Ten benefits of sports massage
Looking for a modern and revolutionary approach to treating lower back pain? Tried every treatment before with no improvement..?
Most people with severe non specific chronic lower back pain (back pain with no specific structural cause found) have two things in common, they usually have severe pain and also a lack of function. Many of them have undergone treatments including manual therapy, exercise therapy, core exercises, stabilising exercises, manipulation, electrotherapy, massage, pilates, yoga , medications, injections etc (the list goes on....). The evidence base for management of back pain has evolved immensely over the last decade but despite this many patients continue to be treated with all of these traditional therapies with little effect.
Even the latest national guidance from NICE (National Institute for Health and Care Excellence) clearly state that practitioners should not be offering acupuncture, injections and electrotherapy for treatment of lower back pain (source).
Frustratingly, these types treatments are still marketed and sold to people in pain on a daily basis. There is therefore a clear need for physiotherapists, doctors, surgeons, osteopaths and chiropractors to improve the quality of what we offer for conservative management of non specific lower back pain and in the process move to a more contemporary approach.
Since its inception, the Consortium clinic has always listed Cognitive Functional Therapy as a service provided for its patients. The research has shown this approach to be significantly more effective than any previous approaches we have traditionally used to manage back pain (source). This is exciting news for the future for those of you who suffer from severe disabling back pain.
What is Cognitive Functional Therapy (CFT)?
When it comes to treating lower back pain - a one size fits all approach simply does not work.
CFT is most importantly patient centred. This means it is focused entirely around you as a person, your life and your goals. CFT looks at the way you move and analyses some of the strategies you have adopted as a result of living in pain. It targets the fears and beliefs that are associated with performing spinal movements and the movement behaviours you often display around your back. It will help you understand that pain will not necessarily cause your back any damage. We will look through your MRI scan with you and help you to dethreaten some of the worrying things you may have been told about it. CFT will try to get you out of the vicious circle that so many patients find themselves trapped within. Often all of these things lead to a significant increase in the tension around your back and this often drives the nervous system to be over sensitised.
CFT will look to undo and change many of these things to provide you with better strategies to ease your pain and lessen your disabilities. It will help empower you to get back to doing the things in life that are of value to you.
What does the research say that Cognitive functional therapy achieves?
The trials for CFT suggest that this approach is far more effective than the traditional management of being manipulated, mobilised or exercised. It has been shown to significantly reduce peoples levels of pain, disability and fear of movement. It often improves your mood and mental wellbeing. Patients who have had CFT often have less need for ongoing treatments or time off work (source).
Is Cognitive Functional Therapy appropriate for everybody?
CFT can be applied to the majority of back pain. It is most appropriate for people with non specific back pain that is provoked by certain movements, postures or activities (85% of back pain). It is often even more appropriate for the more complex and disabled patients. It is also used successfully for those people with mild to moderate levels of back pain. However, CFT is not for everybody..... there are some patients (less than 15%) who have had a very specific structural cause of lower back pain identified, this approach is still beneficial but may focus on specific structural cause of symptoms aswell as all of the other contributing factors.
Want to learn more?
This video interviews one of the key researchers in CFT, it discusses what cognitive functional therapy actually is and the significant effects it can have....
The Consortium clinic believes strongly in the use of the CFT approach for lower back pain. Should you wish to discuss with one of our clinicians then please contact our enquiries line on 01482 847705. We can always schedule one of our spinal specialists to ring you if needed. Alternatively you can email us at firstname.lastname@example.org
Changing your chair to an often more expensive 'back friendly' one is a traditional tactic in trying to tackle lower back pain. Chair type and sitting posture is a topic that patients frequently ask us about during consultations. There is no doubt that office based jobs that involve prolonged periods of sitting can be known to commonly aggravate preexisting lower back pain (source). However... interestingly... it seems highly unlikely that occupation roles involving prolonged sitting are actually an independent cause of lower back pain! (source)
Should we recommend special chairs? Are you wasting money? What does the research say?
Use of chairs with lumbar supports
There is mixed opinion on the use of lumbar supports. Some studies have found that chairs with lumbar supports provide relief (source). Others have found that using a back support reduces muscle tension (source). Other authors have reviewed the literature and decided that there is little evidence to support modifying chairs to reduce lower back pain (source).
What about chairs that create tiny movements in your back as you are sitting?
This is generally referred to as dynamic sitting. There is some support for using dynamic sitting (source) to help promote micro movements in the spine while sat e.g using gym balls and also using kneeling stools (source) to promote more extension of your back whilst sat. However... some argue that while these types of seats may reduce back pain they often create symptoms elsewhere in your body. There are also conflicting reports as to whether spinal muscle activity is either increased or decreased.
So.., obviously a mixed bag of opinions and outcomes...
So what do we recommend you should believe and what should you actually do?
Interestingly...if you read the studies mentioned/referenced so far it is clear that they have many limitations! Perhaps the most common criticism we can make is that the researchers seem to only trial the use of one particular chair for all types of back pain. When we assess people's spines in the clinic each one can be very different. Some have flat/straight backed postures, others have over exaggerated curves. We would treat each type of back pain with different types of physiotherapy, so why don’t we apply this same principle to picking chair types? Surely there should be types of chairs that suit certain types of spine!
One of the most recent papers looking at this specifically is by Mary O’Keefe and her team in 2013 (source). They looked at trying two different types of chair on one particular sub group of back pain patients (people whose symptoms were worse with bending and better with straightening). The first chair they trialled was a traditional office chair with supportive back rest keeping you relatively still (type of chair you would get through your occupation heath dept). The second chair however was one that sloped forwards providing a small dynamic element and a straighter spine when sitting. Interestingly... this group of back pain patients experienced significantly less pain when sitting on the sloping chair. This essentially means that those with worse back pain in bending are better sat with a chair tilted forward in order to increase their extension (arching of their spine) and that for those whom have pain that is worse when they extend (arch) their spines will be better sat in a chair promoting a bent/slumped posture.
Perhaps the main lesson we can learn from this is that there may be some value in investing in specifically designed chairs...but...only ones that are matched to your spinal type. the current approach in occupational health departments seems to look only for a generic norm, assuming all spines and symptoms are the same... it is unlikely therefore that this will work .
You may be best to seek a spinal assessment from a physiotherapist or medic that can match your back type to a certain chair type and work out what is best for you. It is also widely acknowledged that lower back pain has a variety of underlying components. Simply addressing the mechanics of sitting on its own is likely to only effect a small proportion of the underlying causes of most people’s back pain. It is therefore likely that looking at sitting postures in isolation will never really be an effective measure.
If you think this article will be of use to people you know then please share and follow our facebook page. Our main aim as a clinic is to provide you with the highest levels of evidence based care that we can. This is why we read and continue to bring you heavily referenced articles to help you stay healthy!
Thanks for reading
The Consortium Team