Your Good posture Guide.

“Working from home” are three words that have dominated our vocabulary and become a part of everyday life for many of us. While this new career set-up comes with some advantages (sleep-ins, super easy commutes, pyjamas as workwear!), it also comes with some distinct disadvantages - namely, the lack of a proper space from which to WFH.

A recent survey carried out by the British osteopathy Association found about 40% of those who work from home are doing so from their bedroom, or even from their bed. The idea of sitting at home on your laptop, perched on your knees, in bed or on the sofa, makes every chiropractor lose sleep!

Recently Craig McLean was interviewed by Healthy Magazine about the “posture pandemic” and the role WFH has played in our increasing spinal issues.

“Craig McLean, chiropractor and founder of Chiro London, believes that two factors were responsible.‘The combination of people working from home and feeling pretty stressed – both have the potential to create an abnormal amount of tension through the neck and shoulders.’

‘If you’re leaning forward, over a laptop, the muscles at the back of your neck have to work overtime just to hold your head up,’ says McLean. Meanwhile, worrying about the health, financial and social impacts of the pandemic might have caused us to tense up through our shoulders, contributing further to any posture issues. And while niggling pain might be a short-term symptom, a poor desk set-up can cause lasting damage over time. ‘The muscles at the front can get quite weak,’ says McLean. ‘Over time, the bones in the upper back get thinner at the front and stay the same height at the back, which creates a hunch.’ Luckily, there are some easy changes we can make to limit lasting damage.’

Click here to read the full article, which features Craig’s tips on how to lessen the impact of WFH on your spine, including how to set-up your work area to improve posture and simple stretches to increase spinal mobility.

14 Benefits of Seeing an Osteopath

When you think of an osteopath, you might only associate them with treating back pain. But there’s so much more to it than that! Osteopaths can help with everything from chronic pain to sports injuries and poor posture. They offer not just quick fixes but long-term solutions too!

1. A Holistic Approach

Osteopaths don’t just focus on bones and muscles. They treat the whole body. They also consider how every system interacts within the body, which is why they treat more than just joints, bones, and muscles.

An osteopathic diagnosis can identify imbalances between different parts of the body, and an osteopath will create a treatment plan to address these issues and help you reach your goals.

2. Non-Invasive Treatment

One of the best things about osteopathy is that it’s non-invasive! You don’t need surgery or medication to treat your aches and pains. Osteopaths will use different techniques to help your body’s natural healing mechanisms, working with you to achieve progress with minimal discomfort.

3. It's Relaxing

Osteopaths provide gentle, relaxing treatments in serene atmospheres. Your osteopath will ensure your session is as stress-free as possible, allowing your body to not tense up against treatment and kick-start healing. During your appointment, you’ll likely lie on the table while the practitioner works on specific areas, helping you breathe deeply and feel cared for.

4. Chronic Pain Relief

Osteopaths often treat chronic back or neck pain and have systems in place to help manage these conditions. Whether it’s trauma, repetitive strain, poor posture, or sporting injuries, osteopathy can target the underlying cause of your chronic pain and provide long-term relief. Osteopathy can be effective for spinal pain, headaches, knee pain, shoulder pain, and more!

5. Improved Sleep Quality

Quality sleep is vital for our health, but lack of it can lead to depression, anxiety, headaches, and weight gain. Inflammation, stress, and poor sleep patterns can make it difficult to fall asleep. Your osteopath will help reduce inflammation and stress, making it easier for you to fall asleep and stay asleep. Research shows that osteopathic manipulative treatment may even play a role in managing sleep-related problems after trauma!

6. Reduced Risk of Injury

An osteopath can help reduce your risk of injury by identifying weaknesses, imbalances, poor stability, and flexibility issues. They’ll address these issues through treatment and exercises, keeping your body strong and resilient and less likely to suffer injuries during physical activity or sports.

7. Manages Posture

Osteopaths can help manage and improve your posture, which is important for your overall health. They’ll identify restrictions and work with you to correct them, ensuring you have good posture for better health!

