Low Back Pain & Sciatica

  

Low back pain can be located in the mid-low back or off to either side, and may spread up or down, into the buttock and lower limbs. You may feel dull or sharp pain, muscle spasm or stiffness. You may get muscle weakness, numbness or sciatica-like pins and needles or “tingling”. Patients usually have had previous episodes or injury, and may occur in work that involves lifting, bending, twisting or sustained positions. Back pain may be felt on prolonged sitting, prolonged standing, moving, lifting, on sitting-to standing, or turning over in bed. It is also quite common in pregnancy.

 

Low back pain can be caused by problems with the discs, joints, muscles, tendons, ligaments of the back or the pelvic (sacroiliac) joints. Often, back pain is due to postural changes resulting from ankle dysfunction, so co-management with a podiatrist is used to correct biomechanical and postural dysfunction. Disc patients crucially require a rehabilitation programme to help strengthen core muscles and prevent a recurrence, whether after back surgery or instead of an operation.

 

There is evidence to support a conservative Chiropractic approach as a safe and effective treatment intervention for mild-moderate disc “injuries”. Importantly, NHS guidelines recommend spinal manipulation as treatment for “mechanical” low back pain.

 


EVIDENCE

 

Scientific research showing the effectiveness of Chiropractic treatment and management for low back pain can be found in:

 

Acute Back Pain - Primary Care Project; The Wiltshire and Bath Health Commission, 1995.

 

Blokland, M.  Chiropractic Treatment in Workers with Musculoskeletal Complaints. Journal of the Neuromusculoskeletal System, vol 8 No 1, Spring 2000.

 

British Medical Association – General Practitioner Committee. Referral to Complementary Therapists – Guidance for GPs. March 2006.

 

Bronfort G, Mitch Haas, Roni Evans, Brent Leininger, Jay Triano: Effectiveness of manual therapies: the UK evidence report. Bronfort et al. Chiropractic & Osteopathy 2010, 18:3.

 

Carter JT, Birrell LN (Editors) 2000. Faculty of Occupational Medicine. London. Occupational health guidelines for the management of low back pain at work - principal recommendations.

 

Cassidy JD, Thiel HW, Kirkaldy-Willis WH. Side posture manipulation for lumbar intervertebral disc herniation. Journal of Manipulative and Physiological Therapeutics, 1993 Feb; 16(2): 96-103.

 

Clinical Standards Advisory Group: Back Pain Report 1994.

 

European Guidelines for the management of acute non-specific low back pain in primary care. European Spine Journal 2006 March; 15 supplement 2: S169-91.

 

Haldeman S, Carroll L, Cassidy D. Schubert J, Nygren A: The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders: executive summary. Spine 2008. 33: S5-S7.

 

House of Lords Select Committee on Science and Technology report on Complementary and Alternative Medicine November 2000.

 

Lisi AJ. Chiropractic spinal manipulation for low back pain of pregnancy: a retrospective case series. Journal of Midwifery Womens’ Health. 2006 Jan-Feb; 51(1): e7-10.

 

Meade et al. - Medical Research Council. Low Back pain of mechanical origin: randomised comparison of Chiropractic from hospital outpatient treatment. British Medical Journal 2nd June 1990 - Volume 300;1431-1437.

 

Meade et al. - Medical Research Council (Follow-up-study): Trial Randomised comparison of Chiropractic and hospital outpatient management for low back pain; results from extended follow up. British Medical Journal 5th August 1995 - Volume 311; 349-351.

 

Musculoskeletal Services Framework – Department of Health. July 2006.

 

National Institute for Health and Clinical Excellence. Non-rigid stabilisation procedures for the treatment of low back pain, June 2006.

 

National Institute for Health and Clinical Excellence. Early Management of persistent non-specific low back pain. 2009 May.

Occupational health guidelines for the management of low back pain at work - evidence review. Faculty of Occupational Medicine. London. 2000.

 

Oliphant D. Safety of spinal manipulation in the treatment of lumbar disc herniations: a systematic review and risk assessment. Journal of Manipulative and Physiological Therapeutics, 2004 Mar-Apr; 27(3): 197-210.

 

Royal College of General Practitioners: Clinical Guidelines for the Management of Acute Low Back Pain, 2001.

 

Stuge B, Laerum E, Kirkesola G, Vollestad N. The efficacy of a treatment program focusing on specific training exercises for pelvic girdle pain after pregnancy: a randomised controlled trial. Spine 2004 Feb 15; 29(4): 351-9.

 

UK Beam Trial: Back pain, exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. British Medical Journal Nov 2004; 329; 1377-1385.

 

Quon JA, Cassidy JD, O’Connor SM, Kirkaldy-Willis WH. Lumbar intervertebral disc herniation. Journal of Manipulative and Physiological Therapeutics. 1989 Jun; 12(3): 220-7.

 

Van Tulder M, Becker A, Bekkering T, et al. European guidelines for the management of chronic nonspecific low back pain.  European Spine Journal, 2006, 15, Supplement 2: S169-S191.

 

Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. European Spine Journal 2008 June; 17(6): 794-819.

 

Waddell G, Burton AK, 2000. Occupational health guidelines for the management of low back pain at work - leaflet for practitioners. Faculty of Occupational Medicine. London. 2000.