The National Institute of Clinical Excellence provides national guidance and advice to improve health and social care. They updated their guidelines for the assessment and management of low back pain and sciatica in November 2016. Their main recommendations were:
- A group exercise programme (biomechanical, aerobic, mind-body or a combination of approaches) within the NHS for people with a specific episode or flare-up of low back pain with or without sciatica.
- Consider manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage) for managing low back pain with or without sciatica, but only as part of a treatment package including exercise, with or without psychological treatment
- Consider psychological therapies using cognitive behavioural approach for managing low back pain with or without sciatica but only part of a treatment package including exercise, with or without manual therapy (as above).
- Consider a combined physical and psychological approach for people with persistent low back pain or sciatica – particularly when they have significant psychological obstacles to recovery (for example, avoiding normal activities based on inappropriate beliefs about their condition) or when previous treatments have not been effective
- Prescribe oral NSAIDs (Non steroidal anti-inflammatories) for low back pain at the lowest effective dose for the shortest possible period of time and consider weak opiods (with or without paracetemol) for managing acute low back only if an NSAID is not contraindicated, not tolerated or has been ineffective.
- Do not offer opiods for managing chronic low back pain or routinely for acute low back pain
The evidence appears to show that manual therapies, such as osteopathy are worthwhile and effective forms of treatment to improve low back pain with or without sciatica, when combined with exercise therapy. At BOP, as is the case for most osteopathic practices, our osteopaths would generally provide treatment alongside exercise prescription, advice and daily routine advice too. This helps enhance results. The recommendations regarding medication and psychological approaches are also worth consideration. At BOP we firmly believe in assisting both physical and emotional wellbeing and work alongside therapists in-house who can provide this additional treatment, when required.