The National Institute for Health and Care Excellence (NICE) has recently published new guidelines on best management of low back pain. This includes both people with ‘simple’ back pain (localised to the back) and those with referred pain (sciatica) which can affect the nerves down one leg. These guidelines are based on latest evidence and expert analysis of what is the best course of action for people with low back pain.
Here’s how we’re putting them into practice at goPhysio
Assessment
When you come to see us with back pain we will do a thorough assessment by asking a number of questions to find out more about your pain and to rule out any ‘red flag’ conditions. These red flags can indicate serious pathology such as cancer, infection, trauma, inflammatory conditions or Cauda Equina Syndrome. Thankfully these conditions are rare but if we have any suspicion we will referral you on to the appropriate speciality for further investigations without delay.
We will do a complete back examination to assess how the joints, muscles and nerves are functioning. We know there are a number of factors that can influence your recovery both positively and negatively so our staff are undergoing further training on use of the STarT Back Risk Assessment tool. This will help us identify those who are at risk of poorer outcomes and ensure that we tailor our treatment to address these factors.
Treatment
Self-management education is a vital aspect of treatment for any patient. We help you to understand why you have pain and what steps you can take to reduce it – both during an acute flare up of pain but also long term strategies or simple changes you can make to your lifestyle which will help your back.
Your treatment will vary depending on the nature and cause of your pain, how severe it is and a variety of individual factors. Physiotherapy treatment may include manual therapy such as joint mobilisations or massage, alongside a personal exercise programme and advice on pain relief.
Research has shown that anti-inflammatory medications (NSAID’s) such as Ibruprofen or Naproxen are much better than paracetamol for back pain, however, for people that are unable to take NSAID’s or that find them ineffective, weak opioid medications such as Co-codamol can be recommended for simple back pain.
For acute sciatica your GP may recommend stronger ‘neuropathic’ pain medications which are much better for nerve pain (tingling/burning/shooting pain). Please note all medications have side effects and can interact with other medications you are already on or other conditions that you may have so please check with your GP or a pharmacist before taking any new medication.
What happens if you are not responding to treatment?
For acute sciatica you may be referred on to a spinal consultant, who in more severe cases can consider epidural injections or a spinal decompression surgery. However it is important to remember that this is never a first course of action as most episodes of sciatica resolve within 6-12 weeks. Your physio will help you decide when it is appropriate to be referred on depending on how you respond and recover.
Sometimes there are psychological factors affecting your rehabilitation such as depression, anxiety or other mood disorders. In this case your physio may recommend that you are referred on to a psychologist for cognitive-behavioural therapy. This is because we know that people with negative mood and health beliefs rarely respond well to usual treatment without first addressing these factors.
So if your pain is persistent or not responding to usual treatment it is important to seek professional help.
What about x-rays and scans?
X-rays are no longer routine for lower back pain unless there is the suspicion of a fracture (such as after a severe trauma or in people with osteoporosis). This is because it exposes you to radiation but does not often provide any useful information on how we should best treat your back. Likewise MRI’s are only needed to rule out serious spinal pathology or to help a consultant identify if a nerve in your back is being significantly compressed to warrant injection or surgery. The vast majority of this information your physio will be able to deduct from a thorough assessment.
Once an acute episode of back pain has eased off, we recommend continuing with exercise to help keep any further recurrences at bay. Research indicates that any form of exercise is great for people who’ve had back pain – being active and moving helps! many of our patients go on to our specialist clinical pilates classes. These are particularly beneficial as they are taken by our Physiotherapists, so they are well equipped to deal with any concerns or issues you may have with your back and can modify and progress the exercises for you individually. The classes are also small, so you aren’t lost in a sea of people struggling – you get individual care and attention. Have a look at our pilates timetable, there is plenty of choice to fit in with your weekly commitments.
If you’re suffering with back pain and want some peace of mind and reassurance that it’s nothing serious and help to get on the road to recovery, come and see one of our Physio’s at goPhysio. We make it easy for you, with appointments available 8am – 8pm and Saturday mornings, we can normally offer you an appointment within 24 hours, if not the same day. Just call one of our friendly Patient Services Team on 023 8025 3317 or book an appointment online how to book.
