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Back Pain - Help Choosing a Treatment for You

Back Pain - Help Choosing a Treatment for You
In this leaflet we explain some of the causes of back pain, what you can do yourself to help and also how to choose from the many possible complementary therapy options available to help with back pain.

(Note: The contents of this webpage are reproduced from the leaflet available in our clinic. A pdf copy of the leaflet is available by clicking here )

Back pain is a common condition that most people will experience during their lives. Your back is a complicated web of muscles, ligaments, tendons, cartilage and bones. Together these give your back the strength to hold you up, the sensitivity to react to small instabilities when standing or walking, and flexibility. This need for the back to be strong, sensitive and flexible means it is prone to aches and pains.

Anatomy of the Back

Anatomy of the Back

- 24 small bones (vertebrae) that support the weight of your upper body and form a protective canal for the spinal cord.
- Shock-absorbing discs (intervertebral discs) that cushion the bones and allow the spine to bend.
- Ligaments that hold the vertebrae together and tendons to connect muscles to vertebrae and other bones.
- A spinal cord, which carries nerve signals from the brain to the rest of the body.
- Muscles, nerves and fascia (fascia is the layer of tissue that covers the muscles).
Chronic v Acute
Back pain can come on suddenly or gradually, and can last for a long time or just for a day or two. Medically, back pain can be called acute (i.e. short term) or chronic (i.e. long term). If it is acute it may respond more quickly to treatment OR may be an indication of a different and potentially more serious complaint (there is more guidance on this on the back page). Chronic back pain may be due to long term poor posture and therefore could be resolved by changes in posture or lifestyle.
Lower v Upper
Lower back pain affects 7 out of 10 people at some time in their lives. Lower back pain is felt between the bottom of your ribs and the top of your legs. The complex structure of your lower back means that even small amounts of damage to any part of this area can cause a lot of pain and discomfort. Pain in your lower back is usually a symptom of strain or damage to your ligaments, muscles, tendons or discs. Sciatica may be diagnosed if the sciatic nerve is pinched or trapped.

Upper back pain is felt from the ribcage up. The upper spine is very strong and stable which allows it to support the weight of the upper body, as well as anchor the rib cage. Because this section of the spinal column has a great deal of stability and only limited movement, there is less risk of injury to the intervertebral discs

Safety First - Some Key things to Check

Safety First - Some Key things to Check

The most important first step is to check that the back pain is not a symptom of a different complaint. Ask yourself: how did the pain start or is there another condition causing the back pain.

In a number of instances you may need to visit a hospital urgently. If the back pain is acute (has happened recently or suddenly) then you may need to contact NHSDIRECT on 0945 4647 or online via http://www.nhsdirect.nhs.uk for advice.

There is more specific guidance on the back page of this leaflet giving information during 2012 the NHS direct website highlighted as appropriate to call 999.

Why do People Suffer from Back Pain?

There are some specific complaints that can lead directly to back pain.
- Scoliosis - curvature of spine.
- Damage to discs - prolapsed disc (bulging) or herniated disc (ruptured).
- Degenerative ailments - ageing/wear and tear.
- Injury or damage defined by area of body - Lower back (including sciatica) and lumbar pain/ neck pain / upper back (including frozen shoulder). Injuries can occur from a variety of causes: lifting, twisting, carrying things, crashes and falls or even sneezing and coughing!
- Diseases may also lead to back pain such as kidney or bladder ailments, cancer, rheumatoid arthritis or osteoporosis.
- Muscular imbalances, can lead to back pain, with weaker & stronger muscles that should balance each other (antagonist muscles) moving the body "out of shape".
- Skeletal Issues such as having one shorter leg or fallen arches on the feet.

Also lifestyle can play a role in leading to back pain: factors can include excess body weight, high stress and the effects of adrenaline on the body, the way our posture (sitting, standing, sleeping) affects the body.

In some cases you may know what has caused or exacerbated the situation, however, you may also need a diagnosis from your GP or other professional. Usually there is no need for tests such as x-rays or scans as the area is visible or can be assessed by touch.

What You Can Do - Simple Tips

1. Nutrition

Fluid (water) is essential to the functioning of joints. In the intervertebral discs, water is held between molecules that make up the disc and act as the cushioning. Therefore a lack of fluid will be detrimental to the functioning of the discs.

