Dif­fer­ent treat­ments to re­lieve chronic back pain

Great Health Guide - - CONTENTS - Michael Der­man­sky

If I have had back pain for a while, should I get it ma­nip­u­lated, get a mas­sage or start a Pi­lates pro­gram to work on my ‘core’? With con­flict­ing mes­sages from doc­tors, the me­dia and other health pro­fes­sion­als, it can be dif­fi­cult to know what is the best ap­proach to take for chronic back pain. The an­swer is that it de­pends on the cause and chronic na­ture of the pain. Please note that the sug­ges­tions made in this ar­ti­cle, should only be un­der­taken af­ter com­plete di­ag­no­sis of the con­di­tion by a GP. Your GP will be able to rec­om­mend and mon­i­tor ap­pro­pri­ate treat­ments by health pro­fes­sion­als.

1) Hands-on treat­ments, in the short term only – The usual ‘hands-on’ treat­ment such as mo­bil­i­sa­tion and ma­nip­u­la­tion used by health pro­fes­sion­als are ef­fec­tive in re­duc­ing some pain and im­prov­ing the abil­ity to move in the short term. This means that com­bined with spe­cific core sta­bil­ity strength­en­ing, these treat­ments are great in help­ing pain re­lief in the short term, but are not enough to re­duce pain in the long term. Un­for­tu­nately, other treat­ments such as mas­sage, elec­tri­cal stim­u­la­tion (TENS) and laser have no long term ef­fect on chronic lower back pain.

2) Ex­er­cise in gen­eral can re­duce lower back pain, – In gen­eral, sci­en­tific ev­i­dence shows that ex­er­cise fol­low­ing back pain can work both as treat­ment to re­duce pain and to im­prove pain in the long term. Stud­ies into ex­er­cise fol­low­ing back pain have shown that in the long term 80% of the pa­tients con­sid­ered them­selves re­cov­ered af­ter ex­er­cise ther­apy, com­pared to only 47% who fol­lowed the usual rec­om­men­da­tion of pain re­lief med­i­ca­tion, rest and just get­ting on with it.

3) Spe­cific ex­er­cise for core sta­bil­ity is bet­ter – The mul­ti­fidus mus­cle is a se­ries of mus­cles that are at­tached to the spinal col­umn. There are many stud­ies that have shown that core sta­bil­is­ing mus­cles, in par­tic­u­lar the mul­ti­fidus mus­cle, is re­duced in size par­tic­u­larly at the site and the side of a par­tic­u­lar back in­jury. This is com­monly seen and eas­ily eval­u­ated on lum­bar MRI scans and on ul­tra­sound. The good news is that spe­cific core sta­bil­ity train­ing for both the transver­sus ab­do­mi­nis and mul­ti­fidus mus­cles, can im­prove the size of these mus­cles and re­duce back pain by 50%. In fact, im­prov­ing your core sta­bil­ity will re­duce back pain in the long term by 75%, while med­i­ca­tion and rest alone achieves only 25% re­lief.

4) What is the place of Pi­lates in core sta­bil­ity train­ing? - The prin­ci­ples of Pi­lates are still very ef­fec­tive in train­ing the core sta­bilis­ers, both transver­sus ab­domi­nus and mul­ti­fidus, to man­age lower back pain, es­pe­cially if they are spe­cific and tar­geted. In a sci­en­tific study into Pi­lates, fo­cussing on the core sta­bilis­ers, back pain was re­duced and gen­eral ev­ery­day func­tion had im­proved. Both flex­i­bil­ity and bal­ance im­proved af­ter a con­sis­tent 6-week pro­gram.

Back pain can be man­aged. Your GP can ad­vise, as dif­fer­ent treat­ments are re­quired in the short term and the long term. In the early stages, treat­ment from a health pro­fes­sional is im­por­tant. How­ever, in the long term, this may not be enough and spe­cific ex­er­cises to strengthen the sta­bil­is­ing mus­cles of the back are nec­es­sary to give you the best re­sults.

Michael Der­man­sky is a Se­nior Phys­io­ther­a­pist and Manag­ing Direc­tor of MD Health Pi­lates, with 17 years’ ex­pe­ri­ence of treat­ing clients from all walks of life, from 6 year chil­dren all the way to the age of 92. He can be con­tacted through his web­site.

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