, nutrition cannot be used to treat back pain which his caused by muscular pain or injury.  However, some people are sensitive to the tannin and caffeine group of products, e.g. tea, coffee, chocolate, cocoa, cola, red wine, etc, and for them these foods appear to dry out the synovial fluids which lubricate joints.  If synovial fluid becomes low, general wear and tear on the joints (and, of course, the back is basically a series of joints), is greater and you are much more likely to experience “lesser grade” back pain.  A good way to identify whether this food sensitivity is present is to eliminate these products from your diet.  If you then have a pressure headache for several days and are generally slow and mentally unfocussed, you probably do have a sensitivity – you are experiencing withdrawal symptoms, which would be instantly relieved if you were to take half a cup of coffee or tea.  More about nutrition...

AROMATHERAPY

A massage using specifically chosen essential oils can relax and stretch the muscles, calm nervous activity, stimulate the flow of blood and chi (intrinsic) energy and mobilize joints, thereby reducing pain and increasing flexibility.  Two to three treatments involving massage, exercises, and stretches should be enough to relieve back pain, although this is obviously dependent on the severity of the condition, how long it has been present, and your emotional state.  In the case of arthritic or stress-related muscle spasm and in sufferers who do not exercise sufficiently or are overweight, improvement is normally immediate; in other cases total cure is often achieved.

As well as the treatments, it is important for exercise to be incorporated into a patient’s lifestyle if success is to be long-lived; good posture must also be maintained.  Advice on these subjects would be given during the treatment sessions.

The essential oils recommended for your condition can also be used in moderation and under direction at home to relieve early symptoms of back pain through muscle relaxation.  Rosemary is good for muscular pain, while eucalyptus, citriodora, juniper, ginger, and orange are deeply relaxing.   More about aromatherapy...

HERBALISM

This is a useful complementary therapy in cases of acute back pain such as lumbar strain, when a patient is consulting an osteopath or a similar therapist.

Anti-inflammatories such as devil’s claw or turmeric extracts taken internally can be helpful. Arnica tincture applied to unbroken skin, and various arnica creams are useful for any external strain. Very dilute concentrations of various essential oils which have anti-spasmodic and analgesic qualities and which increase blood flow might be recommended as the base for a vegetable oil. Suitable oils include rosemary, peppermint, lemon grass, geranium and nutmeg.

If the back pain is related to a bone problem such as osteoarthritis of the spine, an external treatment with an anti-inflammatory such as devil’s claw and willow bark is still useful. Certain herbs, including capsicum and prickly ash, improve blood flow, which helps osteoarthritis. In addition, horsetail, which contains silica, can help to reconstruct the joints.

In some cases, back pain may be a symptom of depression and this can be treated quite effectively by herbal medicine. The main herb for this situation is hypericum (St john’s wort).   More about herbalism...

SELF-CARE

If you overdo it and back pain is the result, or if you just tend to “suffer with your back,” make sure you sleep on a firm orthopaedic mattress or put a board under the mattress. Use one pillow.

Once you are aware that you are prone to back pain or have a weakness in that area, it is wise to examine ways in which you might relieve the pain yourself before the condition escalates.

Osteopathy

When the pain is acute, rest is the most beneficial treatment. Listen to your body and rest in whatever position is the most comfortable. The application of heat or ice may also be of help. Heat is used in the relaxation of tight muscles and to restore the blood supply; ice helps to reduce inflammation. In an acute case there will usually be tight muscles supporting and protecting an inflamed area, so “contrast bathing” (alternating applications of heat and ice) may help most.

In a more long-term case there may have been repetitive strain of the same area. This area can be helped by maintaining good mobility of the joint with toned muscles. Often posture will play a large part in this (e.g., back muscles are tight, but there is no support from the abdominal muscles). This collapse of the posture into “swayback” will put more strain on the affected lower pain or disk. Keep the back flexible and stretched.

Flower Remedies

The original Bach flower remedies and the extended range of over 2,000 essences from around the world are ideal for helping yourself to combat back pain. Although there are a number from which to choose, and a consultation with a practitioner would pinpoint the most appropriate for your specific condition, in general terms the Australian Living essence Menzies Banksia is particularly recommended for back pain.

SUPPORTIVE TREATMENTS

Certain alternative therapies enjoy good results with back pain but are even more effective when combined with other types of complementary treatment.

Maya Abdominal Massage

A non-invasive massage technique that specialises in treating gynaecological and digestive conditions.  It improves organ function by relieving congestion, enhancing blood supply; increasing lymphatic drainage and aiding nerve supply to the pelvic and reproductive organs. Further Details

Colonic Hydrotherapy

According to colonics therapists, back pain may be caused by toxicity of the muscles, kidneys, or a congested colon or spasms. Where this is the case, colonic hydrotherapy (gently flushing out the colon to remove any unbeneficial material) can alleviate and even remove the condition. In these situations, colonics combine very well with massage to remove back pain. However, if the pain is due to poor posture, spinal misalignment, or serious spasms, colonics is not really appropriate and massage alone or in conjunction with another therapy may be more beneficial.

Remedial Yoga

Before attempting to alleviate back pain through yoga it is important to determine if the condition is due to an acute injury- misplacement or whiplash, for example. Once this is established, yoga can be highly beneficial. Retained tension and overworked muscles bring a lot of pain to the upper spine. You can overwork muscles by the way you use them. In Hatha yoga therapy, you can learn through the asanas (postures) to relax the spine, which makes it supple and avoids further problems in the spine itself.

In cases of whiplash or after surgery, yoga can help renew the tone and suppleness in the spine once you are on the way to recovery.

Yoga also brings strength back to the muscles and helps to build confidence in the affected area (confidence can be lost after experiencing pain), so that the back and the body can once again be used fully. Shock needs to be worked through. One of the ways to break through these blockages is to ensure that breathing is complete and not limited. Breath awareness helps to release the body of blockages.

Chi Kung

The seven basic exercises of Chi Kung and the eight fundamental T’ai Chi exercises form the basic reference point from which treatment begins. Both philosophies treat the person as a whole by using and balancing the chi (intrinsic) energy in the body. The underlying purpose is to bring the patient back to his or her “tantien” centre, thereby strengthening lower back muscles. Gentle exercises, stretching and affirmations are used to release tension in the back and bring relief from pain. Once mastered, Chi Kung can be used as a preventative therapy for back pain.