Lower Back Pain

Lower Back Pain and Lumbar Disorders

Lower back pain is one of the most common reasons for consulting an osteopath. It refers to any pain localised in the lumbar region, that is, the lower part of the back between the last ribs and the pelvis. Lower back pain can be acute (lumbago), subacute or chronic, and it affects a large majority of the population at some point in their lives. Osteopathy offers a manual approach aimed at identifying and treating the mechanical causes of these complaints.

Common Symptoms

Lower back pain can manifest in different ways depending on its origin and severity:

• Localised pain in the lower back — This is the primary symptom. The pain may be dull and constant or sharp and intermittent, worsened by certain movements or postures.
• Stiffness or difficulty moving — Difficulty bending forward, rising from a chair or rotating the trunk. This stiffness is often more pronounced in the morning or after prolonged periods of immobility.
• Pain radiating into the buttock or leg — When lumbar pain is accompanied by radiation into the lower limb, it may indicate sciatica (posterior leg), cruralgia (anterior thigh) or meralgia (lateral thigh). These patterns reflect mechanical nerve irritation.
• Sensation of locking or instability — Some patients describe a feeling of a “locked back” or, conversely, a sense of lumbar instability during certain movements.
• Pain worsened by prolonged sitting or on standing — Sustained sitting increases pressure on the intervertebral discs and lumbar structures, which can aggravate symptoms.

Why Does Lower Back Pain Occur?

Lower back pain rarely results from a single cause. It is most often the consequence of a combination of mechanical, postural and functional factors:

• Poor postural habits — An unsuitable posture at work (prolonged sitting, poorly positioned screen) or in daily life places excessive strain on lumbar structures.
• Pelvic imbalance — Asymmetry of the pelvis, whether functional or structural, alters load distribution on the lumbar spine and can generate abnormal forces.
• Inappropriate sporting activity — Excessive training, incorrect technique or insufficient warm-up can lead to lower back pain in athletes.
• Repetitive strain — Lifting heavy loads, repetitive movements or vibration (prolonged driving) chronically stress the lumbar structures.
• Lack of mobility — Sedentary behaviour leads to weakening of the spinal stabilising muscles and reduced joint mobility, increasing back vulnerability.
• Pregnancy — Postural and hormonal changes associated with pregnancy are a contributing factor to lumbar pain.
• Poorly resolved previous injuries — An old ankle sprain, a fall on the coccyx or past trauma can create compensations that eventually manifest as lower back pain.

Osteopathic Assessment

During the consultation, the osteopath carries out a comprehensive assessment to understand the origin of the lower back pain. The clinical interview covers the history of the pain, circumstances of onset, aggravating and relieving factors, and the patient's medical and injury history.

The physical examination includes a global postural evaluation, mobility tests of the lumbar spine, pelvis, hips and thoracic spine, as well as neurological tests if radiation into the lower limb is reported. This examination allows the osteopath to establish an osteopathic diagnosis and define an appropriate treatment plan.

If the examination reveals signs requiring additional medical opinion (suspected serious pathology, neurological deficit, atypical symptoms), the patient is referred to the appropriate healthcare professional.

Osteopathic Treatment of Lower Back Pain

Osteopathic treatment of lower back pain aims to restore mobility of the involved structures, release muscular tension and re-establish overall mechanical balance. Several types of technique may be employed:

• Manual techniques on the lumbar joints and pelvis — Gentle or structural mobilisations aimed at restoring mobility of the lumbar vertebrae, sacrum and sacroiliac joints.
• Functional techniques to release muscular tension — Work on the paravertebral muscles, quadratus lumborum, psoas and gluteal muscles, which are frequently tense in cases of lower back pain.
• Work on lumbar stability muscles (psoas, transversus) — The iliopsoas plays a major role in the stability of the lumbo-pelvic junction. Its assessment and treatment form an integral part of the management plan.
• Consideration of cervical, thoracic and cranial regions where necessary — The spine functions as a whole. A restriction of mobility at the thoracic or cervical level may have repercussions on the lumbar region.

Global Approach and Referral

The osteopath does not limit treatment to the painful area. The entire body is assessed to identify chains of compensation that may contribute to the lower back pain. Treatment may therefore include work on the lower limbs (ankles, knees, hips), the diaphragm, the rib cage or the cervical spine.

Personalised advice is given at the end of the consultation: strengthening exercises, stretches, ergonomic recommendations for the workstation and guidance on physical activity. If necessary, the patient is referred to a doctor, physiotherapist or other healthcare professional to complement the treatment.

How Many Sessions?

The number of sessions required varies according to the clinical context. For acute lower back pain (lumbago), 1 to 2 sessions are generally sufficient to relieve symptoms and restore mobility. For chronic or recurrent lower back pain, 2 to 3 sessions may be needed, spaced several weeks apart, to address the underlying causes in depth and stabilise the results. Regular follow-up may be recommended for patients with persistent risk factors.

References

• Licciardone JC, Minotti DE, Gatchel RJ, Kearns CM, Singh KP. (2013). Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial. Annals of Family Medicine, 11(2):122-129. PMID 23508598
• Franke H, Franke JD, Fryer G. (2014). Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis. BMC Musculoskeletal Disorders, 15:286. PMID 25175885