Back Pain

Back pain is one of the most common reasons people seek treatment and it can affect anyone regardless of age or activity level.

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In the UK, a significant proportion of the population experiences back pain. Public Health England reported prevalence in approximately 16.9% of people of all ages. Globally, low back pain is the leading cause of disability, with years lived with disability increasing by 54% between 1990 and 2015 (Hartvigsen et al., 2018).

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It may come on suddenly after a specific movement or develop gradually over time due to work, stress, repetitive strain or changes in activity levels.

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Often what appears to trigger the pain is simply the final load that exceeds the body’s ability to adapt.

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This can relate to doing too much, too soon or too fast. It can also relate to doing too little and reduced capacity over time.

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Some people experience a local ache or stiffness in the lower back. Others notice pain spreading into the buttock, hip or leg.

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Back pain can involve muscles, joints, discs or sensitivity within the nervous system. In many cases it is a combination of these rather than a single isolated cause.

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We explore this further in our article on the complex relationship between MRI findings and back pain, and why scans do not always fully explain symptoms.

People with back pain often describe:

• stiffness, especially first thing in the morning or after sitting

• a dull or aching pain in the lower back

• sharp pain with certain movements

• difficulty bending, lifting or twisting

• tightness across the lower back muscles

• pain after prolonged sitting or standing

• symptoms spreading into the buttock or leg

• recurring flare ups linked to activity or stress

• reduced confidence in movement

Back pain can develop for a range of reasons and often there is more than one contributing factor.

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Common patterns we see include:

• prolonged sitting or desk based work

• repetitive lifting, bending or rotation

• reduced movement variability during the week

• gym or sports related overload

• stress related muscular tension

• previous injuries that have not fully settled

• reduced recovery between training or activity

• compensatory movement patterns elsewhere in the body

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In many cases, it is not one single event that causes back pain, but how load and recovery have been managed over time.

People with back pain often describe:

• stiffness, especially first thing in the morning or after sitting

• a dull or aching pain in the lower back

• sharp pain with certain movements

• difficulty bending, lifting or twisting

• tightness across the lower back muscles

• pain after prolonged sitting or standing

• symptoms spreading into the buttock or leg

• recurring flare ups linked to activity or stress

• reduced confidence in movement

Back pain can develop for a range of reasons and often there is more than one contributing factor.

​

Common patterns we see include:

• prolonged sitting or desk based work

• repetitive lifting, bending or rotation

• reduced movement variability during the week

• gym or sports related overload

• stress related muscular tension

• previous injuries that have not fully settled

• reduced recovery between training or activity

• compensatory movement patterns elsewhere in the body

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In many cases, it is not one single event that causes back pain, but how load and recovery have been managed over time.

Back pain is a broad term and in clinic we aim to understand the underlying pattern rather than rely only on a label.

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Common presentations include:

• mechanical lower back pain

• disc related irritation

• Sciatica

• sports related back strain

• postural or desk related back pain

• muscular tension patterns in the lower back

• stiffness linked to reduced mobility or activity levels

Treatment at Virtue Healthcare is based on understanding what is driving your symptoms, not just treating the area where pain is felt.

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Sometimes the diagnostic label is less important than the functional pattern. For example, sciatica can arise from different underlying mechanisms and may present differently between individuals.

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We focus on treating the person in front of us, not just the label attached to the symptoms.

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Often what appears to trigger the pain is simply the final load that exceeds the body’s current capacity. In many cases, it is the accumulation of factors over time that leads to symptoms, rather than one isolated event.

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We look at:

• how your symptoms behave throughout the day

• how your body moves under load

• where tension or restriction is developing

• lifestyle, work and activity patterns

• previous injuries and compensation patterns

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From this, treatment may involve osteopathy, acupuncture, rehabilitation exercises or a combination of these approaches. Rehabilitation is often an important part of recovery, helping to improve movement confidence, load tolerance and long term resilience.

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Most patients are also given simple and individualised exercises to support recovery between sessions.

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This approach aligns with contemporary understanding that chronic low back pain is often multifactorial and benefits from individualised and function focused management rather than purely symptom based care (Hartvigsen et al., 2018; Foster et al., 2018).

Structural osteopathy focuses on how the body moves and distributes load.

This may include work on:

• joint mobility

• muscular tension

• movement patterns

• biomechanics

• areas of restriction or overload

Treatment uses hands on techniques designed to improve movement efficiency and reduce mechanical strain. Treatment often works best when combined with simple rehabilitation exercises to support the changes made during treatment (NICE, 2016; Qaseem et al., 2017).

Manual therapy techniques such as spinal mobilisation and manipulation may provide small to moderate short term improvements in pain and function for chronic low back pain, particularly when combined with exercise (Rubinstein et al., 2019; Coulter et al., 2018).

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Traditional acupuncture is used to support pain regulation, tension reduction and recovery processes within the body.

Within clinical practice it may support:

• reduction in pain sensitivity

• muscular relaxation

• nervous system regulation

• recovery from chronic tension patterns

• overall sense of balance and ease

Evidence suggests acupuncture may provide modest short term improvements in chronic low back pain compared with usual care or sham procedures, although responses vary between individuals (Chou et al., 2017; Vickers et al., 2018; Furlan et al., 2005).

As with manual therapy, it is generally considered an adjunct within a broader rehabilitation approach rather than a stand alone treatment (NICE, 2016).

Often the most effective approach involves a combination of both methods.

This allows us to:

• address mechanical contributors

• support nervous system regulation

• improve mobility and movement confidence

• reduce recurrence of symptoms over time

Treatment is adjusted based on how your body responds rather than following a fixed protocol. This may include hands on treatment, acupuncture, education and rehabilitation exercises depending on what is most appropriate for your presentation (Foster et al., 2018; NICE, 2016).

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Exercise is always adapted to the individual. Rather than a standardised list, we focus on what feels realistic and sustainable for you. A small amount of consistent movement is often more effective than a long programme that is difficult to maintain.

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Manual therapy and acupuncture may also help reduce pain and improve movement tolerance, which can support engagement with rehabilitation (Hartvigsen et al., 2018).

Your first appointment typically includes:

• a detailed discussion of your symptoms and history

• assessment of how your body moves

• identification of contributing factors

• hands on treatment using osteopathy and or acupuncture

• rehabilitation exercises or movement guidance where appropriate

• advice on movement, activity and recovery where appropriate

Everything is tailored to your presentation on the day.

This approach may be suitable if you:

• experience recurring or persistent back pain

• have pain related to desk work or posture

• feel stiff or restricted when moving

• experience pain during sport or exercise

• are recovering from injury

• prefer a hands on and individualised approach

• are looking for integrated osteopathy, acupuncture and rehabilitation care

Recovery time varies depending on:

• how long symptoms have been present

• severity and sensitivity of the condition

• work, stress and activity levels

• how your body responds to treatment

Some people notice change relatively quickly. Longer standing issues usually require a more gradual and structured approach.

It is often difficult to predict early on without a full assessment, but clearer expectations can usually be given after the initial consultation.

Why do scans sometimes show significant changes in people without pain, while others experience severe symptoms with minimal imaging findings?

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Read: The Lumbar MRI Paradox: Exploring Back Pain's Multifaceted Nature

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