BACK PAIN TREATMENTS
Different treatments to relieve chronic back pain
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.