Back Doctor – Low Back Pain Treatment

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Welcome to the Back Pain Solutions Podcast – Low Back Pain Treatment

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Introducing Back Doctor – Low Back Pain Treatment

Ever wondered what the differences are between osteopathy and chiropractic? How will a physiotherapist treat your back pain compared to other practitioners? And which therapist should I see for my back pain? These are common questions that we get asked by patients and the answer is not as straightforward as you may think it should be. There are no doubt crossovers between the different therapies so why have so many different options?

In this episode we discuss the differences, and similarities, between osteopathy and chiropractic. We discuss the history, and origins, of the two professions, which may be a surprise to you. We also discuss how you should approach your treatment, and what things you should look out for whoever you seek advice from. The aim of this episode is to provide some clarity for those looking to seek advice so they can get the best help possible to help them manage their pain.

Show Highlights for Back Doctor – Low Back Pain Treatment

Don’t choose the therapy, choose the therapist! Focus your efforts on choosing the therapist that will provide the best advice, and include a movement based approach in your treatment plan. There are historical differences between osteopaths and chiropractors but today both focus on the diagnosis, and management, of musculo-skeletal pain/injury. The key is to identify the therapist that will employ a movement based approach to recovery as that will be key to your recovery.

Interview Transcription for Low Back Pain Treatment

Ben James 0:00

When we’re young, we move with freedom and confidence with a great resilience to injury. Somewhere along the line, we develop poor habits and become more vulnerable to back pain, smart, strong features, evidence based and practical advice to help you take back control of your health and get back to the activities you love. This is your guide to better health. So join us as we demystify some of the commonly held beliefs about back pain. build your confidence. We’re stronger back this mark. Welcome back to the smart strong podcast Everybody with me Ben James, my co friend, my co host, should I say good friend, Jacob stain. Good evening, Jacob. We’ll be doing. So today is the first of another episode or three episodes of podcasts that we want to focus on different therapies. What are the differences between Chiropractic and osteoporosis? That’s a common question and we often get asked, we want to also talk about what’s missing from traditional management in terms of Back management back pain. And then also what about spinal surgery because a lot of patients that we’ve seen over the years will catastrophize and believe that they’ve got to have some kind of intervention to help them with their back pain and solve that problem. And actually, this is where we want to delve a little bit into the active approach and the commitment people have to take for their own health. And I guess, in terms of this episode focuses very much on the different therapies, chiropractic, this is osteopathy, physiotherapy, why are there so many different options? And what are the differences between those options? And a good place to start I guess is with the history Jacob of chiropractic and osteopathy, because we know that both of those therapies originated in North America. And it was about 10 or 15 years between them in terms of their evolution in terms of their their kind of foundational founding should I say, which seems somewhat coincidental to me. What do you think on that?

Jacob Steyn 2:09

Yeah, definitely coincidental. And we got a breakfast thing that it started with us. And, you know, the same with osteopaths. They think it started with them. But a lot of similarities between the two groups, and the fact that they originated from the same part of the world in the same time. And there’s a lot of similar ways of looking at the body between the two groups of professionals. But I think the main differences is the fact that traditionally we as chiropractors would have looked at the nervous system together with the spine and the osteopathic group focused on blood flow rather than the Nervous System.