8. Better Nervous System Functioning

Your nervous system sends and receives signals between your body and brain. An efficient nervous system helps you move faster and more accurately. Osteopaths can help improve your nervous system with exercises and treatments to relieve nerve pressure.

9. Relief from Nerve Compression

Nerve compression is a common reason to see an osteopath. Nerves act like electrical cables, which can cause pain, tingling, and numbness when they’re compressed. Your osteopath will identify the cause, whether it’s injury or something as simple as poor posture. Nerve compression can be caused by a disc bulge pressing on the nerve, which is most common in the neck and lower back.

10. Improved Joint Mobility

If you’re experiencing stiff joints, osteopathy can help. An osteopath will assess your joints, muscles, and connective tissue and perform gentle manipulations and soft tissue massage to help you move again. These techniques help restore the range of motion and reduce pain.

11. Reduced Pain and Tension

An osteopath can help reduce pain and tension in your muscles and connective tissue by manipulating your joints and muscle tissue. Osteopathic techniques can help with conditions all over your body, not just the spine.

12. Stretches Tight Muscles and Fascia

Osteopaths can help with tight muscles and fascia by using their hands to manipulate your soft tissue and stretch areas of tension and pain. This treatment can help with conditions like sciatica, tennis elbow, and plantar fasciitis.

13. Tailored Treatment Plans

You can get a customized treatment plan tailored to your needs with osteopathy. You can choose when and where to have treatments and what your goals are.

14. An overall feeling of well-being

Osteopathic treatment can relieve pain, stress, and anxiety, leading to an overall improved sense of well-being. You’ll likely feel stronger, more flexible, and ready to take on the world!

Conclusion

There are many benefits of seeing an osteopath. In addition to helping you with any issues, they can also help prevent future problems. By educating you on what it means to be healthy and how best to maintain that state of mind, your osteopath can help you get the most out of your life. If you’re interested in learning more or would like an appointment with one, contact us today!

How to Choose the Right Osteopath for You?

Do you need a medical professional to use a non-invasive manual technique to mobilise, manipulate, ad improve your fascial and musculoskeletal system? Are you in need of osteopathic therapy to deal with back pain, poor posture, arthritis, and other related musculoskeletal issues? If yes, you need to consult an osteopath.

Simply put, an osteopath is a person who has been trained to manipulate the muscles, soft tissues, and skeleton. The service of this professional can make a big difference in your overall well-being.

If you need an osteopath, it is important to select one that can proffer the desired solutions. So, how do you choose the right osteopath for you? This guide can help you.

Research

When you are looking to use the services of any professional, the first thing you must do is research. The situation is not different from finding an osteopath. Spend some time learning what an osteopath does and how they do it. This allows you to know what to look for in the best osteopath.

Also, you should research the best osteopaths in your neighbourhood. A simple Google search can show you most of the osteopaths around you. Facebook marketplace is another wonderful place you can visit to find osteopaths.

Get recommendation

Do you know someone who used the service of an osteopath recently? Such a person can recommend a tested and trusted professional for you. Ask the person about their experience with the osteopath. If they are satisfied with the service, you will likely have a good experience too.

If you don’t get recommendations through a friend, family member or acquaintance, you can join Facebook communities in your neighbourhood to ask for recommendations. Many people will be willing to help you.

Make sure you localise your search. For example, if your health condition requires osteopathy in London, you should get a recommendation for an osteopath in this same city.

Learn more about their training

During your research, you should have gotten an idea of the kind of training that an osteopath needs to operate in your area. So, before selecting an osteopath, you need to ascertain they have the right education to take care of your medical needs.

Are they registered practitioners? Do they meet the registration standards for practising in your area? Are they up to date with the latest development in the field? These questions can help you to learn more about the training of an osteopath.

Find out their experience

Although any well-trained osteopath should be able to help you, an experienced one can offer better services. This is because they must have handled similar situations in the past. Consequently, they know the right things to do to help you.

To measure their experience, ask some relevant questions. When did you start offering osteopathic treatment? How many people with my condition have you treated? Make sure the osteopath knows what they are doing.

