The National Institute for Health and Care Excellence, better known as NICE have recently come out with a new set of guidelines on how best to manage lower back pain. Interestingly, some approaches previously recommended are no longer advocated and a new approach to lower back pain is now advised.
As an organisation NICE provides guidelines for doctors, nurses, physiotherapists and other health professionals on how best to care for people with different conditions and needs. Their latest guidelines for Low back pain and sciatica were published on the 30th November 2016 and replace previous advice published in 2009. The aim of NICE guidelines is to help people to get the best possible care and is based on the latest research available.
“Your healthcare provider should know what NICE has said and should provide you with the care advised in the guidelines.” (NICE, 2016)
Most people’s low back pain is described as non-specific, meaning that the pain is not caused by an infection, fracture or disease like cancer. Sciatica is now included in the advice provided for non-specific back pain and refers to pain going down one or both legs. It sometimes causes pins and needles or numbness down the leg. It’s often caused by irritation to your sciatic nerve, causing pain. The sciatic nerve runs from your lower back and pelvis through your buttocks and down to your feet and can be irritated at any point along its course.
In the latest NICE guidelines a programme of exercise is advised as frontline management for lower back pain. A physiotherapist’s role is to advise you on the right kind of exercise for you taking into account your level of pain and mobility and the kind of exercise you prefer. Exercise may include Pilates, Yoga, or specific mobility, strength and conditioning exercises. The important thing is the exercise is right for you and your needs.
In conjunction with exercise NICE also advocates the use of manual therapy – a hands on technique physiotherapists use to mobilise the spine and reduce pain. NICE clearly states that manual therapy should always be accompanied by a programme of exercise.
To summarise the new advice on how lower back pain with or without sciatica should be managed the table below lists in green the treatments it advocates and in red the treatments that should no longer be used.
Table 1. Common treatments for lower back pain – do they get the green light?
|What’s in?||What’s out?|
|Manual Therapy with a programme of exercise- to include manipulation, soft tissue therapy, manual mobilisation.||Electrotherapy (passing an electric current through tissue)|
|Insoles for footwear|
|Back brace or corset|
At Helix Physiotherapy we are experts in delivering custom exercise plans drawing on our knowledge in Pilates and strength and conditioning. Our goal is to arm you with the tools to manage your lower back pain. We can provide you with continual assessment and advice on your technique so that you can be sure you will be carrying out your exercise plan safely and effectively.
You may benefit from manual therapy as part of your treatment session this could include manipulation of the spine, soft tissue therapy and/or mobilisation techniques. Patient’s often report feeling a reduction in pain and an increase in movement following manual therapy and see it as a valuable way to speed up their recovery and get back to doing the things they enjoy.