Low Back Pain

Our Approach

As with any condition, the management of spinal pain is much more effective when it is dealt with by a group of experts pooling their knowledge and working together in what we call a multi-disciplinary team or MDT. The Good Physio utilises a trusted network of specialists in this area to provide advanced level Physiotherapy as well as Cognitive Behavioural Therapy (CBT), Clinical Psychology, Sleep Behavioural Therapy and Medical & Orthopaedic Management.

At the centre of our approach is a management framework known as the biopsychosocial model. It has become accepted as the most modern and science based approach for the management of pain and illness and, despite this often being neglected in mainstream clinical practice, at The Good Physio it is at the heart of everything we do.

Please scroll down to read more. It is very likely that you have not fully addressed the issues that we can cover for you. Call for an appointment or simply get in touch to ask questions; we are more than happy to call you back and are likely to have the answers that can empower you to get your life back.

Accurate Diagnosis

Firstly, it is really important to understand what is actually causing pain. There is increasing evidence that, contrary to what most of us would think, tissue quality has actually got relatively little to do with pain in most instances. The vast majority of patients do not describe a traumatic onset to their pain suggesting that tissue damage is probably not such an important consideration. Think about it - even if you fractured a bone in your leg, it would be healed and that person back running around happily after 3 months; so why do so many people have spinal pain that goes on and on, completely defying any reasonable timescales for mother nature and healing, even if there was a traumatic onset? Having x-rays and scans of your spine may be important in a very small number of cases (less than 1%) in order to rule out serious medical pathology or illness as a cause of pain. However, the vast majority of the time, MRI, for example, will find things that are ‘wrong’ in populations who have no pain at all. For example, 80% of people aged 50 who do not have back pain will still have “disc degeneration” and around 60% of them will also have “significant disc bulges”. These are people without pain so clearly there is much more to accurate diagnosis than just looking at pictures.

This is not to say that tissue quality, and stiffness, has no role to play at all but, as with any pain, it is the brain that ‘weighs the world’ given all the information it can access (not just sensory input from a spinal disc, for example) and decides if, at any given moment and in any given situation, pain is needed or useful. It does this if the overall perception is one of threat and protection from that threat is therefore a good idea. That is, after all, the whole point of pain; it is the alarm system that enables us to become aware of potential harm to ourselves. It is unpleasant enough to grab our attention so that we stop and evaluate what is going on. It does not actually matter if there is actually any credible threat of harm or not; it is enough just to believe that there is.

Pain Education

Good quality research is now showing that, even without everything else we can help with, modern Pain Education significantly helps most patients with chronic pain conditions.

A huge part of starting to feel better involves really understanding why we feel pain and what pain actually represents. We will take you through all the common myths and misconceptions that you may have developed and help you to re-conceptualise things in a much more accurate, healthy and helpful way.

The Biopsychosocial Model of Pain

The biopsychosocial model provides us with a much better understanding of pain (and illness) and has become accepted as the most modern and effective way to approach all patients, especially those with more chronic problems. This framework teaches us that pain should no longer viewed as an inevitable set response to nerve endings being stimulated in the part of our body that we feel is hurting. Instead, pain is a highly variable brain output, designed to protect us from harm, and is modulated all through the nervous system including the brain itself. It is influenced by our thoughts, beliefs, past experiences and emotions as well as social context (how it affects our social networks, family life and career performance). Particularly as it becomes more chronic, pain has increasingly little to do with tissue quality at all and more and more to do with these psychosocial factors which encourage the brain to produce more pain in a continued attempt to protect us from ‘perceived’ threat. With chronic pain, the brain learns to become overly protective, something that is not at all helpful if, in reality, there really is no real threat of damage to oneself.

The good news is that we are now really starting to understand how best to manage more chronic or persistent pain conditions without resorting to long term dependence on pain killers and invasive procedures.

Cognitive Behavioural Therapy (CBT) & Mental Well-Being

Research demonstrates that, even on its own, CBT is at least as effective as spinal surgery for chronic back pain and, in patients with depression, at least as effective as commonly prescribed anti-depressants. CBT principles filter into everything we do so that our patients evolve a better understanding of their bodies and how they interact with the world. This can be thought of as ‘psychologically informed’ treatment.

Sometimes, patients have quite ingrained mental health disorders such as major depression that accompany conditions such as chronic back pain and migraine. In these more complex patient scenarios, it would be much more appropriate to have a consultation with a Clinical Psychologist, someone who specialises first and foremost in treating mental health problems, and we will organise this for you where needed with one of our expert colleagues.

