1. Introduction / Plain Theory

Low back pain is among the leading causes of disability globally. Research shows that up to 80% of adults experience back pain at least once in their lifetime.

In most cases, the pain is labelled non-specific low back pain (NSLBP), meaning no single identifiable structure (disc, joint, nerve, etc.) can fully explain the symptoms. This does not imply that the pain is “imagined” — rather, it reflects the complex interaction between muscles, joints, ligaments, circulation, and the nervous system.

NSLBP may appear suddenly or develop gradually, often related to mechanical strain, sedentary habits, or prolonged postures.

2. Typical Symptoms and Functional Impact

• Aching or stiffness in the lower back, sometimes radiating to the buttocks or thighs.

• Pain aggravated by bending, sitting, or prolonged standing.

• Occasional limitation in movement or difficulty maintaining certain positions.

• In some cases, disturbed sleep, fatigue, or reduced ability to exercise.

Red flags: Immediate medical evaluation is recommended if back pain is accompanied by fever, unexplained weight loss, trauma, numbness, leg weakness, or loss of bladder/bowel control.

3. Contributing Factors / Underlying Causes

• Mechanical overload: lifting, twisting, or repetitive movements.

• Sedentary lifestyle: weakened stabilizing muscles and reduced joint mobility.

• Postural strain: prolonged sitting or asymmetrical loading.

• Stress and psychosocial factors: can increase muscle tension and pain perception.

• Deconditioning: reduced physical activity, poor recovery, or chronic fatigue.

Low back pain is rarely caused by a single structure. It is usually a multifactorial issue involving movement patterns, tissue health, and how the nervous system processes pain.

4. Osteopathic Approach

Osteopaths view non-specific low back pain within the context of whole-body mechanics and individual adaptation.
An osteopathic consultation typically includes:

• A thorough assessment of spinal mobility, pelvic and thoracic mechanics, and movement symmetry.

• Evaluation of contributing factors such as posture, breathing patterns, and gait.

• Manual techniques aimed at improving tissue mobility, circulation, and neuromuscular balance (e.g. soft-tissue work, joint mobilization, gentle manipulative techniques).

• Discussion of pain mechanisms and supportive habits that promote recovery and resilience.

The aim is not simply to relieve symptoms but to restore movement quality and support the body’s capacity for self-regulation. Treatment is always individualized and may complement medical or physiotherapeutic care.

5. Scientific Evidence & References

Large-scale reviews have found consistent evidence supporting manual therapy and osteopathic interventions as part of multimodal management for non-specific low back pain. Improvements are often seen in pain, mobility, and functional outcomes, especially in the short to medium term.

Below are key systematic reviews and meta-analyses forming the evidence base:

References

1. Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. Lancet. 2018;391(10137):2356–2367. Link

2. Licciardone JC, Gatchel RJ, Phillips N, Aryal S. Effectiveness of osteopathic manipulative treatment in patients with chronic low back pain: a randomized controlled trial. Spine. 2013;38(8):635–642. Link

3. Franke H, Franke JD, Fryer G. Osteopathic manipulative treatment for non-specific low back pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2014;15:286. Link

4. Chou R, Deyo R, Friedly J, et al. Noninvasive treatments for low back pain. Ann Intern Med. 2017;166(7):493–505. Link

5. Coulter ID, Crawford C, Vernon H, et al. Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. Spine J. 2018;18(5):866–879. Link

6. Orrock PJ, Myers SP. The current evidence base for osteopathic manipulative treatment of low back pain: systematic review of controlled clinical trials. Osteopath Med Prim Care. 2013;7(1):4. Link

7. Lewis J, Maher CG, McAuley JH, et al. Combined physical and psychological interventions for low back pain: systematic review and meta-analysis. BMJ. 2021;372:n48. Link

8. Franke H, Fryer G, Ostelo RWJG, et al. Osteopathic manipulative treatment for low back pain: systematic review and meta-analysis of randomized controlled trials. Pain Physician. 2020;23(6):519–538. Link