Physiotherapy provides research evedence based treatment for the symptoms of back and neck pain as well as teaching self management techniques to the client to help prevent further episodes

Government Research recommends Physio

In the comprehensive government research review of back pain (CSAG report 1997) early Physiotherapy was the recommended treatment to reduce chronic problems.

Role of physiotherapy

Through highly skilled clinical practice and well designed research over the last 50 years physiotherapists are able to provide evidence for our practise as a safe and effective management approach as well as pioneering new treatments such as core stability exercises. Physiotherapists are skilled in the assessment, diagnosis, and treatment of patients with low back pain arising from a musculoskeletal disorder. Many surgeons use Physiotherapists to assess there patients prior to seeing a consultant.

Acute Low Back Pain

There is considerable evidence to support that spinal manipulative therapy (including both passive mobilisation and manipulation), McKenzie therapy and promoting early activity is effective in the short term management of low back pain. There is insufficient evidence to support that interventions such as shortwave, heat and massage are effective in the management of the acute low back pain patient.

Chronic Low Back Pain

There is also strong evidence to support that general exercise programs result in reduced disability, reduced absenteeism and faster return to work rate compared to control groups (Frost et al, 1995, Gundewall et al 1993, Kellett et al 1991, Mitchell et al 1990, Moffett et al 1999). Physiotherapists have the necessary training and skills to design, implement and supervise such exercise programs. Physiotherapists are also pioneering investigations into the proposed mechanisms contributing to chronic and recurrent low back pain by evaluating the effects of specific exercise programs (O’Sullivan et al 1997).

The combination of manual physiotherapy and exercise has strong and increasing evedence in the management of low back pain

(Ottenbacher and Difabio 1994, Scheer et al 1995)

Treating low back pain

The current recommended treatment for an acute attack of low back pain which has no danger signs (known as ‘Red Flags’):

• Painkillers
• Continuing with normal activities
• Physical therapy (Physiotherapy) and manipulation if required
• Remaining at work or returning as soon as possible

Bed rest is not recommended and has been shown to makes matters worse therefore it should be avoided. Despite this, the last survey in 1998 showed that GPs still recommended bed rest to one in four of the people who consult them about back pain.

The longer someone is off work with back pain, the lower their chances of returning to work. (50% will return at six months but only 5% after one year) Patients who return to normal activities feel healthier, take fewer pain killers, and are less distressed than those who limit their activities.

Psychological and social factors (’Yellow Flags’) are more important risk factors for developing chronic pain than physical symptoms and signs.

Recent guidelines emphasise the need to monitor low back pain reports in the workplace, and stress the:

• Importance of rehabilitation
• Need to stay at work if possible with any necessary modifications
• Maintain contact if not able to remain at work
• The possibility of returning to work even if not entirely painfree

Back pain affects most of us

According to a survey 1 published in 2000 almost half the adult population of the U.K. (49%) report low back pain lasting for at least 24 hours at some time during the year. In a similar survey carried out 10 years earlier just over one third of the population complained of such back pain. In 1998 almost one in five adults (18%) experienced low back pain for the first time. It is estimated that up to four out of five people (80%) will experience back pain lasting more than a day at some time during their life.

How long does it last?

In 1998 in over half of those people who reported back pain the episode lasted for over 4 weeks - affecting 8 million people and in the case of 2.5 million of these the back pain lasted throughout the year. Young people are more likely to have brief acute episodes of back pain while chronic pain is more characteristic of older people. There is little difference in the occurrence in men and women.

Work related costs

Back pain is the nation’s leading cause of disability, with 1.1 million people disabled by it. Back pain disability has risen more quickly over recent years than any other common disability. At any one time 430,000 people in the UK are receiving Social Security payments primarily for back pain. One in eight (13%) unemployed people say that back pain is the reason they are not working. True costs to Industry are difficult to ascertain as in a recent survey only 17% of businesses had calculated the costs of back strain.

Risk factors for low back pain

Back pain is spread fairly evenly across the community in terms of age, sex and geography but occupation makes a difference. Over 1 million people have back pain or upper limb disorders. Reported back pain is most common in those with skilled manual, partly skilled and unskilled jobs.

Low back pain in children

Studies across Europe show that back pain is very common in children. Around 50% experiencing back pain at some time, although a recent study from France recorded four out of five children having back pain in the last year. In that study the weight of their book bags was one of the strongest predictors.