Correct nutrition can help reduce inflammation. For example consuming more anti-inflammatory Omega 3 Fatty Acids (e.g. fish or flax) can reduce inflammation in the body. Similarly taking less meat/dairy reduces the intake of the pro-inflammatory compound, arachidonic acid.

Reduce excess caffeine, sugars, alcohol and tobacco. These substances are used habitually by many, but may have a detrimental effect on overall wellbeing. Caffeine is an adrenal stimulant and will increase muscular tension, tobacco decreases the blood circulation that is vital for muscular and skeletal health, excess sugars may lead to carrying excess body weight which puts more strain on the back (as well as creating a risk of diabetes), and alcohol is actually a depressant which may mean back pain feels worse than it is (more on the role of mood later).

2. Posture and Movement for a Healthy Back

Our backs perform amazing feats and by considering both your posture and movement, you can help maintain a healthy back.
Warm up/warm down. The principles of warm up and warm down are important even for small movements. Warm up / warm down before and after activity and think about moving slowly from rest rather than jumping up. Warning the muscles that movement is coming is part of manual handling courses.
Exercise. Historically for most back pain GPs recommended rest, however, current advice (including NICE (National Institute for Health and Clinical Excellence) Guidelines means gentle exercise is normally recommended. Equally, appropriate exercise can help to ensure a back stays healthy. Your gym or therapist may help recommend a specific program if needed.
Lifting and carrying objects is a significant source of back pain. Always evaluate what you are going to do and try to avoid twisting motions and excessive loads. Carrying unbalanced objects (e.g. handbags or rucksacks) on a single shoulder can also lead to problems.
Stretching as a routine part of life is recommended by many. This can take many forms such as yoga classes, or simply an individual morning, workstation or evening routine. This may be especially useful if you feel excessive tension in the back, shoulders or neck is playing a role. Many people also find heat packs and hot water bottles useful for helping to ease muscle tension, or rubbing/massaging the affected area.
Body awareness is simply listening to what your body is saying to you. Whether it is how you are sitting, how you use laptop computers, computer games or telephone use, or how you carry bags, your body will tell you what feels wrong.
Your Bed. Choosing the right pillow and mattress can be vital. One of the Japanese therapists in the clinic explained that in Japan they have pillow doctors to make sure the right pillow is chosen, showing how important a pillow is.
Footwear - As anyone who wears high heeled shoes a lot will know, choosing the wrong type of footwear can lead to back pain. Specialist advice on shoes or orthotics from a podiatrist may be useful, although simply finding which footwear minimises your discomfort may also help.

3. Attitude

For some people back pain is resolved in a simple manner, however for others it can take more time. For chronic pain cultivating a "Positive Mental Attitude" has been shown to help. Worrying can lead to additional tension, which reduces the bodys ability to heal, and tensed muscles can stop the back moving to its preferred position. Pain management is sometimes the only available option for back pain from the NHS and increasingly this includes painkillers and talking therapies (to help people see perspective on their situation).

What You Can Do - Simple Tips (cont)

4. Some "Conventional" Choices

Often peoples first port of call for a sore back is their GP or pharmacist. Your may be offered painkilling and anti-inflammatory drugs, or physiotherapy or another specialist, however there are a number of natural supplements, therapies and lifestyle choices that may complement these treatments. These are discussed later. Medications may include: anti-inflammatories, painkillers, muscle relaxants, tension relieving medicines, treatments for nerve pain and others. It is possible that surgery may be recommended, if other options have been unsuccessful or if symptoms are getting worse. Your surgeon will explain the risks and you will be the one who makes the decision, so it may be helpful to explore other options, many of which are discussed below.

What You Can Do - Natural Supplements and Treatments

Topical Treatments

Topical creams which contain plants such as arnica (anti-inflammatory) and capsicum (pain killing) may be useful. Heat or cool packs are often found to be useful, hot for spasm, cold for inflammation. Packs should be wrapped in a towel and applied for 20 minutes every 2 or 3 hours to avoid "burning" (hot or cold). One popular technique for pain relief is to use alternating heat and cool packs.