Read reviews

Have you gotten recommendations about certain osteopaths around you? Did you find some osteopaths during your online research? Don’t rush into selecting anybody. Spend time checking out reviews on the internet.

Google Reviews, BBB, and other platforms provide independent reviews from various customers. Learn about what previous customers are saying about your preferred osteopath.

Pay attention to any red flags raised by multiple previous clients. If everyone has complained about the same thing, you will likely have a similar experience. So, don’t overlook any unusual thing.

Ask about the services they offer

All osteopaths don’t work the same way. While some osteopaths provide all kinds of osteopathic services to deal with various conditions, others focus on some specific services and conditions. As a result of this, certain osteopaths may not be suitable for you.

Before choosing anyone, consider whether they are a specialist or generalist. Regardless of who you pick, be certain they can help you.

Consider location and logistics

To get osteopathic treatment from an osteopath, you will have to visit their office. This is where the consideration of location and logistics comes into the picture. You don’t want to choose an osteopath so that you cannot visit their office comfortably.

What are the things you should consider?

• The proximity of the osteopath’s office to your home or office

• The proximity of the office to a car park

• Availability of stairs

• Wheelchair accessibility, especially if you are an elderly person or dealing with limited mobility

After doing everything above, you are ready to work with an osteopath to treat your condition. Go with your instinct and experience the best of osteopathic therapy.

What many healthcare professionals arent telling you…

Every healthcare practitioner who works with musculoskeletal pain and injury (Chiros, Physios, Massage Therapists, Osteos etc) will tell you they provide results that last (honestly, what kind of professional wouldnt tell you they provide the best service?). They will tell you their treatments work and that your chronic pain can be solved through their ‘insert hands on treatment modality’. Generally, it all starts well and the pain subsides, but after the 6th/7th/8th appointment the improvements stop, the symptoms come back and you are back to square one.

I used to be a practitioner who sold long term results with my ‘magical hands’. But that all stopped when I became the one with the chronic lower back pain. All of a sudden the tables had turned and I was now the one laying face down on the treatment table, the practitioner had become the patient. 

I saw ‘the best’ Chiros, Physios and Massage therapists all who provided me with excellent hands, short term care and all who genuinely cared for my well being. However, my short term pain was not my concern, I was wanting a long term solution, I wanted to get back to exercise, back to driving without back pain, back to being able to stand at the pub with my mates and enjoy a beer without having to sit down after 5 minutes. 

What I came to realize was that short term modalities such as hands on therapies (soft tissue work, manipulation, dry needling etc etc) and simple non challenging exercises (stretching, mobility, activation exercises) provide short term relief ONLY. Their role is to provide short term changes so you can cope better for the next few hours or days. 

So what gets long term results?

I was fortunate enough to stumble upon a strength and conditioning coach who knew all of this. My results ultimately came from someone who wasnt specifically trained in musculoskeletal care (ironic), however, he knew that to get the body to change we must learn to alter its ‘perception’ of what is painful and slowly build back up the qualities of strength and movement variability. 

This approach is inline with the current  research;

1. Have an achievable plan of action

2. Developing strength and capacity

3. Learning to move in different ways 

And are essential to create changes at the local tissues (site of pain) as well as centrally at the nervous system which leads to long term change.

This graph below is one that I show many patients, that we can provide short term relief and that is beneficial, however, once the pain is gone (or at least tolerable) we MUST be putting in the effort to change how we move, to become stronger and more resilient and to address other aspects of our health that may impact our pain experience. We call this ‘above the line’ treatment and this includes, exercise, strength, resilience as well as addressing social and environmental changes.

The issues most healthcare practitioners face is that their systems and education do not prepare them to provide long term results. I had to go back to Uni and do another Masters degree (Masters of Exercise Science (Strength & Conditioning)) to develop an understanding of how to get a body to adapt for long term change, this information is not provided in current Chiropractic and Physiotherapy courses.

So what arent healthcare practitioners telling you?

They arent telling you that their hands on treatments are only going to provide short term results as many dont have the knowledge or systems to implement movement and exercise strategies that have been shown to be the most effective way to resolve chronic pain. 

