The Role Of Aromatherapy in the Management Of Lower Back Pain

by Dr. Jeremy Smyth

As the greatest single cause of lost working days each year in the UK, lower back pain (LBP) is not only a distressing condition for the individual, it also has significant social and economic effects on society as a whole. This article will discuss the causes of LBP, will outline current common medical approaches and will discuss the role of aromatherapy as an adjunct or alternative to conventional medical treatment. A case report of a combined-discipline case will be included to present the discussion in practical terms.

Anatomy And Function Of The Lower Back

The lower back consists of the spinal column, a bony structure of vertebrae separated by intervertebral, cartilaginous discs. Ligaments connect one vertebra to the next to hold the vertebrae together. Through the centre of the spinal column runs the spinal cord and nerves exit through foramina (holes) in the vertebrae, most notably the sciatic nerve. The lower back muscles are connected by tendons to the spinal column; these muscles control the spine and assist in moving the lower limbs. The lower back supports the upper half of the body, assists movement and protects certain tissues and organs. The vertebral column is weight bearing. Injury to, or disease of the area can impair function and cause pain.

Causes of Lower Back Pain

There are five main causes of lower back pain:

1. Lumbar Strain occurs because of overuse, improper use or trauma. The pain is caused by muscle spasm. Typically, the patient will present with poor muscle tone, may be overweight or have an occupation where the lower back is stressed – for example constant sitting or heavy lifting.
2. Nerve Irritation can be from anatomical causes, such as radiculopathy, or inflammation, as in shingles. The symptoms tend to be more precise than in lumbar strain and pain may be felt at some distance from the source.
3. Lumbar Radiculopathy (slipped disc). The intervertebral disc’s outer membrane tears allowing the softer central portion to herniate. This commonly leads to “sciatica”. Pain or numbing in the region of the affected nerve is often accompanied by LBP. Acute sciatic nerve trauma (from rupture of disc L4/L5) is a medical emergency as failure to treat quickly can lead to permanent incontinence.
4. Bony Encroachment. Any condition which causes movement or growth of the vertebrae can cause pressure on the nerves leading to a variety of symptoms.
5. Bone and Joint Conditions can be degenerative (e.g. arthritis), congenital (e.g. Spina Bifida, scoliosis) or traumatic (i.e. fracture).
   In addition to the above, less common causes of lower back pain include kidney problems, pregnancy, ovary problems, tumours, Paget’s disease, pelvic infection, infection of bone or cartilage of the spine, aortic aneurism, and shingles.

The diagnosis is therefore complex and can be made from a complete history, clinical examination (including imaging such as CT or MRI) and exclusion of other causes. Once diagnosed, appropriate treatment can be recommended.

Medical Treatment for Lower Back Pain

The treatment that doctors prescribe for LBP will depend upon factors such as cause, age of patient, concurrent treatments and other medical problems. Medical treatments may include rest, traction, exercise, manipulation, surgery, drug therapy, or a combination of these methods.

The Role Of Stress In Lower Back Pain

It is well recognised that emotional stress can cause many and varied symptoms. Stress commonly leads to headaches, fatigue, depression, non-pathological pain and a myriad of other symptoms.
In terms of LBP, stress and depression can cause pain or worsen existing symptoms. Sadly, conventional medical treatments often overlook the emotional state of the patient. However medical practitioners and surgeons are becoming increasingly holistic in their approach to care. Attitudes are slowly changing.

Treating Lower Back Pain With Aromatherapy

When proposing to treat a patient with LBP the therapist should consult with the patient and his or her medical practitioner to ensure that the aromatherapy course will not interfere with concurrent medical treatment. The aromatherapist should expect a significant percentage of clients to have lower back pain. Indeed, it may well be the reason for attendance. It is useful to follow a protocol for assessing the client and this aspect of care should be undertaken carefully and thoroughly.
If the client has been referred by a medical practitioner it is wise to discuss the case with the doctor (with the client’s written permission) unless the referral is clear and comprehensive. If the therapist has any reason to suspect a serious condition then immediate referral with the client’s doctor should be considered essential. I suggest the following outline for a protocol of care:

• a. Client Details and Reason for Attending
• b. Social history
• c. Medical history (including operations, medicines, diseases)
• d. Detailed History of Complaint
• e. Examination of affected area.
• f. Treatment plan agreed with the client (including cost)
• g. Continual reassessment
• h. Full and detailed notes of initial and subsequent visits

Using the above protocol the therapist can assess the need for and response to therapy. The underlying cause of many complaints cannot be treated; however, therapy aimed at reducing symptoms should be considered a worthwhile goal.

