What is OAK Backs?

Here at Aneurin Bevan University Health Board we are offering a session called OAK (Options, Advice, Knowledge) Backs which is dedicated to improving the understanding and management of low back pain and related leg symptoms (commonly referred to as sciatica). OAK Back sessions have been developed in collaboration with GP’s, Orthopaedic surgeons, Physiotherapists and people like you, who have low back pain related symptoms.

The 90 minute group session is delivered by specially trained physiotherapists in several community facilities throughout the health board. They offer the opportunity for people who are experiencing low back pain related symptoms to learn more about this common condition, how they can help themselves and what health care professionals can do to help.

We all appreciate that people are different; we enjoy different things and have different goals in our lives. Similarly, low back pain symptoms affects people in different ways, so finding the right treatments or management plans to suit your needs is important.

That is why at OAK we believe you should be at the centre of making the decision about how you want to manage your situation.  We know that people who are involved in these decisions are more likely to engage in treatment and to have a more successful outcome.

OAK Backs is about sharing information and experiences that will help you to make those decisions. We provide up to date, trustworthy information about low back pain, what it is and what it isn’t. We also bring the science, which tells us which of the treatments are safe and effective for management. There is also information about what services are available locally to help you. Importantly, you and others can bring your own experiences, how it affects you and what has or hasn’t been effective in your experiences.

By the end of an OAK session you should have a better understanding of the condition, what matters to you, what you want to do to manage it and how to go about getting any further help you need.

Advice & Education

We know that having up to date reliable information on the medical problem you are dealing with is important and can improve your outcome.  That is why we developed OAK, why these web pages have been produced and why it is important that you read and consider the information and advice provided.  Throughout these pages we have provided other trustworthy resources for you to view and use.

For low back pain and related leg symptoms, prolonged bed rest is not advised, providing no benefit in the long-term and in some can cause a slower recovery.  However, it is recognised that some initial rest after an injury may be unavoidable and appropriate, but aim for no greater than 48 hours and gradually increase your movements and activities.

Pain is often the main reason why people seek help for their back and related leg symptoms.   Getting your pain better controlled in the early phase of low back pain or leg symptoms can be a significant step in the right direction to having a natural recovery and return to your normal.  Pain can often be effectively managed with simple over the counter medications although a discussion with your GP or pharmacist can be important before starting any new medication to ensure it is not harmful for you.

Ibuprofen is a non-steroidal anti-inflammatory and is recommended for low back pain.  However, some people should avoid using ibuprofen and others should use it with caution.  Those with severe heart failure, a history of stomach ulcer, liver disease, asthma, taking aspirin or have had a previous reaction to non-steroidal anti-inflammatory drugs should speak with their GP or pharmacist before starting. Use pain medications as directed on the label or leaflet. Discuss with your GP or pharmacist if you are getting any side-effects or this is not helping after 2 weeks.

Hot/Cold – use hot or cold compression packs for short-term relief – you can buy these from a pharmacy, or a hot water bottle or a bag of frozen vegetables wrapped in a cloth or towel will work just as well. More information can be found on heat and ice treatment.

If you are experiencing persistent leg symptoms related to your low back pain, there can be some medications that can be occasionally helpful for nerve related symptoms such as Amitriptyline / Gabapentin and it may be worthwhile discussing this further with your GP.

The simplest and safest medicines that are effective are encouraged first.  If your pain continues to be distressing, affecting sleep and simple daily tasks, it is advisable to consult with your GP to discuss your pain medication options further.

Manual Therapy

Manual therapy is the common term used to describe ‘hands on’ treatment delivered by a therapist such as a physiotherapist, chiropractor, osteopath, sports therapist and masseur to name a few.  The main treatment approaches are spinal manipulation, mobilisations and massage aimed to reduce pain, improve movement and support function.

The current UK guidelines suggest that these treatments should not occur on their own but form part of a package of care alongside activity and exercise.

All NHS physiotherapist are trained to deliver manual therapy appropriate for your needs and goals. If you wish to consider private treatment make sure the therapist you see is registered with a valid UK governing body.  You can also check whether you are receiving recommended up to date care by asking your therapist whether they are aware and considerate of the National Guidelines on the management of low back pain and sciatica (NICE NG59), and how the treatment plan they have agreed with you reflects this.

The National Institute for Health and Care Excellence (NICE) have produced Information for the public on this topic.

Activity & Exercise

We know that exercise is one of the most powerful tools for helping people to manage many musculoskeletal problems and persistent pain. However for many people with ongoing problems this does not always make sense. You will have read that most cases of low back pain and related leg symptoms are a combination of the interaction between our physical system, our brain and nervous system and our environment.  We know that by being active and exercising, this can condition our anatomical structures (muscles, tendons, bones), improve our physical fitness, manage our thoughts and feelings and allow us to manage the challenges of our environment.

So what do we mean by exercise. Well pretty much anything really. As long as it works your limbs and back or your heart and lungs, or preferably both, it will help your pain and function. It is important to get a balance and little and often is usually the best place to start.

Most people who exercise regularly do so because they enjoy it and often because it comes with a social situation or friends that they enjoy spending time with. So it’s worth considering these things.

We have put a lot of information on the website about leisure facilities and groups that might help you find something you enjoy.

One option to help you become more confident to exercise is the National Exercise referral Scheme, or NERS for short. This is available throughout Aneurin Bevan University Health Board region. It is a community run scheme supported by most council run leisure centres. It provides a variety of activities and exercise types, there really is something for everyone. To access the scheme, you will need a referral from your GP, physio or another healthcare professional. There is also a small cost associated with the programme. A commitment to attend twice a week for 16 weeks would be necessary. More information can be found on this NERS leaflet.

Physiotherapy is another option for helping with your back pain symptoms. Consider physiotherapists as experts in human movement and how pain or disease can affect this. A physio can assess your situation and physical ability, and discuss recommendations for how to reduce some of your symptoms and improve your function. Exactly what options are used will vary depending on the person, and what the physio finds. These options will be discussed with you at the time of your assessment.

Physiotherapists will nearly always recommend the use of exercise to build physical fitness. They can help you find the right option for you. In some of our physiotherapy departments we have group exercise classes dedicated to improving physical fitness for those with back pain and related leg symptoms.  These are usually 30-60 minutes exercise sessions once per week for up to 6 weeks.  If you are interested in this option discuss with your physiotherapist.

Some people feel confident to exercise without professional support, and we would absolutely support this. So the decision of how to exercise, on your own, with friends, at NERS or with Physiotherapy is up to you and your preferences.  Further information on exercise can be found on the NHS Exercise website.

Psychologically Informed Management

As you have already read, our thoughts and feelings can significantly influence our behaviour and therefore can impact on our potential to recover and rehabilitate successfully.  For some individuals who are experiencing persistent pain and reduced function this can be an important area for them and requires just as much consideration as their physical health and fitness.  Having the opportunity to actually talk through some of these issues and introduce some strategies can be really useful for some.  All NHS physiotherapists are trained to support individuals with common musculoskeletal concerns and pain anxieties, but in some cases a discussion with your GP and the options of further counselling with a professional in this area may be necessary.