Anti-inflammatory foods, herbs and supplements

The anti-inflammatory omega 3 fats mentioned earlier can be found in oily fish, cod liver oil, flax oil or fish oil supplements. Turmeric is also known to be an anti-inflammatory spice.
Many people take glucosamine for joint pain which could be helpful considering the spine is essentially a series of joints. You may also consider a combined glucosamine and chondroiton supplement. A more recent product, Celadrin appears to have anti-inflammatory properties and may be worth considering. Herbs which have anti-inflammatory properties are also available (e.g. devils claw (Harpagophytum procumbens) and white willow (Salix alba) taken internally were both used traditionally for joint pain. Note: If you have an aspirin allergy white willow should be avoided and devils claw should be avoided by those with stomach or digestive system ulcers.

Pain relieving

There are very good pain relieving plants available, however many of the best natural pain killing plants are often only available after a consultation with a Herbalist. The amino acid supplement DLPA which supports the bodys pain killing mechanisms may also be considered.

Vitamins, Minerals, Amino Acids

There are a wide range of vitamins and minerals that could be useful. 2 classics are the B-vitamins for stress, or magnesium for support with relaxing muscles.

Herbs for Stress, Anxiety etc

You may be able to buy over-the-counter (or after a consultation) herbs such as Passiflora (Passiflora incarnata), Siberian Ginseng (Eleutherococcus senticosus), Valerian (Valeriana officinalis) or others to help with stress and anxiety, helping to maintain a positive attitude to your situation and reduce the effect of stress on the back.

Homeopathic Tablets

Some people have found homeopathic medicines to be useful therefore it may be worth trying some of the over-the-counter options available to see if they suit you.

Support for Weight Loss

For some people weight loss is a viable treatment for back pain, by reducing the stress on the back. If this is the case there is a wide range of natural ways to support weight loss.

What we can do - Choosing a Therapy

With the wide range of therapies available, it can be difficult to find the right one. In the section below we outline some of the options available at Woodland Herbs.

Choosing a Therapy - FAQs

Q: Which therapy is best?
It has been estimated that there are more than 200 different treatment options for back pain. Some of these are well-established and well researched while others are more experimental and less mainstream. When having to decide what treatment to try, you may want to ask yourself the following questions:
1. Is there any scientific evidence that shows the treatment is effective & safe?
2. Is the therapist registered with a governing/regulatory body?
3. What are the possible benefits, the possible risks and the costs of the treatment?
When making a decision you will have to weigh these three.

4. Is the treatment on offer appropriate for my condition and circumstances?
5. Can you get information and advice on the treatment on offer from multiple sources, speak to the therapist, or speak to people who have had treatment.

We provide information to answer some of these questions for some therapies available at Woodland Herbs in the next section, however as everyones situation is unique it is not possible to give specific individual guidance in this leaflet.

Q: How many treatments?
Most therapists believe they can help in many situations, however they would need to get "hands on" to assess and this will require a full first visit. After the first consultation and treatment it is possible that you will need 1 or 2 further sessions to be able to assess if you are responding to the treatment. It may be that 1,2 or 3 sessions are enough to resolve the situation, however it is also possible that once the therapist has identified how you are responding to treatment, they will be able to give guidance on how they believe you will progress with more treatments or if regular ongoing sessions may be useful .

Q: Can my GP refer to a therapist?
It is difficult for GPs to recommend treatments as they would become accountable for the care provided. They are more likely to recommend not having a treatment they feel is inappropriate, OR to be "relaxed" if you wished to try something they didnt object to. GP referral is not needed for any of the therapies at Woodland Herbs although the therapist may ask to contact your GP before treatment in some situations.

Choosing a Therapy - Some Therapies to consider


There are new types of massage treatments being introduced all the time. In our clinic we offer aromatherapy, therapeutic massage, sports massage, hot stone massage, and more. As muscular tension often plays a role in back pain. a massage treatment may be a suitable treatment for many cases of back pain. From the range of massage therapies at Woodland Herbs we would most often suggest booking for a therapeutic massage, rather than one of the other massage options.

Bowen Technique

Bowen therapy was developed by Australian Tom Bowen and is a gentle treatment encouraging realignment of the soft tissue through a series of gentle rolling moves. Unusually, the therapist leaves the room for a few minutes between moves. On returning they assess how the clients body has reacted and continue with treatment.