So what to do if you are experiencing chronic pain?

Find a practitioner who focuses on exercise, who will give you a clear plan of action and will support you throughout your recovery… Or just book in at Scope (shameless plug!) as this is what our entire business was built to do.

Tips for Effective Recovery

How important is post-exercise recovery?

 Whether you are a recreational athlete, professional sportsperson, fitness enthusiast or gym junkie, you may find yourself placing a great deal of emphasis towards training or performance variables. For instance, the type and frequency of training that you are doing, or how long you are doing it for, or what intensity you are aiming to achieve for that given load. 

However, it is essential to remember that the most important aspect of training isn’t necessarily what is happening on the field – it’s what you do when you get home that is just important, and can also reap more positive fitness outcomes.

More specifically, it is how you recover which also matters. 

Why is recovery important?

When we exercise, the muscle glycogen (energy) stores which provide our muscles with the fuel it needs to perform begin to deplete. Additionally, the muscle tissue breaks down in response to the physical stress placed on the body during exercise. Therefore, a sufficient recovery time post-exercise allows these energy store to replenish, and it allows the muscle tissue the opportunity to repair, rebuild and strengthen following a work load. Hence, it prepares the body for a much better performance during the next training load, as well as reduces the potential for injury or overtraining. 

Continually, physical activity – especially during intense or frequent training periods, loads stress on the body. Therefore, and by principal of progressive overload, it is fundamental to let our bodies rest and recover. This will ultimately absorb the stress and allow physical adaptations to occur, so that our body can become more efficient during the next training phase.

Tips for effective recovery

1. Active recovery

Active recovery involves a period of low-intensity physical activity, that encourages increased blood flow to the muscles which promotes venous return. This is necessary to remove the waste products which can accumulate during exercise e.g. lactic acid. Active recovery can be achieved through activities such as swimming, jogging, walking or cycling.

2. Sleep

Sleep is an important aspect of recovery. During the sleep cycle, our body increases the activity of the human growth hormone, which is critical for muscle tissue repair. It also improves glycogen synthesis which is necessary for refuelling muscles energy stores, as well as modulate levels of the stress hormone, cortisol, which can lead to improved performance.

3. Nutrition and Hydration

As part of an effective recovery, it is also essential to consider what we put into our body. To improve recovery, it helps to hydrate with adequate amounts of water and consume nutrient dense foods post-exercise. This can assist in refuelling the body’s energy stores and replace fluid loss, which can reduce the instance of fatigue and improve recovery.

4. Rest

Within a given exercise week, it is important to give your body the opportunity for a full rest day for the reasons discussed above.  

For more tailored advice on recovery, book an appointment with one of our physiotherapists today!

By Lauren Kendall – Physiotherapist and Clinical Pilates Instructor

Low Back Pain Mythbusters

Low back pain (LBP) is a very common condition. In fact, it is estimated that up to 75% of people will experience low back pain at some time in their lifetime (Fatoye, Gebrye & Odeyemi, 2019). For up to 30% of this population, LBP can become persistent and debilitating, however, rarely is it considered a dangerous condition.

LBP can be divided into three different categories. The first category is LBP that is attributed to a serious or systemic pathology such as cancer, inflammatory disorders or infections, and it accounts for only 1-2% of LBP patients. Next, there is LBP with a specific pathology, such as spondylosis or spondylolisthesis, bone fractures or disc prolapse with radicular pain, which is experienced by 5-10% of the LBP population. Finally, a huge 90% of LBP patients experience “non-specific LBP” which describes LBP with no pathoanatomical contribution.  Fortunately, acute LBP has a favourable natural history with up to 80% of episodes resolving in 3 weeks. 

Unfortunately, there are a lot of negative misconceptions regarding low back pain which may instill fear and worry in patients, and heighten their pain experience. Let’s debunk common misconceptions about low back pain, and empower patients to tackle their pain. 