Movement Assessment & Specialist Exercise Rehabilitation

When our bodies move, they do so with varying degrees of efficiency. Unfortunately, our modern lifestyles often encourage us to hold ourselves and to move quite inefficiently. ‘Sub-optimal’ movement habits will inevitably end up creating a greater volume of sensory input for the brain to have to interpret. For a great many people, as well as often misinterpreting these signals, we also help to create a more intense pain experience than might otherwise be the case if we could learn to move more efficiently and therefore reduce the volume of sensory input for the brain to evaluate.

With the right approach, patients who learn to move more optimally can often decrease pain levels very quickly, even when they have had really chronic spinal pain for many years or even decades. With exercise therapy, it is not as simple as just doing more. As with many things in life, it is often not what we do but how we do it that is really important. The Good Physio specialises in this kind of movement rehabilitation.

Manual Therapy & Cognitive Functional Therapy (CFT)

Whilst we understand that, ultimately, movement is the key ingredient in restoring normal sensory processing again in patients with chronic pain, manual therapy can be a really useful tool to get people able to move again. Manual therapy refers not just to the more passive ‘hands on’ treatment such as massage and manipulation but also to any techniques that can be applied through physical means to assist movement and, importantly, to encourage more optimal or efficient movement strategies. Applied in the right way, they can provide immediate symptom relief or significant symptom reduction and create a window of opportunity for many patients to then be able to start moving more freely again. Really good quality research looking at patients with many years of chronic back pain, has demonstrated immediate reduction in pain levels achieved simply by the researchers encouraging more efficient movement patterns. Left alone, patients in pain will often adopt compensatory movement patterns that, instead of helping their pain, actually reinforce their problems and are termed ‘maladaptive’. Their bodies are just not quite sure how to get into more comfortable postures and patterns of movement and this is likely to be encouraged by negative thoughts where patients associate on-going pain with more damage or harm. With education and the right encouragement, they can be shown how to move effectively and comfortably again and, importantly, re-conceptualise ideas they may have developed about pain that reinforce negative thoughts and behaviours such as fear of the perceived consequences of pain and the tendency to avoid movement, the very thing that ultimately would have helped them to restore more normal sensory processing.

Current research is starting to show just how effective CFT, is in managing patients with persistent pain conditions such as back and neck pain.

Medical Management

There are a small number of patients who present in clinic with serious underlying medical reasons for their pain. Although this only amounts to around 1-2% of back pain cases, for example, when you consider that 90% of us will have back pain at some point through our lives, this does represent a great many people with possible serious medical pathology as the cause of their symptoms and must not be overlooked. Thorough screening and, where indicated, scans and blood tests are vital for anyone who’s medical history gives cause for suspicion to avoid missing potentially life threatening illness or conditions that may result in long term disability. The Good Physio group has trusted colleagues in Spinal Surgery, Neurology and Medical Pain Management who can provide these services.

Despite their best efforts, some patients with persistent pain are just unable to improve their symptoms without more invasive medical interventions. Doctors who specialise in Pain Management are able to advise on the best types of medication to help your specific type of pain as well as administer injections and other interventions such as spinal cord stimulation to help manage this small group of patients with more stubborn pain conditions. Whilst this is not usually a permanent solution, it can often improve quality of life and also, for many patients, provide a significant ‘window’ of at least some pain relief where they are then able to concentrate more effectively on the non-medical strategies that will hopefully provide longer terms solutions.

Sleep Behaviour & Other Lifestyle Interventions

It should not be under-estimated just how much positive impact good sleep quality has on pretty much every single part of our physical and mental well-being including immune system and metabolic functions, both of which relate to chronic pain such as back pain, IBS and headaches. Research clearly shows that even one night of sleep deprivation significantly lowers pain thresholds. So just imagine what it does when pain stops us from getting good quality sleep for months or even years as it does for many chronic pain sufferers.

An easy way to assess if you are getting good enough quality sleep it to simply ask yourself, “do you wake up feeling refreshed?” If the answer is “no”, even if you have had a good amount of time apparently asleep, it is likely that poor sleep quality is exacerbating your pain levels as well as your general health. ‘Sleep Hygiene’ or ‘Sleep Behavioural Modification’ refers to some simple and practical routines that you can implement for improving sleep quality and subsequently on pain levels and general well-being.

Other lifestyle habits that relate to chronic back pain include nutrition, general exercise and promotion of general well-being.