Ben James 3:01

Yeah. And I think that’s the key. The key similarity is the the kind of viewpoint that the misalignment of the spine and the vertebra is impacting those different two systems, whether it be the nerve flow or whether it be the blood flow. And it seems that if you look at the history, and you look at the evidence, asked the apathy seem to originate first, and that was actually by a medical doctor, Dr. Andrew still, who had three children, in fact, die through meningitis, which is a hugely sad story there behind the front of beginnings of osteopathy, but he felt that traditional medicine obviously didn’t work. Because if he had three children that died, and he could do nothing to intervene and help to save those children, something wasn’t right and that’s where he started to look into this contract. The spine and misalignments of the spine could could impact or influence blood flow. And actually, if blood flow was restricted, that was the cause of disease. And then chiropractic seemed to evolve maybe 10 or 15 years later, although it’s it’s never, I suppose, accurate. But the principle is the same that misalignments of the spine cause disease, but it’s through the impact and the influence on nerve flow. So, it’s definitely a bit of a coincidence when I think the distance between the two locations in terms of where these two industries we say or practices developers about 180 miles or something, and when you look at the size of North America, that’s pretty vast. So definitely a coincidence in my view, and definitely, I think A position and a way of thinking that is, that is changed now I think there’s very few osteopath. So very few chiropractors that would believe that it is misalignment of the spine cause disease or are there still practices out there that you see that, you know that, that belief and thinking that way?

Jacob Steyn 5:22

I think there’s a, there’s a there’s quite a big group of chiropractors and I can’t speak for the osteopathic chop division, but amongst the chiropractic, or chiropractors out there, there’s definitely still quite a big group who believes that the, the body and the function and health and diseases determined by misalignment of the spine. So, but that, you know, you know, and I have to say that, that probably lies more with the folder chiropractors and and I think that as our profession developed and also our educational syllabus has has been has been modified in the last maybe 1020 years. It’s always, there’s always become more evidence based on the last years, but also but but especially the last few years, I think there’s there’s been a shift towards understanding and following more of a biomechanical approach. And also because we know that from the evidence, there’s actually no evidence really pointing towards a bone out of place, or misalignment of the spine causing pressure on the nerves. So I think there is a big group substantial. And, but I also know that there’s a rising group who really appreciates the research in terms of the biomechanical approach.

Ben James 7:02

And do you think that did you think that’s, that’s? That’s true? Or do you think that’s because that your interest in terms of the rise because I think there’s still, like you said, it’s definitely still a lot of practitioners that kind of take the what we kind of, I guess, call a wellness approach. And for me, there’s a wellness approach, which is kind of adjust in the spine regularly and trying to influence these misalignments or whatever that that kind of view is, there’s also the kind of maintenance You know, there’s definitely patients that have had back pain for a long, long time. And because of postural changes, etc, etc, we’re never going to get them 100% better with any approach and therefore, a certain amount of maintenance treatment is not necessarily a bad thing.

Jacob Steyn 7:48

But there is there is there is maintenance and there’s maintenance.

Ben James 7:53

Sure, absolutely. And, and I guess, do you think that there’s a lot of Do you think there’s a lot practitioners that truly believe in it? Or do you think there’s a lot of practitioners just see it in terms of the revenue stream and the way to survive is to continually treat the same patients?

Jacob Steyn 8:12

I think maybe I’m a little bit biased because I follow this biomechanical approach. And for me, that’s a big answer. I think it’s very difficult for any practitioner to say that what they do is the complete answer, but it’s a big answer, you know, you can see when it works, you can see when it doesn’t work, you have the ability to diagnose and accordingly treat and correct this functions and restore health and add weight. And so, yeah, my bias is definitely towards that side. There. Yeah, that’s a good question. There probably is still a quite a big group who and bigger group who follows the spine out of a lot Went out of alignment approach, thinking, you know, the the adjustment period the problem?

Ben James 9:12

Sure. Another thing, I suppose the big question there is in terms of, you know, we very much favor the research and the biomechanical approach in the active based approach. It just makes sense. Particularly, I think, and I feel for lower back pain for sure. And I guess, you know, those kind of the traditional view or the origins of chiropractic or osteoporosis in terms of the adjustments, does that have any benefit Do you feel in treating these patients or should we never adjust? And we should just be focused on exercise?

