Osteopathy and Lower Back Pain: Science, Myths, and Realities

Lower back pain (LBP) affects up to 80% of the population at some point in their lives. While osteopathy is a common response, it is often surrounded by theoretical concepts that are appealing but scientifically fragile. For effective management, it is essential to separate physical manipulation techniques from the myths that surround them.

Understanding Lower Back Pain: A Multifactorial Origin

Back pain can be acute (less than 6 weeks) or chronic (12 weeks or more). It generally involves:

• Mechanical factors: Muscle strains, dysfunctions of the facet joints, or sacroiliac joints.

• Inflammatory factors: Disc degeneration or herniations.

• Psychosocial factors: Stress and limiting beliefs regarding pain.

The Myths of Osteopathy

While structural osteopathy has moderate evidence of efficacy, three areas remain particularly criticized by the scientific community:

A. The Posturology Myth: "The body is misaligned"

Posturology suggests that "poor alignment" (uneven shoulders, a "twisted" pelvis) is the direct cause of pain.

• The Myth: There is a "perfect" posture. If you are not symmetrical, you will have back pain.

• The Reality: Studies show a very weak correlation between postural asymmetry and pain. The human body is naturally asymmetrical. Claiming to "reprogram posture" to align the pelvis is a widely oversold concept that lacks solid clinical evidence.

B. The Cranial Osteopathy Myth

• The Myth: One can treat the lower back by manipulating the bones of the skull to release cerebrospinal fluid.

• The Critical Reality: In adults, the skull bones are fused. No study has proven that the human hand can feel or modify a cranial rhythmic movement. The effect felt is related to deep relaxation (contextual effect) and not to a mechanical modification of the spine.

C. The Somato-Emotional Myth

• The Myth: "Your pain is an emotion trapped in your liver or your vertebrae."

• The Critical Reality: The idea that an osteopath can "release" a traumatic memory through manual pressure is a pseudo-scientific interpretation. This can be risky by avoiding necessary psychological care provided by qualified professionals.

The Scientific Reality: What Actually Works

The effectiveness of structural osteopathy is recognized, particularly for chronic lower back pain, thanks to identified biological mechanisms:

• Neuromuscular Reset: Techniques such as MET (Muscle Energy Techniques) utilize the Golgi tendon organs to force a contracted muscle to relax.

• Pain Modulation: Manual touch stimulates mechanoreceptors, which "closes the gate" on pain signals in the spinal cord (Gate Control Theory).

• Inflammation Reduction: Markers such as Interleukin-6 (IL-6) tend to decrease after effective structural manipulation.

Toward Modern Osteopathy

Osteopathy is a valuable tool when it stays within its field of competence: structural manual therapy. It should not be seen as a method to "realign" a body, but as a way to reduce pain to allow the patient to get back into motion.

Movement remains the N°1 treatment for lower back pain. The osteopath helps restore mobility, but physical activity is what stabilizes results in the long term.

Alain Guierre