Without doubt the most frequent kind of problem with which I am asked to deal is pain coming from the spine. This can manifest as pain in the areas near the spine (the back and the neck) or in areas connected to the spine by nerves (frequently the legs, the arms or the thorax and chest). Sometimes there are other, associated symptoms in these connected areas, like tingling, pins and needles or numbness.

My approach to these problems is based on an osteopathic view of health and illness. It follows that it differs in fundamental ways from the usual approach of orthodox medicine or physiotherapy.

The medical approach to spinal pain

As medicine is generally practised it:

• Allows little time for the doctor to spend talking to and examining the patient.
• Aims to identify a distinct pathological cause (i.e. a “disease”).
• Makes frequent use of x-rays, scans and blood tests to do this.
• Tends to regard the painful or diseased part in isolation.
• Uses the principal strategy of suppressing symptoms.
• Relies on drugs as first line treatment, physiotherapy as second line, surgery as third line.
• Physiotherapy reflects these characteristics of the medical approach.

My approach to spinal pain

In contrast, as an osteopath, I:

• Allow as much time as is necessary for talking to and examining the patient.
• Am more interested in why you have become unwell than in the name of your disease. Generally the kind of treatment you receive is not greatly affected by your medical “diagnosis”. It is determined much more by how your body is working mechanically, the factors in your life which are preventing you from getting better, and your general state of health.
• Find only secondary and relative value in x-rays, scans and blood tests. That is because in most cases of uncomplicated spinal pain, they are not relevant to your treatment or management.
• Try to relate your problem to what is happening in your whole body, your mind, and your life.
• Believe that suppressing symptoms can cause bigger problems (symptoms are often a necessary part of the body’s healing response), preferring instead to remove any obstacles to healing.
• Rely on manual treatment, lifestyle changes and counselling: this is usually sufficient and complete treatment.

A complex system

The spine is not just a column of bones. It could be likened to an extremely sophisticated robotic machine controlled by extremely sophisticated computer circuitry. There is immense potential for glitches in its workings even with no sign of anything that might be labelled medically as a “disease”. Osteopaths call such glitches in spinal workings “dysfunction” or sometimes “osteopathic lesions” (an older term).

I use manual treatment to remove or reduce these «glitches», helping the spine to return to as near normal functioning as possible. Clearly, if joint or disk degeneration have significantly altered the basic shape or quality of the tissues of the spine, improvement may take longer or be incomplete. However, moderate improvements in function can turn a painful spine into a largely pain-free one even in the presence of what doctors call “disease” (for example, arthritis, disc hernias, etc.)

Craft, expertise, and modern science

In my experience the osteopathic approach, well practised, is clearly beneficial for patients who suffer from spinal pain. Osteopathy is a craft. I have been learning this craft for nearly three decades, and I am still learning. Nothing that I have learned so far has led me to doubt the basic principles underlying its usefulness as a therapeutic discipline. However, scientific knowledge of the workings of the spine and its problems is constantly expanding. As an expert in the care of patients with spinal problems, I keep myself continually abreast of the most recent research, in order to ensure that I am able to deliver the best care.

Copyright (c) Robert Hale 2022. Photo by Marco Verch, via Flickr. Creative Commons CC BY 2.0 licence.

Robert Hale practises osteopathy in Santa Eulalia, Ibiza.