Jacob Steyn 9:46

Yeah, I definitely think the adjustment has a place and that could be lower back, upper back, neck. Knee, I treat a lot of people with a knee and after I adjusted knee, the knees actually a lot more stable, together with a little bit of pressure on the property as muscle. So I think they both have a place. But I think too, I think the ultimate goal is to restore movement. And we use movement to restore movement and to maintain proper movement and function because we ultimately stimulate the brain, which understands and executes the movement. Sure all of that. Three movements, but the what happens and I think that’s where I think a lot of people don’t really understand why chiropractors believe so much in adjustment. I think a big problem is the fact that we’re in this modern, modern world where we, we do a lot of stuff that we wouldn’t have necessarily done. You know, and I’m not saying that back in the day we were we were better off physically, but maybe in a more ideal situation. Their body is meant to make More low level, healthy movement that would maintain joints in a different way than this opposed to this dexa denturri lifestyle and we need at the moment, which then leads to this cascade of inflammation, scar tissue stiffness at a joint that continues for 10 years in your office job and ending up in a very non mobile, low back where the brain has lost the capability of actually controlling the movement. As I know, we have a, you know, we have a hardened joint complex down there in the low back and we also have cramped up muscles. And so then I think the adjustments actually are a great thing to get that just going in.

Ben James 11:48

Yeah, and I suppose the the kind of take a message there is absolutely it plays a role. And it might be that that adjustment plays a role in a low back Pain sufferer, but that role is actually very much focusing on theoretics, where there’s stiffness in the middle of the back. That is that is causing your lower back maybe to work that a little bit more and therefore, that’s where your your injuries come from because of, you know, another area of the spine being being a little less mobile, should we say? And I suppose a great question there then is, you know, if we’re saying that, yes, adjustments work, but actually only ever, in conjunction with a movement based approach. Is it fair to say therefore, that if you are giving anybody advice, say a family member or a friend that that wasn’t close to you and therefore couldn’t be treated by you? Is it more about choose the practitioner rather than choose? The kind of therapy, you know, osteoporosis versus chiropractic? Actually no. Choose the therapist. That is going to introduce you to a movement based approach.

Jacob Steyn 13:04

Take myself and yourself we’re not married to a profession. Sure. Am I correct? So, yeah, you know, we’re married to, I like to think that we we do the thing that’s necessary to get that individual better. So it would be it would be an individual approach to the person never nevertheless of their or your profession. So if I know of a very good physio or I know very good osteopath, who has, to my standards, a good functional approach and the ability first of all to make a proper diagnosis to understand the problem and therefore understand what’s needed to correct that. Then it doesn’t matter.

Ben James 13:51

Sure. And you mentioned there physiotherapist. A lot of people that were listening and thinking well, I can movement then I’m gonna be movement based and surely, surely that’s what the physio does. That seems to be the perception that that’s very much focused more around the movement, the exercise, compared to your chiropractic, your osteopathy.

Jacob Steyn 14:13

No, no, I see where you’re going there, Ben. No, that’s the, you know, I think the difference, first of all, from physiotherapist to physiotherapist, but it definitely differs between countries as well. Because I, I’m very well aware of the approach followed in the Netherlands, here where I practice and it’s a you know, it’s not a functional approach in general, and most of the time, there’d be a couple of exercises given and it would be you know, more of an excuse for an exercise it would be lying on your back rub thrown both knees to the one side and to the other side on the bed, you know to loosen up your back or pull your knees to your chest unless you No no, nope, no thought behind any of those sort of movements given to patients and otherwise, mainly a manual approach. So just massaging maybe trigger points. I’ve heard the weirdest things patients tell me when they’ve been to a practitioner with or a therapist with such an approach, you know, this muscle is too short and therefore that muscle is, you know, I mean, how do you quantify that? How do you measure that? Yeah, really blowing hot there.

Ben James 15:30

Yeah, there seems to be a lot of that or there’s a muscle imbalance or I’ve got tight hamstrings, and therefore, yeah, no, that’s my problem. Well, and that’s just, that’s just something unique to you compared to your friend down the road or your, you know, your colleague at work. But I think it’s interesting. You mentioned about the stretching, that seems to be a common thing that a lot of patients will communicate. That is whether it’s a medical doctor, whether it’s a physiotherapist, even chiropractic, osteopathy, there seems to be a lot of a focus on this stretching of the low back, when people often feel that, that that relief, and therefore they think it’s doing them I’m doing I’m good, it’s a benefit. But, you know, a lot of the evidence is saying, Well, actually, you know, we want to we just want to keep that spine in neutral.

