Physical Therapy: the logical approach to SI pain

Physical manipulation and mobilisation, especially together with exercise, have been shown to offer the best approach to treating low back pain.

Treating back painResearch by the Medical Research Council

Back Pain Exercise and Manipulation
“shows convincingly that both manipulation alone and manipulation followed by exercise provide cost effective solutions to best (back) care in general practice”

British Medical Journal 2004

As with any profession, the standard of treatment you receive can vary greatly. The number of letters after the names often means little.

In deciding who to see we suggest three golden rules to follow:

  1. Consult a Professional Clinician. In practice this means
    • a Registered Chiropractor. By law, they must be registered with the General Chiropractic Council.
    • a Registered Osteopath. By law, they must be registered with the General Osteopathic Council.
    • a Chartered Physiotherapist. They should be registered with the OCPPP (Organisation of Chartered Physiotherapists in Private Practice)

    These are the only people (other than specialist doctors) who are qualified to carry out a complete physical examination and diagnosis. There are many other therapists who can help to some extent. Be aware their education may be patchy and approach limited. Rather like seeing a dentist, we suggest you stick to the professionals.

  2. Consult a professional who comes with good personal recommendation, especially from your GP or practice nurse. Most registered or chartered health clinicians are professional, honest and competent, but there will always be a few exceptions for whom your wallet is more important than your health.

    Look for :
    • Widespread word of mouth recommendation
    • Clean professional premises with receptionist, essential for female patients seeing male practitioners
    • Detailed history taking and examination.
    • Clear, detailed explanation of diagnosis and plan of treatment / costs.
    • Concise stretch and exercise advice.

    Avoid :
    • Being frightened into an expensive long term plan of treatment, especially paying for treatment “up front”.
    • Being swung along….if you are not making measurable progress after 6-8 visits, get a second opinion elsewhere.
    • Unwillingness to review or discuss your progress honestly and openly.
    • Arrogance, scruffiness, lack of attention, failure to keep progress notes.
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  3. Don`t just put up with it. If your doctor or chosen practitioner can`t make the improvement you need, see someone else. Your health is the most important thing you have. A good practitioner would never be offended by this, a poor one will be defensive.

Other Approaches of treating lower back pain

Acupuncture: Although not a physical therapy, acupuncture can be very useful, and has helped a great many people. Again, many individuals have excellent, professional training, but for every one of these there are others with very patchy education indeed. Never be afraid to ask for details of qualifications and experience.

Exercise: gentle, low impact exercise, eg Yoga, Pilates, is always a good idea. However, it makes sense to get your back and pelvis loosened, aligned and fully functional before doing more strenuous exercise.

Surgery & Joint Injections: For sacroiliac syndrome, there is little evidence of success using these approaches. If suggested, read widely on this subject and always seek a second opinion.

Drugs & pharmaceuticals: Short term use of pain killers and anti-inflammatories is a good idea and can be helpful during a course of physical treatment. Their use in the long term has to be questioned.

Supplements: In a perfect world there would be little debate on this subject but with modern diet and lifestyle, there are few of us who don`t take a vitamin, mineral or dietary supplement from time to time. Glucosamine has been the subject of much research. At least two clinically controlled trials have shown significant benefits. None have shown any adverse effects. Taking glucosamine, especially formulations including chondroitin, MSM & associated vitamins would appear to be an inexpensive and potentially helpful option.

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