The general population frequently experiences pain in the lumbar region of the spine, with a reported prevalence ranging from 31 % to 64 % (Tunås et al. 2015). Nonspecific low back pain, or chronic low back pain, is characterized by pain with no known specific cause and is the most common form of back pain (Bahr et al. 2004).
Osteopathic treatment for lower back pain is one of the effective solutions used to manage such problems.
Pain in the lumbar spine can significantly impact people's lives. It negatively affects their psychological well-being, reduces motivation, and increases stress and anxiety, while also lowering the quality of life and, in some cases, leading to early retirement (Noormohammadpour et al., 2016).
Risk factors for lower back pain include poor muscle strength and endurance, poor flexibility, poor posture, previous injuries, high stress levels, and anxiety. Age, gender, and body mass index (BMI) also have an impact on it (Hübscher et al., 2010).
Additionally, visceral issues such as constipation, irritable bowel syndrome, gastrointestinal bloating, and bladder or pelvic floor muscle problems can cause lower back pain (Villalta Santos et al. 2019).
Treatment options
Current treatment options for lower back pain often include physical therapy, medication, and surgery. Physiotherapy Maribor is an example where local experts offer solutions to patients with back pain. The most common approaches involve the use of manual techniques, exercises, and physical agents such as: TECAR therapy, high-intensity laser therapy (HILT), focused shockwave therapy, and magnetic field therapy. The combination of physical therapy and osteopathic treatment for lower back pain can yield even better results for patients.
These techniques aim to reduce inflammation and pain, increase mobility, and improve the function of affected areas (Israel 2012). Manual therapy has proven to be one of the most commonly used methods in recent years. It achieves a high rate of recovery while also being cost-effective (Hainline et al. 2017).
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Osteopathy is based on the belief that the body is a single entity and that disturbances in one part of the body can be connected to other body systems. The osteopathic approach is based on the principle that the body can heal itself and that its structure and function are interrelated (McSweeney et al. 2012).
Recently, general interest in osteopathy has been growing, especially in Slovenia. Among other things, researchers have proven a connection between non-specific low back pain and visceral functional or structural issues, such as urinary incontinence, chronic bladder inflammation, polycystic ovaries, breathing disorders, abdominal scars, and gastrointestinal disorders (Bertuit et al., 2021).
Deep anterior fascial line
These connections can be explained by both mechanical and neurological mechanisms. Functional problems of internal organs after surgery or inflammation can cause adhesions, which can affect the mobility of visceral connective tissue, such as fascia. These affect the movement of neighboring somatic tissues or tissues with corresponding spinal innervation (Cervero 2000). The altered elasticity of the fascia negatively affects its ability to absorb forces and provide stability and support.
Mechanical stress due to poor posture or inflammation can alter fascia at the cellular level, which can disrupt spinal biomechanics and cause myofascial pain. In addition, reduced fascial sliding decreases blood and lymph flow, which can hinder the removal of inflammatory substances. The resulting decrease in pH in soft tissues can provoke increased sensitivity of pain receptors to mechanical stimuli, which can cause or worsen pain (Panagopoulos et al. 2013).
The abdominal and pelvic organs are connected to the lumbar spine via connective tissues such as the abdominal mesentery and mesocolon. These connective tissues contain blood vessels, nerves, and lymphatic vessels, and can influence the mobility of somatic tissue near the organs in the area of the corresponding spinal innervation.
This states that the condition of the abdominal and pelvic organs can affect distant body segments via the sympathetic nervous system (Villalta Santos et al. 2019).
Sympathetic nerves, which provide information about internal organs, merge with somatic nerves in the dorsal part of the spinal cord. This convergence can lead to confusion in pain perception, as conscious sensation may be perceived from somatic structures instead of visceral structures, which is known as referred pain.
This mechanism is the best understood way in which altered organ relationships can contribute to a condition such as non-specific low back pain (Panagopoulos et al. 2015).
Innervation of organs by the sympathetic and parasympathetic branches of the autonomic nervous system
When treating a patient, ‘authentic’ osteopathic manipulative treatment (OMT) is used, in which practitioners are recognized as osteopaths or osteopathic physicians and have the option to choose manual techniques. The osteopat determines independently which form of treatment is most appropriate for the individual patient, without the requirement of following standardized treatment protocols. Osteopathic treatment for low back pain allows for the adaptation of each treatment method to the specific needs of the individual, which best represents the practice of osteopathy in the real world.
McSweeney et al. (2012) demonstrated that the application of visceral techniques in healthy individuals increases the pain threshold in related vertebral segments, indicating that visceral manual therapy can immediately induce hypoalgesia in somatic structures that are segmentally connected to the mobilized organ.
Accordingly, Dal Farra et al. (2021) and Licciardone et al. (2016) found that various osteopathic techniques, including spinal mobilization and local soft tissue techniques, effectively reduce pain and improve function in individuals with chronic and acute lower back pain. These results highlight the potential benefits of osteopathic treatment in managing pain and functional issues associated with lower back pain.
Ferreira et al. (2013) found that a combination of physical therapy and osteopathic treatment is more effective at reducing pain and improving function in individuals with nonspecific low back pain than physical therapy alone. The study showed that the group that received the combined treatment achieved greater improvement in pain scores, mobility, and quality of life than the group that received physical therapy alone.
These studies show that both osteopathic treatment and physiotherapy can effectively treat non-specific low back pain, and that a combination of both treatments can offer even better results for patients.
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