Low back pain is a major worldwide health problem which is affecting a vast number of people, largely because of the ageing and increasing world population (Clark and Horton, 2018). For the vast majority of people affected by low back pain, the identification of a specific nociceptive cause (i.e., what activates the ‘danger’ receptors in the body) is not possible. Only a small number of low back pain sufferers have a well understood pathological cause - e.g, an infection, fracture or malignancy (Hartvigsen et al 2018). Contrary to commonly held beliefs amongst patients and healthcare professionals, research demonstrates that spinal degenerative changes like osteoarthritis are common in most asymptomatic individuals; therefore, in most cases low back pain cannot be attributed to “wear and tear”. In contrast, psychosocial factors such as fear of movement, anxiety and depression, stress and job dissatisfaction are strongly associated with low back pain. In particular, obese individuals, smokers and those with highly physically demanding jobs are at greatest risk of developing low back pain (Hartvigsen et al 2018).
gives you an excellent overview of this very common health problem and provides excellent advice. At the Osteopathic Health Centre our team of osteopaths and physiotherapists are highly experienced in the diagnosis, treatment and management of individuals with low back pain, and their approach is underpinned by recently published clinical guidelines. Patients are assessed taking into account their general health and pain/disability experience. Our clinicians provide with you with a package of care which includes hands-on manual therapy (e.g., manipulation and soft tissue stretching) and exercise and other treatment strategies aimed at challenging negative cognitions and emotional response to pain. These strategies include cognitive reassurance to change your perceptions and beliefs through education and advice on how to adopt healthy lifestyle behaviours.
In her book, she writes: “I thought fixing my back would be as straightforward as fixing a broken wrist. I’d find a surgeon and get it done.” But as she began researching her options, she tells me: “I started to see ‘lack of evidence’, ‘absence of evidence’, ‘poor evidence’ and I’m thinking: excuse me? I started to wonder what the heck was really going on here.”
The six-year investigation that began as an attempt to find relief from her own pain and ended up exposing an exploitative, corrupt and evidence-free $100bn industry, is fittingly described in the title of her book: Crooked.
The papers tell us low back pain is an “extremely common symptom, experienced by people of all ages”, although it peaks in mid-life and is more common in women than in men. There are 540 million people affected globally at any one time and it is the main cause of disability worldwide. In the UK, over the last 20 years, there has been a 12% increase in how likely a person is to experience disability as a result of low back pain; globally, the amount of years people live with low back pain disability has risen by 54% in 25 years. In Europe, it is the most common reason for medically certified sick leave and for early retirement. According to the Office for National Statistics, almost 31m work days were lost in the UK in 2016 due to musculoskeletal problems including back pain. The costs attributable to low back pain in the UK are estimated at £12.3bn a year, with £1.6bn spent on treatment.
The findings in these papers were not surprising for Cathryn Jakobson Ramin, a veteran investigative reporter and back pain survivor, whose gripping takedown of the back pain industry in the US was published last year. Her story began 10 years ago, when she put a note on her calendar to “find a spine surgeon”. She says: “When I began this hunt, I was a patient. I was looking, as all of us do, for a solution. I’d experienced back pain from when I was about 16 years old and I’d always coped with it. But I couldn’t cope any more. I struggled to sit or walk for more than a few minutes.”
y alarm went off one morning about 18 months ago and I woke up to realise I was in agony. It was my back. I tried moving, I tried lying still, I tried sitting: everything hurt. I visited a physiotherapist recommended by a friend. I do not remember what she said, but I felt listened to. Over the next days and weeks, the pain lessened, but I was still terrified to move. It was most intense just above my left hip, but it had infused my whole being, taken my energy, taken any pleasure I had in life. It was exhausting, being in pain or worrying about being in pain. I felt very low. I went from exercising four times a week to doing none at all. I wanted it to get better straight away, so that I could get back to my old life. There is something about back pain that makes you desperate to find a magical solution. Bearing the pain, waiting for it to get better, is unthinkable.
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