Latest News

Back pain: the great unknown, or poorly understood?

Musculoskeletal disorders are the biggest cause of disability. Despite the billions spent, the problem is just getting worse. Latest medical guidelines strongly recommend exercise therapy as the first-line-treatment for musculoskeletal disorders instead of much more expensive surgeries.

By Geoffrey Mackay, getback Co-Founder and Clinical Director

It may come as a surprise to some, but back pain and particularly chronic low back pain (defined as present for more than six weeks), is often poorly understood and poorly managed. 

While researching this blog, I visited the websites of two respected Physiotherapists who offer back pain treatment. The information from one Physiotherapist was contradicted by the other. 

Physiotherapist 1 attributed back pain to habits acquired sitting, standing or lifting and stressed the importance of core strengthening exercises. Their contention was that bending and twisting activities like gardening, DIY activities and repeated everyday activities can trigger back pain.   

Physiotherapist 2 categorically stated that back pain was not due to poor posture or a ‘weak core’ and that backs do not deteriorate through everyday loading and bending. 

Both of these Physiotherapists are highly respected and have been successfully treating patients with back pain for many years. 

The difference is that Physiotherapist 1 follows a traditional, hands-on approach using massage, joint mobilisation and joint manipulation. This approach relates back pain to the lumbar discs and facet joints and the signs and symptoms associated with these structures. 

Physiotherapist 2 approaches back pain from the perspective of what the patient is experiencing, largely using techniques that are hands off and which give the patient greater control of their pain management. This technique retrains patients in functional movements and in part relies on dispelling some of the myths created by a traditional medical approach.

The behavioural approach of Physiotherapist 2 reflects how sensitive the structures are, rather than how damaged they are. This approach recognises that while pain is largely attributed to mechanical factors, pain can also be triggered by poor sleep, stress, tension, low mood and unaccustomed activity. The pathway here to understanding chronic back pain includes the influence of the nervous system and how a patient can take charge of this. Man and woman testing the getback devices

Medical practitioners have traditionally relied on radiology and scans as a way of diagnosing back pain. These scans are useful in a minority of people, but many of the findings reported by scans are what we call False-Positive results. 

These results can indicate structural changes and degeneration that are asymptomatic, and which can be found in people who don’t have any back pain. 

Based on these results, medical practitioners have referred patients for spinal procedures including spinal injections, facet joint injections, surgery, or trials with opiates. These interventions come with risk and are often not a long-term solution for chronic back pain. 

The latest high-level recommendation from The Lancet journal is to not rely on radiology, but to ask the patient what activities they can and cannot do.

Thankfully, there is common ground between the approaches of the two therapists to treating back pain. Although poles apart with regards to the influence of ‘core’ strength, both Physiotherapists acknowledge the importance of the Multifidus muscle. 

Understanding the role and importance of the Multifidus muscle is a relatively new concept.

Professor Emeritus John Carlson highlighted the importance of the Multifidus muscle in his recent blog, The Mighty Multifidus. In the blog Professor Carlson explains why getback has focused on research findings about the Multifidus to deliver specific movement and stabilisation treatment for the spine.

By introducing patients to appropriate and specific exercise in caring practice environments with trained therapists, getback can overcome the fear of movement patients experience due to chronic pain. We complement this caring environment by offering cost-effective programmes that are flexible to suit patients’ lifestyles.

The getback vision is to help people live their lives unrestricted by back and neck pain and to provide evidence to sector influencers about the efficacy of our approach.