Background:
Lower back pain is an extremely common symptom in the general population and incurs great economic and social cost.

About 80-90% of adults in the UK suffer from low back pain at some point in their life, the majority will improve over a 3 month period (90%), but unfortunately nearly 50% of those will have a recurrence at some point in the future.

Most low back pain is classified as non-specific low back pain. This means that the pain is not due to any underlying disease process, and generally is due to ‘irritation’ of a number of tissues in the spine (facet joints, intervertebral disc, muscle, ligaments) rather than one distinct specific structure. Pain is generally mechanical in nature in that it is provoked with specific directions of movement / patterns of loading such as bending, leaning, and sitting. Since the nerve tissues which innervate the muscles and skin of the lower limb originate from the low back it is not uncommon for leg symptoms including pain (sciatica), pins and needles, numbness and even muscle weakness to be present.

Treatment:
Due to the mechanical nature of most low back pain successful management hinges on identifying and treating the underlying causes of the problem.

Poor function of the stabilising muscles of the region (often referred to as the ‘core’) is one of the more common causes. Research has demonstrated that pain itself causes inhibition of these stabilising muscles. Further to that these muscles do not recover their function unless specifically retrained, even if the pain magically disappears overnight. This is thought to one of the reasons back pain is so recurrent in nature. In more recent years studies have shown that retraining of this stabilising musculature significantly decreases the rate of recurrence. Longer term Pilates can be an effective means of maintenance.

Poor sitting and standing posture is common amongst low back pain sufferers, especially those that relate their pain to sustained postures. Good postural alignment is also needed to facilitate activity in the stabilising muscles.

Other underlying causes include altered movement patterns, instability of the pelvis during walking/running, lack of hamstring and quadriceps flexibility, and ergonomics of the workstation / desk environments, particularly in those whose pain is aggravated by sitting.

As with most conditions there is a variable amount of manual therapy needed in order to release tissues that have become tight or painful – most often these restrictions are in the direction opposite to that which aggravates the symptoms.

We also successfully treat many women with pelvic pain during and following pregnancy. Retraining muscles of the pelvic floor and deep abdominal wall as well as postural spinal muscles and gluteal muscles is vital for maintaining a stable, pain free pelvis.  Without this pubic, lower back, buttock and sciatic pains that may have been developed or increased during pregnancy often prove very hard to shift.