Misconceptions #1 #2 #3

“Rest is the only solution” … 

… “Bending my back is bad”

… “I have to avoid heavy lifting”

In some instances, relative rest may be required during the first couple of days following an acute episode of low back pain to avoid aggravating intense pain during this early recovery phase. However, beyond this timeline, rest is counterproductive both in acute and chronic LBP. 

There is strong evidence that suggests that prolonged rest and avoidance of activity for people with low back pain actually leads to higher levels of pain, greater disability, poorer recovery and longer times spent away from work (Gordon & Bloxham, 2016). Additionally, more research shows that physical activity and regular exercise is especially helpful for improving low back pain, and is effective in the prevention of future episodes. 

Unfortunately, the body loses muscle strength and endurance much faster than it can regain it. Therefore, it is so important to stay as active as possible – start slowly, and build up the amount and intensity of the activity in a gradual manner. 

Misconception #4 – “Pain equals damage”

It is important to remember that the back is a strong and resilient structure that is not easily damaged. Rather, the pain experience is a product of various contributing factors, and not necessarily attributed to anatomical changes which may or may not have been revealed on clinical imaging.  

Overall, pain is a good thing – it is a protective mechanism, and warns the body about any threats of harm. However, if pain has been occurring for long periods of time – particularly in chronic low back, central sensitisation can occur. In this instance, the  central nervous system becomes amplified and makes people much more sensitive to pain. Therefore, activities or movements that would normally not be painful, become painful. 

Additionally, the perception of pain may become amplified due to:

• Poor sleep

• Stress 

• Fear-avoidance behaviours 

  • It can lead to reduced physical activity which can prolong pain as outlined above, and may also contribute to muscle guarding and restricted movement patterns which contribute to pain chronicity (Synnott et al., 2015

• Research also suggests that a lack of social support and demanding jobs are also associated with musculoskeletal back pain.

Misconception #5

“I have to get an X-ray and MRI to tell me what the problem is”

Among health care professionals, there is an overreliance of medical imaging for LBP. However, current research indicates that LBP does not correlate with the structural abnormalities that may be reported on an X-ray or MRI. Rather, imaging findings are often attributed to normal age-related changes, and are not necessarily the primary reason for LBP (Morgan et al., 2019).

Interestingly, some literature also report that degenerative changes are present in nearly 37% of 20 year olds, 66% of 50 year olds and 96% of 80 year olds of individuals who do not experience LBP, and who lead pain-free and active lives (Brinjikji et al., 2015).

Additionally, the outcome of medical imaging may often contribute to low back symptoms and prolong recovery. This is because it can contribute to psychosocial factors of pain, including catastrophic thoughts and beliefs, unhelp expectations, poor motivation, perceived disability which act as catalysts for chronicity, contributing to poorer recovery, prolonged disability (Synnott et al., 2015).

Misconception #6 

“Surgery is the only way to fix a ‘slipped’ disc”

Research suggests that over 85% of patients with acute lumbar herniated discs experience resolution of symptoms within 8-12 weeks (Dydyk, Massa & Mesfin, 2020), with a lot of literature suggesting that physiotherapy is effective in controlling disc herniation-related pain and help reduce and eliminate pain.

Image source: Pexels (4506109, 7218596, 4498158)

References:

Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., Halabi, S., Turner, J. A., Avins, A. L., James, K., Wald, J. T., Kallmes, D. F., & Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR. American journal of neuroradiology, 36(4), 811–816. https://doi.org/10.3174/ajnr.A4173

Dydyk, A. M., Massa, R. N., & Mesfin, F. B. (2020). Disc Herniation. StatPearls [Internet].

Fatoye, F., Gebrye, T., & Odeyemi, I. (2019). Real-world incidence and prevalence of low back pain using routinely collected data. Rheumatology international, 39(4), 619-626.

Morgan, T., Wu, J., Ovchinikova, L., Lindner, R., Blogg, S., & Moorin, R. (2019). A national intervention to reduce imaging for low back pain by general practitioners: a retrospective economic program evaluation using Medicare Benefits Schedule data. BMC health services research, 19(1), 1-10.