Acupressure Massage / Shiatsu

Acupressure massage incorporates principles of oriental medicine, including TCM, with the use of pressure points, light manipulation, stretching, exercise and advice on lifestyle and diet. Acupressure massage can be gentle or vigorous depending on the clients needs and options available include shiatsu massage.

Alexander Technique

Consider taking a series of Alexander technique lessons to learn how to use your body in a more efficient way and to improve posture. It is now recommended for back pain by NICE in England & Wales.

Manual Lymph Drainage (MLD)

MLD is useful if there is a lot of inflammation/swelling, especially if those areas didnt responded well to massage/other treatments, or if massage causes muscle spasm.

Medical Herbalism

A medical herbalist may be able to treat a range of condition by prescribing herbs for pain management, topical or internal anti-inflammatory herbs as well as herbs which support mood/stress as appropriate.

Other Possible Therapy Options

- Acupuncture - a system using needles based on Traditional Chinese Medicine principles. - Reiki - a hands off "energetic" treatment.
- CBT /Hypnotherapy - part of the healthy mind approach to back pain.
- Myofascial Work - this is often a part of the treatments of more experienced therapists who have completed further studies. E.g. in our clinic the Bowen, MLD and some massage therapists have studied this further. Likewise, trigger point is a technique that some therapists use within treatment sessions.

3 other things your therapist may suggest

- Pilates, exercise classes, yoga, swimming etc: as discussed earlier, movement and exercise can help reduce back pain or may support a healthy back. Remember to start slowly/gently!
- Podiatry - focusing on your feet/footwear to help your posture. Normally available through your GP or NHS (available by self-referring).
- Physiotherapy(or as an alternative Osteopathy/Chiropractic) - You may be referred to physiotherapy within the NHS (or you may also self-refer to an NHS physiotherapist). Due to budget restrictions if you are seen through the NHS, treatment is likely to focus on exercise and self-stretching, rather than hands on treatment. More extensive treatment may sometimes be provided.


Back pain can be debilitating; but there is a range of ways to reduce your risk, or to self-manage or treat the condition. A wide range of therapies are available at Woodland Herbs that may also help.


Important note:

Important note:

This leaflet is intended for educational purposes only. If you suspect you suffer from any of the conditions mentioned, we recommend you consult a medical professional before self treating. If you are pregnant, breastfeeding or taking prescribed medication, please see a qualified practitioner.
Safety First - Some Key things to Check The most important first step is to check that the back pain is not a symptom of a different complaint. Ask yourself: how did the pain start or is there another condition causing the back pain. In a number of instances you may need to visit a hospital urgently. If the back pain is acute (has happened recently or suddenly) then you may need to contact NHSDIRECT on 0945 4647 or online via http://www.nhsdirect.nhs.uk for advice. During 2012 the NHS direct website highlighted the following as appropriate to call 999.
If you are experiencing any of the following:
severe pain in your abdomen (tummy) that seems to be:

i. moving down your legs,
ii. towards your back, or
iii. from your back towards your abdomen,
- a pulsating sensation (like a heartbeat) in your abdomen (tummy),
- pain in your chest, shoulder, arm or jaw, or
- pain that feels like it is ripping or tearing along your back bone?
For Upper Back Pain
- If you have had a heart attack before, is the pain similar?
Or are you:
- experiencing a severe pain in your chest, back, shoulder, arm or jaw, - so short of breath that you are unable to talk in sentences, or - turning blue or pale around your lips or at your nail beds?For Lower Back Pain
- experiencing a new and sudden difficulty in moving your legs, feet, arms, or hands,
- experiencing tingling or pins and needles in your legs, feet, arms or hands, with a feeling that you have lost strength in your limbs,
- experiencing numbness (loss of feeling) in your legs, feet, arms or hands,
- experiencing numbness around your anus, or
- experiencing a new and sudden loss of control of your bladder or bowels (so that you have no control over when you go to the toilet)?
In addition the following instances may require hospital treatment and NHSDIRECT can advise, whether to see you GP, dial 999 or visit your nearest hospital.
Have you recently:
- had a slip, trip or fall,
- had a blow or injury to your back,
- been lifting heavy weights, or
- been involved in a road traffic accident?
Other situations that may affect what to do will depend on your own circumstances, including previous and current medical history. Please seek further advice for children.