Active Lifestyle
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What treatments work best for lower back pain?
Many of us will experience lower back pain at some point in our lives and when it does happen, no doubt we will all get advice from people about what to do- everything from rest to exercise, from back braces to manipulation.
So what treatments actually work?
The best way to answer this is to have a look at current scientific evidence (yes, I must admit that scientific evidence is by no means perfect and is always being updated, but it does provide us with some good information about what works most of the time, for most people).
To begin with, your back pain should always be assessed by a qualified healthcare professional (e.g. GP, physiotherapist or chiropractor) to rule out any serious injuries or disease processes, and to get advice about how it should be managed (there is excellent evidence for this!).
Here is how current popular treatments stack up under clinical trials and systematic reviews:
1.Advice to stay active
For acute low back pain, there is significant evidence that staying active and maintaining normal activity levels leads to quicker recovery time and less time off work.
2.Bed rest
There is no evidence to suggest that bed rest improves outcomes for people with acute or chronic lower back pain, and in fact it is more likely to cause harm from muscle deconditioning, weakness and stiffness.
3.Exercise Therapy (stretches, strength exercises etc.)
Believe it or not, there is still no evidence to suggest that structured exercises work well for treating acute low back pain despite being a regular part of treatment. Therefore if you are doing some basic exercises for acute back pain and it’s working, then fantastic, keep doing them. If they aren’t working, then stop!
There is very good evidence on the other hand, that core strengthening and general strength and fitness exercise programs are good for treating people with chronic back pain. The evidence also suggests that results are significantly better when these programs are supervised. Some specific exercises can reduce the chances of lo back pain from recurring in the future as well.
4.Spinal Manipulative Therapy
This is anything from gentle mobilising of the spine to high velocity manipulations or “cracking” the spine. It is one of the most common ways that physiotherapists, chiropractors and osteopaths treat back pain. It has been shown to be an effective way of decreasing pain in acute and sub acute back pain, however, to the surprise of many it has recently been shown to be no more beneficial for acute lower back pain than good advice and paracetamol.
It has also surprised a few recently to find that a study has shown some benefit of spinal manipulative therapy for people with chronic back pain. In general, it could be said that spinal manipulative therapy can reduce pain in the short term, but probably doesn’t significantly alter the course of lower back pain.
5.Acupuncture
Despite many studies, there is no significant evidence for acupuncture providing any benefit for acute low back pain. Interestingly, there are many people who are raving fans of acupuncture and current guidelines recommend that, as long a clinical and functional improvement can be demonstrated, acupuncture can be used for treating low back pain.
6.Massage
Massage on its own has been shown to be more effective than relaxation and acupuncture, but less effective than exercise and spinal manipulative therapy. It is best used in combination with other treatments rather than by itself.
