Part of being a physiotherapist involves keeping up with all of the latest evidence on how to maximise the effectiveness of the treatments we give as therapists. The gold standard of evidence comes from NICE (The national institute of health and care excellence). In 2016 they released a new set of guidelines and advice for lower back pain and sciatica. Around 85% of people in Britain develop lower back pain at some point in their lives. So if you have developed pain in your lumbar spine (Lower back) you are not alone!
If you are reading this because you have lower back pain which is limiting your daily function, and stopping you from completing all of the activities you would like, then Physiotherapy is consistently recommended in the NICE guidelines. A mainstay for the treatment of lower back pain is exercise. As physiotherapists, we offer many different types of treatments and manual therapies, but the very first treatment approach we are taught and should implement is exercise therapy. This is because it is consistently shown to be the best approach for long term resolution of symptoms, and nowhere is this more true than for the lower back.
If you are being treated by any practitioner, and exercise is not a major part of their treatment approach, then it is likely they are not treating you with the most effective and efficient strategies. You can also suspect this may be the case if you feel you continuously have to go back for more treatments, almost feeling dependant on the practitioner to keep you going.
If this sounds familiar, try physiotherapy. We aim to identify the route-cause of the problem and address it at its source. Improvement of your symptoms which then stay improved. No matter what your practitioner tells you, keep an open mind and be aware that it’s in their best interests to keep you coming back for more treatment. Because of my experience in the NHS and private sectors, I work slightly differently. I use manual treatments to get quick, natural and effective results, but I also supplement these treatments with strategies to prevent symptoms from returning, and so exercise is something I ALWAYS include for my lower back pain patients, whether they have sciatica or not. I do this why? Because I only use evidence based practice so you know you'll be getting only the most effective treatments that are proven to work.
Taken as direct quotes from the most recent NICE guidelines(2016), one of, if not THE most researched evidence base in the world:
“1.2.3 Do not offer belts or corsets for managing low back pain with or without sciatica.”
“1.2.4 Do not offer foot orthotics for managing low back pain with or without sciatica.”
“1.2.5 Do not offer rocker sole shoes for managing low back pain with or without sciatica.”
“1.2.6 Do not offer traction for managing low back pain with or without sciatica.”
“1.2.8 Do not offer acupuncture for managing low back pain with or without sciatica.”
“1.2.9 Do not offer ultrasound for managing low back pain with or without sciatica.”
A lot of passive treatments mentioned above, like ultrasound, orthotics, traction, acupuncture and more are all shown to have poor long term outcomes by the evidence NICE has accumulated.
Above all this though, one message rings true for the best way to treat lower back pain, and keep the pain away rather than feeling dependant on manual and passive treatments your practitioner may be offering you. Exercise comes first, and manual therapies are there to help supplement the treatments you are providing.
Again form the NICE guidelines (2016):
"Consider manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage) for managing low back pain with or without sciatica, but only as part of a treatment package including exercise, with or without psychological therapy."
"[Use] exercise programmes (biomechanical, aerobic, mind–body or a combination of approaches)] [for people with a specific episode or flare-up of low back pain with or without sciatica.]"
So next time you feel like you are taking too many trips to your practitioner, or feeling reliant on the treatment they are offering, have an open mind and ask yourself do you think they have explored all avenues, do you think they have addressed any hidden weaknesses which we know can only be addressed with exercise? Is that why you never seem to be getting to the bottom of you pain?