Jacob Steyn 16:22

Yeah. Or the idea of going straight going. You know, starting yoga because of my low back or I’ve done yoga, I got an injury and my injury is half half way better, but really, actually still a problem. And I just, you know, I want to do yoga again, I’ve had I’m still stopping so many people just doing that or I do my best to explain why not. Why it’s not a good idea and how we’re actually interfering with the healing process. Yeah. So it’s, it’s that’s really a problem. It really keeps people quite often far away from actually healing.

Ben James 17:04

Sure, yeah. What what’s your view on the party’s element? Because yoga seems to be very much more about that flexibility and that movement and you’ll often see those movements. And I’m not saying that, that yoga in many ways can’t be a benefit, but in terms of the stretching through the lower back, you often see those kind of movements bilities but it seems to be more focused on the core, but then there again, it seems to it seems it doesn’t that doesn’t seem to be a generic approach. Not that there should ever ever be a generic approach but there seems to be a mix and a hybrid of stretching and core strength with with peloton So, again, it’s it’s maybe a little bit confusing and therefore not necessarily helpful for for back pain sufferers.

Jacob Steyn 17:52

Well, just getting back to the yoga, there’s different styles of yoga. I’m not a yoga expert. I have a good friend of mines. The yoga teacher for quite a while now. And she’s, she’s giving lessons Hello, CrossFit gym. And she’s very familiar with different styles for many courses and retreats and so on. And you know, they’re, I think it’s called vinyasa. It says very extreme form of yoga, which means you really look up in ranges of motion, you know, in range of motions, and you’re holding it. Yeah, so, you know, and there’s lighter forms of yoga. And that would be maybe more suited. I mean, just for most people in general. And comparing that to builders. Yes, builders definitely have a lot, a lot more core work on hands and feet. And, you know, by and for the rest. I’m not really, like I say, I’m an I’m based in the Netherlands and people here seem to be yoga fanatics and not do any large as far as I know.

Ben James 19:00

Wow, okay. Interesting. Yeah, this seems to be a lot of, well, it seems to be a lot of both over here in the UK. But again, that doesn’t seem to be doesn’t seem to be true consistency between the two. But that’s for sure. I wouldn’t, you know, I wouldn’t go to a yoga teacher and truly no one else what I was gonna get, yeah, you know, in continuity to politics, you know.

Jacob Steyn 19:24

But you never know what you’re going to get in contrast to another yoga teacher. So, sure, you know, that’s the thing, and people don’t know that. And sometimes also the stories I hear from patients, you know, this yoga teacher was pushing me or pulling my leg, you know, all in the favor of getting more stretched through the tendons and the ligaments and stuff like that. So, yeah, and people don’t know that. And I think it’s the responsibility lies with the teacher.

Ben James 19:56

Yeah, and I suppose the take home message for people listening is First and foremost, you know, as always, you need to be comfortable that you’re getting an accurate diagnosis. You know, that is the one difference. I would suggest with osteopathy and, and chiropractic compared to physiotherapist and, and no doubt that’s doing a disservice to some physiotherapists out there but certainly they seem to work more commonly in terms of a diagnosis given from a GP, potentially. And whereas osteopathy in chiropractic should be more first line in terms of that, that diagnosis in that initial examination we would always say you know, you should be looking, getting a very thorough examination if it’s anything less than two hours, start to question, the practitioner. That’s that’s take him advice. Number one, you want to be sure that someone is truly analyzing not just a very thorough history taken and questioning of what you’re you’re doing on a daily basis, the activities you’re doing on a daily basis that cause that pain eight, you should be, you know, very much scrutinized in terms of that that activity in that movement on a daily basis, because I think that’s hugely important in terms of is identifying what could be the pain triggers and what could be causing the problem or certainly, and preventing that issue from healing. I think that’s, that’s takeaway number one. The second thing is you should be expecting a movement based approach because the, the evidence is telling us that without focusing on those movement patterns without focusing on the core strength, you are going to be very, very lucky to get better from suddenly from a chronic low back issue if you’re not getting that advice alongside any passive treatment or therapy.

