Osteopathy for Back Pain

Osteopathy treats back pain with a combination of conventional medical treatments and spinal manipulation. Osteopathic manipulation techniques (OMTs) are particularly well suited for treating common causes of back pain.

Osteopathic manipulation techniques (OMTs) for back pain are often used in combination with:

• Pain medications
• Muscle relaxants
• Spinal injections with steroids, morphine or other agents
• Electrical stimulation of the spinal cord
• Surgery to repair damaged muscle or tissue

What types of back pain are treated with Osteopathy?

At least 80 percent of people in the industrialized world suffer from occasional back pain and an estimated 50 million Americans endure chronic back pain. Back injuries account for 33 percent of all disability costs in the United States and acute low back pain is the most common cause of disability in people under age 45. Low back pain is also one of the most common reasons for visits to osteopathic physicians (Doctors of Osteopathy, DO).

Nearly half of all visits to primary-care physicians and specialists for low back pain involve spinal manipulation by osteopaths or chiropractors. In addition to treating acute low back pain, osteopathy can be effective for treating back pain resulting from strains, sprains, and other injuries, and conditions such as scoliosis—a sideways curvature of the spine.

How Does Osteopathy Treat Back Pain?

Using their hands, osteopaths examine the back and other parts of the body to identify sources of pain and restricted movement that may indicate injury or impaired function.

Osteopathy aims to relieve back pain by:

• Stretching the muscles and supporting ligaments of the back
• Relaxing muscle spasms
• Restoring normal mechanics to the vertebrae of the back
• Promoting free movement of the musculo-skeletal system
• Improving blood flow and drainage

An osteopath may also advise a patient on techniques for avoiding and relieving back pain, including:

• Proper posture
• Exercise and stretching
• Diet
• Stress management
• Proper lifting techniques
• Workplace ergonomics

What Osteopathic Manipulation Techniques (OMTs) Are Used For Back Pain?

Most back pain originates in the muscles, ligaments, or joints of the back. Direct osteopathic manipulation techniques (OMTs) move the tight or painful tissues toward the area of tightness or restricted movement. Indirect OMTs move the tissue away from the area of restricted movement. The tissue is held there until the muscle relaxes. Most OMTs for back pain take 2-6 minutes to perform.

A high-velocity low-amplitude (HVLA) thrust is the most common osteopathic manipulation for back pain. It is commonly performed to correct misalignment in the spine by decompressing the joints of the spinal vertebrae. After identifying the dysfunctional vertebrae, the osteopath locks the facet joints. These are the hinges that join the vertebrae together at the back of the spine and allow the spinal column to move. By locking them, the osteopath prevents any spinal movement other than that of the affected vertebrae. A quick, short, sharp thrust is directed at the involved vertebrae in the direction of the restricted movement. Indirect HVLA is delivered through the locked vertebral column. A direct or short-lever high-velocity low-amplitude (HVLA) thrust is delivered directly to the affected vertebrae.

Osteopathy treatment for back pain may include:

• Massage
• Gentle release techniques
• Soft tissue techniques that apply rhythmic stretching, deep pressure and traction to the muscles around the spine to promote elasticity and motion
• Myofascial release techniques that apply sustained pressure to tight muscles and connective tissue to eliminate pain and restore motion
• Muscle energy techniques that involve the patient in actively stretching and relaxing muscles against a counterforce applied by the osteopath
• Articulation or repetitive oscillatory movements to stretch connective tissue around a restricted joint and improve range-of-motion
• Rhythmic, passive joint mobilization--slow movements within or at the limit of the joint’s range-of-motion
• Joint manipulation - high-velocity thrusts to a joint, moving it beyond its restricted range-of-motion
• Counterstrain techniques for acute injuries, in which the patient is moved away from the restricted position toward one of greater comfort

Is Osteopathy Safe?

Serious complications from osteopathy for back pain are rare. Osteopathic manipulation techniques (OMTs) occasionally result in a temporary increase in pain or soreness that usually disappears within one day. Although direct techniques are usually more effective at eliminating pain than indirect manipulations, they do have a greater potential for complications.

Osteopathic manipulations should not be used on patients with:

• Broken or dislocated bones
• Damaged ligaments
• Bone or joint infection
• Spinal fusion
• Bone cancer
• Osteoporosis

Osteopathy is usually not recommended for patients who have undergone recent joint surgery or are taking blood-thinning medications such as aspirin or warfarin (Coumadin).

Is Osteopathy Effective For Back Pain?

Osteopathic manipulation techniques (OMTs) for back pain are believed to work by:

• Reducing bulging discs--the elastic structures between the vertebrae—and correcting the internal displacement of disc fragments
• Freeing adhesions around a prolapsed disk
• Inhibiting transmission of nerve impulses
• Relaxing tense muscles by sudden stretching

The clinical guidelines of the U.S. Agency for Healthcare Research and Quality indicate that spinal manipulation may be helpful for acute low back pain if used within the first month of symptoms. They recommend discontinuing the manipulation if symptoms and functioning do not improve after one month of treatment, although further treatment is not considered to be dangerous.

Three major studies of Osteopathic manipulation techniques (OMTs) for low back pain have reported some benefits and less use of medications and physical therapy. Other recent studies have found that OMTs are as effective as other medical treatments for relieving low back pain. However most studies on spinal manipulation have been performed by chiropractors or physical therapists and may not accurately reflect the results of manipulations performed by osteopaths.