Low Back Pain

Location, location, location!

As obvious as it might sound – lets first talk about what back pain is…

It’s pain or discomfort felt in the low of the back to the upper buttock. It can radiate down the back of the legs, but essentially it rarely goes below the knee. I write this because quite often patients describe this pain as “sciatica”. Sciatica is very specific to the irritation of the sciatic nerve – please see the article sciatica.


There are many causes of low back pain. We can’t list them all.

A clinician will first need to take a detailed case history and do some tests. Among the list of red-flag conditions they will be ruling out will be:

  • Spinal stenosis
  • Spinal tumours
  • Spinal infection
  • Tuberculosis
  • Spondylolisthesis (forward slippage of the spine)
  • Cauda Equina
  • Fractures
  • Spondylitis

An Osteopath being regulated under a parliamentary act will be skilled and responsible enough to recognise the signs and symptoms for a speedy referral to 1) your general practitioner 2) hospital/walk-in centre 3) private medical providers. This is where an Osteopaths clinical medicine expertise really comes into effect. As is often said – it’s easy to be a technician, but a diagnostician & clinician is a very skilled and highly responsible job. Especially in the resource pressured NHS of today, it is good to have someone on your side that can act as another check and balance; helping you receive prompt and complete care.

Low back pain can refer to any number of structural problems. Muscles are among the easiest to resolve. Identify the muscle; massage, ultrasound, and needle it – hay presto! It’s a bit more involved than that – but in essence that’s what it is.

What Townosteo really specialises and excels in are problems with enthesiopathies. Enthesiopathies are what I regard as “junction problems”. Where ligaments and tendons meet the surface of the bone. Below are 3 diagrams where all the ligaments of the low back are shown. It’s quite involved! We can’t help all the ligaments – because some are unreachable. But thankfully in the majority of cases the ligaments that are damaged are the ones we can affect either directly or indirectly.

Spinal Ligaments

My favourite spinal ligaments to treat are the interspinous, supraspinous, intertransverse and facet joint capsule. By skilfully directly reaching these ligaments, we aim to elicit structural changes to those ligaments. Structural changes that result in more tolerant nerves and stronger structures. We also aim to provide flexibility to some ligaments, because being overly stiff can result in a lessened ability to shock absorb and translate forces.

Disclaimer: the articles are informal writings from the experiences seen in a clinic setting. They are not written for formal publication or academic critique. Nor do the writings reflect the views of Osteopathic Medicine. They are the personal views of the writer, subject to change and correction. They should not be used for diagnosis or treatment. Formal articles, lectures, research and investigations are outside the scope of this intended use. We could write in such a format – but it would be very boring to read for the general public!