Aromatherapy can help alleviate the symptoms of lower back pain in a number of ways including:

a. Listening sympathetically and understanding of the client’s case and giving advice on posture. Studies show that musculo-skeletal pain improves in 50% of patients after consultation only. Once the client feels that someone cares the reduction in worry and stress will lead to reduced perception of symptoms.

b. Relaxing Effect of Massage. Massage relaxes the musculature which in turn reduces the stimulation of pain centres. In addition, muscular stress can cause asymmetry in the spine and lower back and aggravate any underlying condition. Massage also improves blood flow and tissue tone as well as eliminating toxins and waste products in the tissues. The client should experience a “feelgood” sensation caused by the stimulation of endorphins (morphine-like chemicals in the brain). Emotional stress is reduced and mood is lifted leading to a reduced perception of pain.

c. Therapeutic Effect of Essential Oils. When assessing the client the therapist will be aware of the required therapeutic need and can select an oil or blend of oils to meet that need. For example, one might select an oil blend with anti-inflammatory and analgesic properties to directly reduce the pain along with antidepressant or relaxant oils to calm and de-stress the client. A standard reference work such as Aromatherapy an A to Z by Patricia Davis will guide the therapist in the selection of oils, as will a good diploma course such as that run by the School of Natural Health Sciences.

Conclusion

Lower back pain is extremely common and accounts for significant morbidity in the general population. The causes of LBP range from simple strains to complex and dangerous medical conditions. The aromatherapist possesses the skills to reduce lower back pain through massage and the use of appropriate essential oils. Aromatherapy massage should be considered a valuable addition to the treatment armoury for LBP sufferers.

Case Report

The following case report illustrates the valuable contribution made to a patient’s care by aromatherapy massage. The case describes the use of massage to provide symptomatic relief for a patient who had two previous spinal operations. The patient suffers from lower back pain and permanent numbness of the left buttock, perineum and back of left leg. The patient continues to be seen weekly. The case will be described in note form following roughly the same protocol as suggested earlier in the article.

1) Client Details and Reason for Attending: Mrs. K.J., married, age 50, senior manager, first attendance December 2006. The patient suffers from lower back pain and permanent numbness of the left buttock, perineum and back of left leg.

2) Social History:
Race: White European, British citizen living in Germany for past 10 years.
Education: degree level (BSc Food Technology).
Employment: Full-time senior manager.
Marital / Family status: Married 27 years, 2 grown up children.
Religion: None.
Substance use: non-smoker, social drinker.
Hobbies/Interests: Food, film, naturism (beware photosensitising oils), swimming, gardening, dog walking (last three good for relieving back pain).
Future plans: Home improvements involving manual work by builder, client will help decorate (advise on correct lifting techniques). Preparing for a naturist holiday in France. Early retirement to France later this year.

3) Medical History:
Chronic anaemia – diagnosed 15 years, low level, untreated.
1992 – laser removal early cervical cancer cells, no recurrence.
1994 – removal of benign bony tumour from right shoulder.
2003 – moles removed from back and face (check skin during massage for suspicious moles as she likes the sun).
Two dilatation and curettage procedures for dysmenorrheia.
1999 and 2002 – removal of intervertebral disc.

4) Detailed History of Complaint: First experienced LBP in mid 1998. Pain in back and left thigh. Operation 1999 to remove disc L4/L5, symptoms completely relieved. March 2002 return of symptoms with gradual worsening. December 2002 operation repeated. Post-op physiotherapy. Now permanent numbness left buttock, perineum, back of left thigh.

5) Examination: 50 year old woman, 5’8″, 10st 3lb – ideal weight for height. Tightness felt in left hamstring and right erector spinae. When prone and viewed from toe to head, curvature of spine to right seen. Upper and lower abdominal muscles ill-defined, some wasting of quadriceps femoris (pain limits movement such as deep knee bending therefore quadriceps underused).

6) Treatment Plan: General aim of treatment to relax patient emotionally and relax and tone back and leg muscles to aid spinal support. Patient also concerned at potential skin damage from sun. Treatment to include full body massage with concentration on legs and back. Introduce gentle stretching and toning exercises. Oils to be selected for anti-inflammatory, analgesic and relaxant effects as well as providing nourishment for the skin (but avoid photosensitising oils).

7) Reassessment: The patient found the massages very pleasant and relaxing and reported a reduction of pain symptoms but no change to numbness. Muscle tone and flexibility is slowly improving yet the tightness in the back and leg remain. She thinks her skin feels softer and is probably more pleased with this than with the reduction in back pain! The weekly sessions will continue until she moves to France where, I hope, she will be able to find a therapist to continue therapy. She will be given a copy of her case notes to take with her.

8) Assessment of the Outcome: This case demonstrates that the symptoms of lower back pain can be alleviated by aromatherapy massage to the benefit of the client. Furthermore, underlying emotional stress can be eased and, as in this case, coincidental problems (skin care in this instance) may be helped. As part of a holistic approach to patient care the aromatherapist can play a valuable role in alleviating chronic symptoms of organic disease. The role of aromatherapy massage is of especial benefit for musculo-skeletal problems such as lower back pain where the aromatherapist can positively influence the client’s quality of life.

Bibliography
Aromatherapy an A to Z by Patricia Davis
A Massage Therapist’s Guide to Lower Back and Pelvic Pain by Leon Chaitow and Sandy Fritz
Integrating Complementary Therapies in Primary Care: by David Peters, Leon Chaitow, Gerry Harris, and Sue Morrison
Mosby’s Fundamentals of Therapeutic Massage by Sandy Fritz