Synnott, A., O’Keeffe, M., Bunzli, S., Dankaerts, W., O’Sullivan, P., & O’Sullivan, K. (2015). Physiotherapists may stigmatise or feel unprepared to treat people with low back pain and psychosocial factors that influence recovery: a systematic review. Journal of Physiotherapy, 61(2), 68-76. doi: 10.1016/j.jphys.2015.02.016

Wertli, M. M., Eugster, R., Held, U., Steurer, J., Kofmehl, R., & Weiser, S. (2014). Catastrophizing—a prognostic factor for outcome in patients with low back pain: a systematic review. The Spine Journal, 14(11), 2639-2657.

Posture vs. Pain

Seemingly, there has always been much emphasis on our posture. But how important is it?

From early childhood, your parents may have encouraged you to “sit up straighter” or “stand taller”. In the work place (and especially amidst COVID-19 times) companies are providing ergonomic assessments for their employees, with the purpose of developing more posturally ideal work stations and desk set-ups. 

This postural focus in people’s day to day lives may have instilled a public perception of what ‘good’ posture is, and comparably, what the consequences are if you assume a ‘bad’ posture. As such, it is broadly reinforced that such ‘bad’ posture can lead to pain. 

But, does posture even matter? 

Amongst the literature, there is less of a correlation between posture and the frequency and/or intensity of pain compared to what is initially thought. For instance, one study explored the relationship between sitting posture and neck pain and/or headaches. The 1100 subjects were grouped into one of four postural categories, including upright, intermediate, slumped thoracic + forward head posture, and erect thoracic + forward head posture. It was revealed that people in pain don’t have different postures to those that aren’t in pain. 

Therefore, research would largely deny a link between posture being a primary cause for pain. An important reason for this being that pain is multifactorial, and that contributing factors such as stress and poor sleep for example, can increase muscle tension and cause discomfort. 

The biggest problem is not necessarily of posture (although there is a time and a place for posture to be specifically addressed), but rather of movement. Posture only matters if you are unable to move from that position, or are in a position e.g. sitting or standing for a prolonged period of time. 

Interestingly, the body has Acid Sensing Ion Channels which detect a change in the pH levels of the tissue. Prolonged static positioning may cause reduced blood flow, which may increase the acidity of the tissue. These channels sense this pH fluctuation, and can cause a sensation of discomfort or pain.

Therefore, it more important to understand that your next posture is your best posture!

So then, what is a ‘good’ posture. Currently, there is no agreed upon gold standard of the most optimal static posture in the literature. Individual variability is normal, and there is no one size fit all approach. One’s own best posture, is one where they are most relaxed, comfortable and pain-free.

By Lauren Kendall, Physiotherapist and Clinical Pilates Instructor

Physiological and biomechanical changes in the aging runner

The New Year often brings resolutions to be more active. Runners who gather renewed resolve to hit the trail may register for an upcoming race to inspire their training. Statistics show that the age of those participating in races is increasing dramatically. From 1980 – 2000, the New York City Marathon showed an almost 200% increase in runners over the age of 40 years(1). When researchers drilled down into the specific age groups, they found that the over 60-year-old brackets quadrupled their participants during that time span(1).

 Researchers attribute the increase in numbers to two likely causes. The first is that aging runners chose to maintain a running program throughout their lifespan. The second reason being that some people decide to start running later in life. Either way, while research and resources typically focus on young elite athletes, the reality is that the runner coming to seek your services will likely be over 40.

 Physiology of aging

 As the body ages, it undergoes changes in function. One change anyone with an aerobic training background knows immediately is the decrease in maximal heart rate recommended during aerobic activity (220 – age = Max Heart Rate (MHR)).  This in turn lowers overall cardiac output (Heart Rate (HR) x stroke volume) and the body’s ability to take in and utilize oxygen during exercise (basic calculation for VO2max = 15.3 x (MHR/Resting HR). There’s no getting around it, aging decreases endurance. Not only that, the lower VO2 max associated with aging is a known risk factor for chronic diseases1. Therefore, running later in life is an effective strategy to decrease one’s risk of declining health due to age(1).

