Back Pain


Approximately 50 million Americans suffer from back pain, and it is one of the main reasons for visits to the doctor. There are a variety of reasons for back pain, including bad posture, excessive weight, lack of exercise and trauma.

Osteopathic manipulative treatment can be used to alleviate low back pain. Unlike other physicians, Osteopathic physicians use their hands to examine the back, as well as the joints, tendons, ligaments and muscles to test movements and texture to find restrictions and injuries that explain the culprit for the discomfort. In addition to diagnosing, we osteopaths are trained to treat the cause of the pain. Our hands-on skills set us apart from allopathic physicians.

The New England Journal of Medicine published a study in which patients receiving osteopathic manipulative treatment for low back pain needed significantly less medication and physical therapy compared to those who did not receive osteopathic treatment. Although this was a favorable study, it is important to actually diagnose the cause of the pain in order to treat it. With skilled palpation, osteopaths often can tell the difference between back pain caused by a disk versus pain caused by the facet joints. Additionally, it is important to test reflexes and assess for any weakness or other neurologic complications (see Red Flags below).

A website focusing on musculoskeletal disorders published data from several studies regarding the effects of osteopathic manipulative treatments on patients with low back pain. All the trials suggest a significant reduction in pain in patients treated using osteopathic methods. For detailed information regarding these studies, visit BMC Musculoskeletal Disorders.

More information on osteopathic manipulative treatment and its effect on back pain can be found at the American Osteopathic Association (AOA).

The AOA released a comprehensive document with guidelines, some research, and lots of details about how the technique is used. Those interested should navigate to The Journal of the American Osteopathic Association.

Home Treatment of Low Back Pain: The Feldenkrais “Windshield Wiper”

ry this only if it feels ok to lay down on a firm surface (the bed is usually too soft) with knees bent. Remember to raise yourself out of any laying position by log rolling (not twisting) to one side, then push yourself up to sitting position with your hands. Separate the knees hip-width, then gently move the knees to one side and slowly bring the knees back to the midline. Repeat for the other side, paying close attention, and doing it slowly. Attempt to penetrate the area with your thought in order to feel what is going on. The side to side “windshield wiper” movement only needs 10 degrees of rotation to access the L5-S1 joint. Pay careful attention to the smallest muscles closest to the spine and minimize the use of the larger muscles away from the spine and in the hips. This gets your brain to start talking to the tiny postural muscles closest to the spine. These muscles are easily overpowered by dysfunctional movement and posture. They can fatigue and spasm easily, so this movement is not a stretch and its not supposed to get overworked. By building up communication between your brain and the painful, tired, spasmed muscles, these muscles are able to be less guarded, less spasmed and more intelligent in their movements. With just a few gentile repetitions you can get these tiny muscles to unwind and improve circulation.

As you rotate the knees farther to the sides, the rotational movement in the spine goes up the back from L5-S1 to L4-L5, on up to T12-L1. Remember to go slowly. Go only a few degrees to the sides and stop with less rotation than you might expect. Feel for the spinal level being affected.

In order to work the pelvis and sacroiliac joints, a variation of the “windshield wiper” movement is to keep the knees together when you do the side to side. Knees together helps put torsion in the pelvis and can unlock the sacroiliac (SI) joints, and generally feel good in the way it twists the pelvis. When the knees are apart, the pelvis moves more as a unit and it is easier to isolate the lumbar segments.

Another variation on “windshield wiper” is to side bend the lumbar and then rotate to the same side. This will help stretch the quadratus lumborum, paraspinal and spinal muscles on the convex side of the stretch. Fine tune the sidebending to localize the area you want.

Red flags for low back pain:

If you have any of the following, you should get your back pain assessed by a physician and appropriately imaged (often with MRI):

Lumbar MRI T2 – Sagittal

Lumbar MRI T2 – Sagittal

  • History of cancer

  • Unexplained weight loss

  • Immunosuppression

  • Prolonged use of steroids

  • Intravenous drug use

  • Urinary tract infection

  • Pain that is increased or unrelieved by rest

  • Fever

  • Bladder or bowel incontinence

  • Urinary retention (with overflow incontinence)

  • Significant trauma related to age (e.g., fall from height or motor vehicle accident in a young patient, minor fall or heavy lifting in a person with possible osteoporosis)

Physical examination red flags:

  • Saddle anesthesia

  • Loss of anal sphincter tone

  • Major motor weakness in lower extremity

  • Fever

  • Vertebral tenderness

  • Limited spinal motion

  • Neurologic findings persisting more than one month

Complementary, integrative, & alternative therapies for low back pain are nicely review in this brief article from The BMJ.

I generally recommend adequate vitamin D levels, adequate vitamin C intake, good hydration. Never, ever smoke. It dries out the spinal disks and makes people achy and tender all over.

Evidence is strong for the use of chondroitin sulphate, glucosamine, and S-adenosylmethionine (SAMe), but I’ve never really recommended it much. Maybe I should.

I’ve also seen good pain relief with TENS unit stimulation around the painful area. It doesn’t work for everybody.

If you ever take NSAIDs (ibuprofen, naproxen, aspirin, etc.), be certain to take it with food to avoid bleeding stomach ulcers. Never take NSAIDs if you are dehydrated because it will knock out your kidneys.

Acetaminophen (Tylenol) is generally safe up to 3000 mg per day. It is completely different than NSAIDs. Tylenol and NSAIDs can be taken together.

Eric Vanzura