A Guide To Back Pain Management

My name is Dirk Laubscher. I've been a physiotherapist for over the last ten years and working in Harley Street for the last six, and today, I'm going to talk to you guys about the causes and the management of back pain. Okay, a guide to back pain management.

Now, it's very important to understand firstly, before we can manage pain, where the pain is coming from. The management is also different from an acute episode to a chronic episode. So, the management of that will differ.

I think, what I'll talk to you about today is chronic back pain management as this is quite a complex problem that a lot of people have. Now firstly, like I said, you have to realize where it's coming from. Now, back pain can only come from the disc or the joints, the fatted joints, or the nerve tissue or the soft tissue which is muscles and ligaments, and also because of weakness.

Now, that is the biggest problem in my experience that people are missing out when they try and manage it. Basically, what it's all about for management is drugs that are prescribed as soon as the patient goes and see the doctor. For me, drugs are not a very good management because it only masks symptoms and I think too many people are relying on drugs for the management of their pain, and it's a very poor management and skill.

What we also do with management is we go and see a physiotherapist or people are going to see osteopaths and chiropractors. Because I'm a physiotherapist, I'm going to talk about that. The management from a physiotherapist is we actually want to cure the problem and not just give it pain relief.

So, what we do is we do a full assessment, a very thorough assessment to make sure we know where the pain is coming from, if it's from your disc or your joint or nerve, and then we sort of form a plan around that. We use a lot of techniques. There's spinal mobilization which I'll show you a bit later, manipulations, we use strengthening of the core muscles, also neuro-mobilizations if there's any tightening in your nerves and also giving stretches.

One big thing that's missing in a lot of managements is people – hamstrings, for example. A lot of people have hamstring tightness so we have to make sure those hamstrings are stretched and flexible. Okay, also, there's a lot of very good management tool but when we get to chronic back pain, a lot of people need a bit more than just pilates and costly exercises.

It's very important that the patient, you as the patient, get your hands laid on and actually get worked on. There are too many physiotherapists, unfortunately, and some osteopaths and chiropractors who don't put their hands on you and don't work physically on the spine. Then, as well, we have to give you posture correction, the way you sit, the way you stand, ergonomical assessment, at work, again how your desk is set up – too high, too low, the chair you're sitting in.

We weren't designed to sit for 8 to 10 hours a day so, you know, it's not a surprise that the majority of today's world is millions of people suffering with back pain and it's because they're sitting all day more than anything else. If you sit for too long, your back muscles doesn't have time to exercise and it's a major cause. I always say it's maximal damage at 0 miles per hour which you get, and also the way you sleep.

How's the mattress? Is it soft, is it hard? Do you sleep on your side or your back or your stomach? In general, sleeping on the stomach is very bad because it puts stress on your back, and then even if the mattress is soft as well, then that will increase the pressure on your back even more. So, it's very important, you know, when you sleep, you're supposed to rest, 6 to 8 hours average that people sleep, so you have to make sure that your spine is in the perfect condition, so you wake up feeling refreshed instead of having pain and stiffness. And then also, some functional advice, how to lift things and bend your knees, you know, when you