 Better with age

 Knowing that the aging process takes a toll on the cardiac system and therefore, endurance, how does one explain athletes who perform better as they age? The key may be their ability to maintain or improve their running economy. Running economy (RE) is the rate of oxygen consumed during sub maximal running(2).  Good RE requires less energy and therefore less oxygen. Unlike VO2max, age doesn’t seem to effect RE.

 For the aging athlete with less than optimal RE, perceived effort increases as VO2max decreases. Due to the rise in exertion required, runners may lower their training volume or intensity. With a drop in training stimulus, VO2max suffers a further decline. Therefore, the consequential easing off of training from having to work harder magnifies the changes already taking place in the cardiovascular system of the aging athlete.

 Holding back the years

 Though sparse, longitudinal studies of elite runners show that runners who train at more intense thresholds throughout their life span show less decrease in VO2max over time than those who’s training levels off or declines(1). Training to increase VO2max requires near maximal effort over a sustained period of several minutes. Repeated training allows adaptation of the cardiovascular system as it becomes more efficient. While nothing can turn back the clock, training, even in Master athletes, can improve VO2max and stall the effects of aging. Therefore, encourage older runners to train at volumes and intensities at the limits of their abilities.

 Reference

 1.Sports Med Arthrosc Rev. 2019 March;27(1):15-212.Sports Med. 2004;34(7):465-85

Lower back and pelvic pain during and after pregnancy

Roughly 50% of pregnant women suffer from lower back pain or posterior pelvic pain; this increases towards the end of the pregnancy and through the first year after giving birth. The most widely accepted explanation for this is that these areas provide the most compensation for the increase in weight in the abdomen.

This research study is a systematic review, meaning it incorporates a large number of existing studies to draw the most accurate conclusions. This includes unpublished theses, and studies not written in the English language.

Does osteopathy work for lower back and pelvic pain associated with pregnancy?

Osteopathy provides significant reduction of pain, and improvement in function, for lower back and pelvic pain associated with pregnancy.

The key findings were:

• Osteopathic Manual Therapy (OMT) was significantly more effective than usual care alone, or no treatment.
• There were no serious side effects of OMT. Tiredness after treatment was a minor side effect.

Techniques that fell under the umbrella of OMT included structural, visceral, and cranial techniques. Specifically, structural techniques were listed as soft tissue manipulation, stretching, joint mobilisation, muscle energy techniques, and spinal manipulation. It is important to note that these techniques were used along with the philosophies of osteopathy. They were not just applied locally to the lower back and pelvis, but holistically, wherever needed to improve the body as a whole.

The study recognised that there was a limited amount of high quality evidence, but that the papers analysed were still significant with regards to OMT. Evidence was low to moderate for the benefit of exercise for pain and function. There was also low quality evidence to support craniosacral therapy, use of a lumbopelvic belt, and acupuncture. Due to the low quality of the evidence, it was difficult to compare to osteopathic treatment. The authors suggested that further research on the topic should involve more long-term follow-up for better quality evidence.

In the discussion, the point is raised that although there is clear benefit of osteopathic treatment, the exact reasons why are unclear. The authors draw the hypothesis that, as manual techniques have repeatedly been shown to reduce pain sensitivity, that these mechanisms allow for better neuromuscular function and control. This leads to the patient beginning to feel better, improving pain beliefs, and and allowing for further pain reduction and benefits to function.

—Franke, H., Franke, J., Belz, S. and Fryer, G. (2017). Osteopathic manipulative treatment for low back and pelvic girdle pain during and after pregnancy: A systematic review and meta-analysis. Journal of Bodywork and Movement Therapies, 21(4), pp.752-762.

WHAT NEW BACK PAIN RECOMMENDATIONS MEAN FOR YOU!

Ditch the pills. That’s what updated clinical guidelines[1] from the American College of Physicians revealed in early 2017. It’s so easy to head straight for the medicine cabinet when a twinge in your lower back has you howling, but a comprehensive review of randomized, controlled trials and systematic reviews on back pain relief is recommending clinicians encourage patients up nonpharmacological routes instead.

Why nonpharmacological treatments?