Jacob Steyn 21:58

Can I add a point there?

For those listening, if you do yoga and you do a yoga routine every morning and it doesn’t feel good, especially with bending forward and hanging down and making movements through the low back, it doesn’t feel good probably isn’t good. So you know, either scaler down less intense, less less time doing yoga, and it might be better doing it in the evening. Because then your disks or has less moisture in it, then there’s less less pressure. So instead of drying it off to work on evening instead of or if you start late morning then you might do it after you’ve been off for a couple of hours but do not do it. First thing first thing in the morning if you have discomfort.

Ben James 22:47

Yeah, sure. We always talk about how the spine is more vulnerable first thing in the morning and certainly looking to maintain that. That neutral spine for the first half hour of the day. So like you say, if you’re in If you’re doing any yoga parties exercises within that first half hour, then definitely be Be careful but, but even after that any movements that you’re doing that don’t feel right or are causing discomfort, then really consider avoiding them and also avoid stretching exercises through the low back because they’re exercises that sometimes can feel a little bit more comfortable or they give you a bit of relief. But actually, as we’ve discussed before, they kind of activate a stretch reflex that that gives you initial relief, but it’s it’s aggravating the problem ultimately, and therefore, you know, definitely definitely movements to avoid, for sure. And another question, just go back to the kind of adjustment conversation Jake, what what can patients expect those that have never experienced an adjustment, what is what is an adjustment, what should it be doing what what is the what is the expected or perceived outcome or therapeutic outcome? an adjustment.

Jacob Steyn 24:02

So the adjustment is aimed at moving to bones in relation in relation in relation to each other. The the two elements that we can consider when we do that is, first of all, if there has been a period where these two bands have not been moving in their optimal range of motion in relation to each other, you will start getting scar tissue forming. Let’s use the low back, for example, sitting in an office every day, a lot, not really moving through your back other than getting up from a chair and moving somewhere but you’re not doing a sort of any sport where you get the proper movement through low back. So you get that scar tissue forming. You know, after a few weeks off a few months, it will just build up it’ll get stiffer. So the first element to the adjustments actually where we we literally break those scar tissue fibers and restore movement between those two votes that sounds very violent, when in fact, actually it’s a very short high amplitude fast movement, which shouldn’t reality not be painful at all. And just from that short movement, we create the necessary movement, maybe sometimes in multiple adjustments, not not just in one go. And so when we restore that movement, the brain can pick up that there’s movement again and utilize that movement, which otherwise wasn’t possible. And the second element is where we stimulate nerve endings at the joint. These nerve endings are in a joint capsule, when other tendons, ligaments around the joint that then sends information to the brain. And so we light up that joint in the brain. So the brain then understands that this joint is now active. We stimulated those nerve endings. And so it can be it can connect more with this joint in terms of directing muscle function to stabilize.

