As humans, we are designed to walk, run, lift, and twist. But most of us have lost the joy of these basic, primal movement patterns because of low back pain. We must recover the joy of movement by taking control of the pain – whether acute or chronic – through education, reassurance, therapy, and lifestyle modification. The pain is an opportunity to learn: it is NOT a BAD BACK!
DIAGNOSING THE PROBLEM
Low back pain is the second most common complaint in the nation is the most common complaint we see in our office. Given the frequency of low back pain, it’s surprising how little is known about the root causes of the condition. Despite amazing advances in imaging technology that have provided us with unsurpassed image quality, we are usually unable to pinpoint the underlying causes with certainty.
That’s the bad news. The good news is that only one tenth of one percent of low back pain stems from serious pathology such as a tumor, infection, or fracture. A good history and physical exam by a competent practitioner can easily rule out such serious pathologies because they have conspicuous behaviors. So, once we have ruled out the bad stuff, what are we left with?
Our first order of business is to try to determine the source of the problem – the pain generator. There are many possible candidates, because the lower back is a complex functional unit comprising deep and superficial muscles, big and small nerves, ligaments, facet joints, bones (vertebrae), arteries, veins and inter-vertebral discs – all of which involve nerves. So how do we figure it all out?
With a thorough history, physical exam, and skilled palpation, combined with complete knowledge of the anatomy and physiology, I believe we can do a much better job at determining the specific tissue causing the pain. Once we are confident we have a good working diagnosis, we can begin a targeted treatment program.
The approach we have developed is based on a three-tiered model:
- Patient education and reassurance
- Hands-on therapy
- Lifestyle management
PATIENT EDUCATION AND REASSURANCE
We have found that once patients have a basic understanding of their injuries (and the relative mildness of them), and once we give them reassurance that they will recover (usually much quicker than they initially thought), their fear is often reduced. Once the fear is reduced, we frequently see a significant reduction in pain.
One difficulty with addressing low back pain is that very mild tissue damage (not even enough to appear on imaging) can cause some patients excruciating pain, while others who present with a horrible looking MRI may only have mild discomfort. These contrasting situations mandate that we treat the patient and not the picture. This philosophy defines our treatment program.
This address the actual physiological event and it's where, through 10 years of experience and knowledge, we have realized a breakthrough in simplifying and targeting the therapy exactly where it is needed. Years of clinical experience, a critical review of current studies and literature, and my own personal experience of back pain have allowed us to focus on efficient hands-on therapy. Although all structures within the low back functional unit can be pain generators, we believe that certain tissues are far more prone to be the culprits. Most studies and empirical evidence suggests that inter-vertebral discs and deep segmental stability muscles are frequently to blame. These two specific tissues have similar physiologies in that they demanded a constant supply of oxygen.
Chronic faulty movement patterns combined with local and global muscle imbalances and joint hypo-mobility (think sitting all day) can cause constriction, starving the tissues of oxygen, a condition called hypoxia. This can lead to a heightened pain responses which, in turn, may cause fear of movement leading to more faulty movement patterns -- all resulting in a vicious circle.
By encouraging better segmental movement and better oxygenation, we quickly improve the healing environment. We accomplish this through a firm targeted, manual release at the specific segment involved -- something we have determined by palpation. Once the area is decongested with manual release, gentle but progressive mobilizations within the patient's tolerance are begun to improve segmental movement. The patient's response to this treatment plan allows us to refine our working diagnosis, if necessary.
During this treatment tier, we help patients learn strategies for managing their backs in order to live life without restrictions. This is an opportunity for our patients to improve how they move, improve their associated joint mobility and flexibility, and build a stronger back. This is exactly opposite of the old paradigm in which people experiencing low back pain reduce their activities to the detriment of their lifestyle because of their "bad backs."
Low back pain has become a scourge in our modern world. The costs of imaging, injections, and surgeries -- all directed at low back pain -- have become a colossal burden to our already overburdened health care system. Knowing that the vast majority of low back pain episodes are benign, but also understanding that they can be very painful, we must a low cost simplified approach. Our approach is designed to help patients recover the joy of movement through education, reassurance, therapy, and lifestyle management. Remember 99.9% of the time, it's not a bad back!