Regardless of treatment, most acute or subacute low back pain has actually been shown to diminish over time. The risks of popping over-the-counter pain relievers or even prescribed opiates far outweighs the risks of simply letting your back heal on its own.

Expediting the healing process, however, and obtaining relief from pain, enhancing your overall day-to-day functionality, and being able to return to work (if low back pain has prevented you) is possible with noninvasive practices. Surprising to some, the American College of Physicians first recommendation includes heat therapy, massage, acupuncture, and spinal manipulation. If medicinal aids truly are needed, skeletal muscle relaxants or nonsteroidal anti-inflammatories should be administered.

How do those treatments work?

Acute or subacute back pain is typically the result of overused, strained or inflamed muscles. Heat therapy is the simple application of hot packs, warm compress or heating pads to the affected area of your back (a warm bath counts too). Heat therapy helps relax swollen muscles, boost blood flow to the affected area, and eliminate lactic acid waste buildup which, in turn, relieves pain. Unless otherwise indicated by your doctor, heat should be applied for up to 20 minutes at a time, around three times a day.

Massage combines the power of tactile sense with targeted pressure, rubbing, and muscle manipulation to relieve low back pain. A 2011 study[2] found that participants who received one hour weekly massages over 10 weeks experienced low back pain reduction, a boost in functionality, and a reduction in the amount of anti-inflammatories they were taking. Massage therapy should be conducted by a trained and licensed therapist who knows the proper muscle groups to target and manipulate to alleviate back pain.

Acupuncture, while hotly debated at the turn of the century, has picked up steam as a short-term pain reliever for back pain sufferers. This ancient Chinese practiced involves super thin needles being inserted into the body’s skin and tissues at key points (meridians) which affect your body’s natural flow of energy (qi). Researchers believe the practice in fact stimulates a nervous system response which turns on opioid receptors and results in an analgesic effect.

Spinal manipulation which involves jolting and moving joints, massage, and applied pressure can help reduce inflammation, relieve pressure on joints, and improve nerve function. When used in combination with exercise, a 2015 randomized clinical trial[3] found that manual-thrust spinal manipulation reduced acute and subacute low back pain at up to 4 weeks of treatment.

What If My Back Pain is Chronic, Not Just Acute?

Treatment of chronic low back pain goes a step further with the ACP recommending more physical activity as treatment[4] – exercise, yoga, tai chi, multidisciplinary rehabilitation, motor control exercise, and progressive relaxation, for example. Regular physical fitness when completed daily for at least 30 minutes helps increase blood circulation, reduce muscle inflammation, loosen stiff joints, and boost feel-good endorphins.

Mindfulness activities including yoga practice and tai chi weave in meditation, deep breathing, and relaxation techniques to foster positive feelings of self-awareness and peace, also helping relieve stress and anxiety which might be amplifying back pain. Additional treatment incorporating spinal manipulation, biofeedback, and behavior therapy are also in the guidelines for treating chronic low back pain.

What Happens When None of Those Treatments Work?

Inadequate response to nonpharmacological treatments can be frustrating and stressful for both patient and treating clinician. With opioids having a high risk for abuse and addiction, the ACP recommends them as the last, last choice in treating chronic back pain.

Instead, NSAIDS (nonsteroidal anti-inflammatories) like aspirin and ibuprofen can be helpful pharmacological aids when taken in the directed doses. On a chemical level, NSAIDS actually block an enzyme in the body which produces compounds that lead to swelling and inflammation. Acetaminophen, commonly known in the US as Tylenol, is not an NSAID and is not recommended in efforts of reducing painful back muscle inflammation.

It is important to note that the updated guidelines do not address topical therapies (i.e. arnica or capsaicin cream), injection therapies, or the benefits of wearing a back brace for lower back pain. As pain is defined as electrical signals sent from your nerves to your brain, the noninvasive and nonmedicinal treatments that work for you may vary from those that work for the next patient. Treatment that works for you without creating unhealthy behaviors like overeating or not exercising, and with low risk to your organ health (i.e. your heart, brain, and kidneys) is always a good place to start.