Ben James 26:15

Excellent. Excellent. So and yeah, like we say, I think very therapeutic definitely beneficial in terms of the overall approach to treatment and management of a back pain but in isolation question, you know, question that that approach if that is all you’re receiving, then definitely challenge challenge that practitioner. I think it’s, you know, that’s the kind of take home message there. You always want to be been given some exercises to do at home and some movement based advice because without that, then you know, it is definitely going to be a struggle and it’s something that even if you get a bit of relief, the Common messages. Yeah, it feels a bit better after treatment, but it’s still uncomfortable or it’s, it’s not fully better. And that’s when you start to see people that have seen multiple different practitioners. And they might seen an osteopath, they might seen a physio they might see a chiropractor. They felt a bit of relief from all but actually the problem still remains. And unless you’re changing, as we’ve said before things on a daily basis, then you’re undoubtedly going to struggle on and become very frustrated and disillusioned by by the problem. So I think there, there’s, there’s two key kind of take home messages there. Today, don’t don’t overly think the, the profession or the therapy that you’re receiving, it’s very much about the individual. And if they’re giving you that movement based approach, then fantastic. And, you know, from an adjustment point of view, definite benefits there. But it’s got to be in conjunction with that. That movement based approach. Because otherwise, like we say, and we continue to say and we kind of labor the point but your will struggle with, with complete resolution and, and, and a management of that pain, which is clearly a frustration.

Jacob Steyn 28:15

And once that’s healed a long term, long term resolution.

Ben James 28:20

Exactly. And that’s where the kind of insurance comes in and the, the awareness and building those movements into the subconscious mind, I guess, you know, initially it takes effort, there’s no doubt you know, it does take effort and that’s where we’ve got to break away from this kind of approach that you know, I get unwell and therefore I take a tablet or I get some form of intervention that makes me better again, you know, back pain can’t be there’s no magic pill for back pain. There’s no see a practitioner get an adjustment walk out and now I’m fine again, it you know, really think about that, that you know, things If you’ve had a bad if you’ve been suffering from back pain for six months, you honestly go in, get an adjustment or to walking out of there and never suffering again. You know, what has caused that problem? Have you ever discussed that with your practitioner because it’s often more than 90% of cases are. I didn’t do anything specific or that one thing specific that you think you did was the culmination of, of months years of, of poor movement. And so, you know, really think about that and think about how you want to manage your spine health in the longer term, you only get one back, so look after it.

Jacob Steyn 29:41

So yeah, I agree with you, Ben. We only have one back. And it’s not like we can replace a knee anytime. And we have really got a lot of difficulty when it comes to strategies in terms of surgery at the back or we’d rather avoid any of those procedures. So, I think it’s a question of taking responsibility. And I think that’s the the best approach instead of actually having the responsibility over to somebody else.

Ben James 30:11

Yeah, exactly. Yeah. And Ted, you know, at least try, you know, before you seek those, certainly those interventions that, you know, when we when we start to get down the path of, of surgery, that’s, that’s a one way path, you know.

Jacob Steyn 30:28

Not only surgery, but also the path of, look, here’s my problem, you do something with it. I think, as practitioners, what we like to do is we’d like to guide people in taking responsibility, understanding what’s going on with them, and helping them to get better to what they’re doing. So they get empowered to know that actually, this is in my hands, you know, they have to have the feeling that it’s in their hands and they can do something with it. Yeah, I think that’s that’s where that true power lies.

Ben James 31:03

Yeah. Yeah, the true power lies in the the responsibility and the ownership of the problem. And then get any getting the empowerment and the education, you need to be able to make that transformation. Because we always say that pain always has a cause. And with the right management and the right approach, you know, you can definitely resolve that problem, certainly significantly improve the suffering that you’re experiencing. But it it takes effort on your part, you know, we’ve said it before we say again, out, certainly go out and get that advice and get that support. Don’t overly think the person that you’re seeing or don’t only think the profession you see and think about the person, think about a movement based approach. But make sure that you take action yourself daily, to help the problem and if you do that, there’s no reason why you can’t overcome that pain. So as always, thanks again, Jacob. As we say the next episode in the series of episodes are going to be focusing a little bit more on other topics around the management about pain, particularly later down the line around surgery and a little bit more on the evidence and an information regarding that. So listening to the next couple of episodes in the series, and as always, give us a rating on iTunes. It always helps with us to get the message out there and we’ll be continually putting podcasts out at the moment on a weekly basis, and endeavoring to improve and inform as we go with the aim to help you with your transformation. So we’ll speak again soon.

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