The pain, violent, located in the lower back, occurs suddenly after a false movement, carrying a load, or simply long hours of sedentary life. The first instinct is often to stay in bed until it passes or to drag yourself to the pharmacy to get a painkiller. Either way, it’s an error. “Several studies have shown that drugs are not very effective in treating lumbago, confirms Dr. Laurent Grange, rheumatologist at the CHU Grenoble-Alpes. Of course, they can help to overcome the first stage of acute pain, but no more.”
The High Health Authority insists that physical activity is the number one asset for recovering faster and avoiding recurrences. “Forcing yourself to straighten up and walk a little limits ankylosis and inflammation”, explains Marc Picard, physiotherapist and author of Get moving, trust your back. There is no miracle solution, 100% effective for all patients, but a wide range of proven resources.
Doctor and physical activity: the essential duo
Prior passage by a general practitioner and/or specialist (rheumatologist, specialist in physical medicine and rehabilitation) is imperative. Only its clinical evaluation can rule out the hypothesis of a symptom linked to a disease. It is also he who, in view of your medical history and your psychosocial context (depression, anxiety, social problems, work-related stress, inappropriate fears and/or beliefs, inappropriate painful behaviors), can assess the risk that the illness becomes chronic and prescribe appropriate treatment. The combination rest/work stoppage + analgesic, still too frequently prescribed to treat common low back pain, should no longer be part of it. If Health Insurance has been campaigning in this direction for two years, it is not fair to preserve its accounts.
Alexandra Roren, rehabilitation manager at Cochin Hospital, specifies that then aerobic physical activity, that is to say practiced at an endurance threshold at which we begin to “burn” sugars (i.e. approximately 30 minutes ), “has also demonstrated, in all pathologies, a global effect on the organism”. It allows you to re-train your cardio-respiratory activity. By activating the secretion of endorphins in the brain, it also improves the mental state.
“Passive” therapies: for occasional relief
A priori attractive, massages and other manipulations can soothe at first, but do not necessarily bring long-term solutions. The HAS is categorical: so-called passive therapies, such as massage or chiropractic, which consist of manipulating the patient without putting him back to exercise, “cannot be used in isolation, because they have no effect on the evolution of low back pain”.
“They can even contribute to its chronicization”, warns Éric Bouthier, physiotherapist, “because they condition to think that the evil is necessarily linked to a single cause, requiring an external intervention, instead of teaching the patient to act himself.
- The massage: pleasant at the time, it only momentarily relieves: “Soon after, the pain will come back , assures Eric Bouthier. If it can intervene in addition to an active physiotherapy session, in adjuvant treatment of pain, there is no proof that massage has long-term effects on the evolution of back pain. »
- Osteopathy: approximately 3 out of 5 French people rely on this complementary medicine. Osteopaths propose to treat all functional disorders, and to restore the overall balance of the body by manipulations which aim to resolve the tensions identified in the tissues surrounding muscles and organs. More than 30,000 osteopaths practice in France. Trained by different schools, they are not necessarily health professionals: in 2018, only 39.6% of them were. Inserm, which devoted a report to osteopathy in 2012, pointed to the insufficient number of reliable comparative studies to assess it. At best, some find it of modest interest, and only when it is added to conventional medical care.
- Chiropractic : the chiropractor claims to be a specialist in the back and treats osteo-articular pain by spinal manipulations. The profession has been recognized since 2002, regulated since 2011, but the intervention of chiropractors, trained by 5 years of standardized studies (only one school in France), is not reimbursed. “They are neither doctors nor from paramedical professions” , warns Pr François Rannou rheumatologist at the Cochin hospital (Paris). In a 2011 evaluation report, Inserm noted the limits of existing studies on the effectiveness of chiropractic, considered at best equivalent to other alternative treatments, in low back pain and neck pain. It also involves risks, rare but serious, of secondary accident after handling.
The physiotherapist: an ally in care
In the event of chronic low back pain or at risk of becoming so, the physiotherapist contributes to the necessary multidisciplinary care, with the rehabilitation doctor, the pain doctor, the occupational doctor and the psychologist. He is a health professional trained by 5 years of study. His intervention – reimbursed if prescribed by a doctor – is resolutely active. He reassures and guides the patient, making him aware of the thoughts or gestures that stand in the way of a good evolution of his condition. In addition, he retrains him for movement and effort, through progressive exercises adapted to each individual.
Read also :
- 9 tips to relieve your back pain on a daily basis
- Why working on a ball will reduce your back pain?
- Back pain: the 6 sports that relieve
