Services · Lower back pain & sciatica
Lower back pain and sciatica
The short answer
Most lower back pain is mechanical and does not need a scan. Osteopathic treatment alongside a specific exercise plan is a reasonable first step if the pain is movement-related and you have none of the warning signs below. If an approach is not helping, we will say so and change it or refer you on, rather than keep booking you in.
What causes lower back pain?
In the large majority of cases no single structure is to blame. Pain comes from a combination of load, position and time, a joint that hasn't moved much all week, muscles holding one posture for eight hours, a lift performed at the end of a long day. Imaging routinely shows the same changes in people with no pain at all, which is why we spend the first part of an appointment watching how you move rather than reaching for a scan.
The patterns we see most often at Wantirna Road:
- Sustained desk posture, pain that builds through the day and eases with movement. Common among the office workers who make up much of our Ringwood caseload.
- A single loading event, bending, lifting or twisting, often something trivial that happened to land at the wrong moment.
- Deconditioning after a break, returning to running, the gym or the garden after time off.
- Referred leg pain (sciatica), where a nerve root is irritated and pain, pins and needles or weakness travel below the knee.
Will it get better on its own?
Often, yes. Plenty of episodes settle without any treatment at all, which is a fair reason to be sceptical of anybody promising a long course of care.
Treatment is aimed at easing the painful stretch and getting you moving.
The episodes that don't settle by themselves tend to be the ones where pain has been there a long time, where there is leg pain below the knee, or where fear of moving has led to weeks of guarding. Those are worth seeing someone about rather than waiting out.
What does treatment involve?
A first appointment runs 45 minutes. Around fifteen of those are history and examination, how it started, what makes it worse, how you move, and a neurological screen if there is any leg symptom. The rest is treatment: soft tissue work, articulation of the joints that aren't moving well, and manipulation where it is appropriate and you are comfortable with it. You leave with two or three specific exercises, not a photocopied sheet of twelve.
Subsequent visits shift steadily towards what you are doing between appointments. If you aren't doing the exercises, tell us. We would rather rebuild the plan around something you will actually do than keep prescribing one you won't.
Three things a long time in practice has taught us
Between us we have been treating backs since 1997 and 2004. Some of what that changes is technical. Most of it is not.
- The people who recover best are rarely the ones who rest most. Movement, modified around what hurts, is what the evidence supports over waiting it out. A short spell of relative rest is sometimes sensible. A long one almost never is.
- Fear does more damage than the injury in a lot of persistent cases. Being told your spine is "crumbling" or "unstable" by someone reading a scan report can set a recovery back. We are careful about the words we use for that reason.
- The second episode is more preventable than the first. Much of what we do, once the pain has started to ease, is aimed at that, and it is the part patients most often skip.
None of this is unique to us, it is where the evidence has been heading. It is simply what we have watched happen in this room.
How many visits will I need?
We give the number of visits at the start. Not at the end, and not one visit at a time. Where we can't estimate it honestly, and sometimes we can't, we say that instead of picking a figure.
When this is not a job for an osteopath
Please book with a GP, or go to an emergency department, rather than with us, if any of the following apply:
- Loss of bladder or bowel control, or numbness in the saddle area between the legs. This is an emergency.
- Weakness in a leg that is progressively worsening over days.
- Back pain with unexplained weight loss, fever, or pain that is worse at night and unrelated to position.
- A history of cancer, or long-term corticosteroid use, with new back pain.
- Significant trauma, a fall from height, a car accident.
If any of these apply, see a GP or go to an emergency department first. The symptom check asks about the most serious warning signs, but it does not cover everything.
Exercises we commonly prescribe for this
Pulled from the library. Which of these you get, at what dose and in what order depends on your assessment, this is what the shortlist usually looks like, not a plan for you.
Common questions
Do I need a referral from my GP?
No. Osteopaths are primary contact practitioners in Australia, you can book directly. A referral is needed for a Medicare GP Chronic Condition Management Plan, which covers up to five allied health services a year for eligible patients with a chronic condition.
Do I need a scan first?
Almost certainly not. For uncomplicated mechanical back pain, imaging can draw attention to findings that were never the problem. If your examination suggests a scan would change our approach, we will refer you for one and say why.
Will it hurt?
Treatment shouldn't be painful, though some soft tissue work is uncomfortable while it is happening and it is normal to feel tender for a day afterwards. If anything hurts during a treatment, say so straight away and we will change what we're doing. You never have to sit through something you don't want.
What should I wear?
Something you can move in, shorts or leggings and a t-shirt are ideal. You will not be asked to undress beyond what is needed to examine the area, and you are welcome to bring someone into the room with you.
Can I claim it on private health?
Yes, with extras cover that includes osteopathy. We claim through HICAPS at the desk so you only pay the gap.
What if it doesn't work?
If an approach is not helping, we say so and change the plan or refer you on, to a GP, a sports physician, or another discipline. That is a standing rule rather than a judgement we make case by case, and it applies whether or not you raise it.