LOW BACK PAIN WHO OWNS LOW BACK PAIN?

A MULTIDISCIPLINARY SYMPOSIUM AND DEBATE

By Kesh Patel MSc and Dr Suzanne Patel PhD

INTRODUCTION From a therapeutic perspective, the issue of low back pain exists on a variety of levels ranging from medical intervention, manual therapy and exercise therapy, psychology, complementary therapy, through to occupational health, health insurance, and local health authority and government policy. Of course, within this frame- work, it’s important not to forget the needs and objectives of the patient, and factors such as motivation, compliance and adher- ence should not be overlooked in the treatment process.

The treatment of low back pain has changed dramatically over the past 25 years. As late as the early 1990’s, bed rest and immobili- ty was still advocated as the primary treatment modality for back pain (1). Today the general consensus is in favour of mobility, either in the form of manual therapy and/or gentle, yet specific exercise. As well as there being a number of available options for immediate treatment, such as physiotherapy, osteopathy, chiro- practic, and other forms of manual therapy and bodywork, pre- ventative measures are crucial to long term back health, with movement generally accepted as a major tool.

This debate, which took place on the evening of Wednesday 21st March 2007, included a multidisciplinary panel of experts (see Table 1) with the aim of discussing issues surrounding the current and future management of low back pain. The panel were invited to present their thoughts in response to the following questions: 1. What would you view as the primary causes of low back pain? 2. What are the key factors you would recommend to help a low back pain sufferer? 3. Based on your experiences and research, discuss any limitations you see with the traditional treatments for low back pain, and how you feel these could be addressed in the future? 4. What role do you feel both you and your profession has in the management of low back pain over the next 5-10 years?

This article provides a brief overview of the panel’s views and highlights some important points for therapists to consider when treating low pack pain sufferers.

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This exciting symposium and debate was the first of its kind to bring together a multidisciplinary panel to present on and then debate the subject, ‘Who Owns Low Back Pain?’ Hosted by Professor Ann Moore, editor of Manual Therapy Journal and director of the Clinical Research Centre for Health Professions at the University of Brighton, the symposium brought together an impressive array of international experts from disciplines including physiotherapy, osteopathy, chiropractic, surgery, corrective exercise and alternative health. This article attempts to put in writing some of their views on the issues surrounding low back pain, including current and future management.

WHAT ARE THE PRIMARY CAUSES OF LOW BACK PAIN? From a structural perspective low back pain may involve disc, joint and muscle pathology in the first instance (2), that arises as a result of mechanical overload. As well as resulting in disc deformation leading to pain, excessive loading is consistent with end-plate fractures that can also cause pain, and further highlights that excessive loading causes tissue damage and damage causes pain (3). It’s interesting to note that excessive loading of the spinal tissues may not be the sole factor in producing back pain. Unbalanced loading at loads well below tissue failure rates may contribute to low back pain over pro- longed periods of time, especially if left uncorrected. Ultimately, the outcome will involve changes in disc and joint structure and function and subsequent pain. The structural paradigm is still commonly accepted within the context of low back pain, secondary to a number of causative factors. Based on this model, optimal strategies for treating low back pain should focus on methods that help to reduce unnecessary loading of tissues. The panel identified a number of predictive factors that may contribute to unnecessary tissue loading, and may help practitioners understand the aetiology of low back pain with a view to preventing it in the future. These factors included: ■ Acute trauma ■ Compensatory movement strategies (secondary to acute and chronic trauma)

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