The Low Down on Low Back PainDec 01, 2022
If you have never suffered from lingering low back pain, you’re lucky or, more likely, too young.
Research shows that up to 80 percent of Americans will experience low back pain at some point in our lives. And for most, there won’t be any specific cause. That is because most back pain is a cumulative affect of what has been happening in our bodies over several years. In all the years I have been treating patients with low back pain, I can count on one hand those patients that have had a traumatic incident that triggered their back injury and pain.
If you are like most people suffering from chronic low back pain you probably have been suffering for a while. Most people will say that treatment has worked for a while but the pain always returns. The reason the pain continues to return for most people is that they never truly change what is causing the back pain in the first place. Having back pain can be a normal aspect of aging that should be met with acknowledgment, patience and, even more important, a change in lifestyle, particularly exercising and stretching more.
There are several things that need to be addressed to properly treat back pain. If we covered it all here in one post it would take you until the end of the week to finish reading it. What I have decided to do is break down some important facts I feel everyone should know about how to approach back pain that can lead to a better understanding of what is causing your particular symptoms and how to develop a successful treatment plan.
In my many years working with clients with low back pain I have found that there were numerous reasons why their previous treatments never fully worked:
1) A lot of people get sub-par, outdated physical therapy.
2) Most people are more concerned with only treating the pain than with actually fixing the injury.
3) Patients believe the results of their diagnostic imaging are the final word on their diagnosis. No one relates those results to what is happening functionally in their bodies.
4) When looking to return to a regular training routine most practitioners are unsure of what will exacerbate their symptoms so patients get a hefty list of contraindications instead of a clear understanding of how to properly train.
Here are some recommendations to help guide you through understanding and treating back pain:
1. Recognize that you may never get a definitive diagnosis.
Everyone has known someone with back pain so bad that no one can figure out the cause or fix it. As I mentioned earlier over 80% of back pain has no identifiable cause. First one must find out the true cause of the pain vs. getting a definitive diagnosis. For example the diagnosis you receive from the doctor may be a HNP (herniated nucleus pulposes otherwise known as a herniated disc). However the herniated disc may not be what is causing your pain at all. Rather it could be the extra 100 pounds your midsection seems to have been carrying around with you over the last year or the fact that you sit 10-12 hours a day or maybe that you haven’t seen the inside of a gym since the days of leg warmers and step aerobics. Identifying the true cause of your pain will help you be able to carve out the proper plan of treatment that will result in lifelong success.
Which leads me to…
2. Recognize that what your MRI reports says and what is actually causing the pain are very frequently two different things:
In 1994, the New England Journal of Medicine published a study that showed that when doctors looked at MRIs of 98 asymptomatic backs. Researchers noted the following:
“52 percent of the subjects had a bulge at least one level, 27 percent had a protrusion, and 1 percent had an extrusion [82% of subjects]. Thirty-eight percent had an abnormality of more than one intervertebral disk.”(3)
Here you’ve got loads of people with absolutely no pain, yet they have diagnostic imaging that’d tell you that they ought to be in absolute misery. We also frequently see the opposite where patients are being carried into the clinic in severe pain but their MRI does not show anything too terribly out of the ordinary. The problem with diagnostic testing is that it is usually preformed lying down and always in a static position. This is no way identifies what happens to the lumbar spine when you are upright and more importantly when you are moving.
Here’s a great excerpt from prominent NY radiologist: “Medical imaging is simply one piece of the clinical puzzle. An analogy can be made with astronomy. You can image the universe at visible light, x-ray, ultraviolet, infrared, etc. Each modality provides a vital, but incomplete picture of the universe. You have to put it all together to get the big picture.”
3. Appreciate that where you are feeling pain and what the cause of that pain is are usually found in two different places.
I learned from a very well known Physical Therapist many years ago that when treating patients with back pain we should “find the pain and look elsewhere for the cause”.
This point is probably most simply illustrated by the patient that comes in with complaints of pain in the bottom of the foot. Many patients with low back dysfunction will never actually report pain in their low back. If the practitioner does not do an extensive evaluation and just goes about treating the pain in the foot with massage and ultrasound the pain may never get better. Pain at the bottom of the foot can also be related to the lower lumbar nerve root coming from the spine. Even though there may not be any pain in the spine that is where the treatment should be focused. One of many reasons you should seek out the treatment of a qualified and knowledgeable practitioner.
4. Recognize that even though you may be asymptomatic, you’re probably still a complete structural mess.
So your physician prescribed some medications and an injection or two and your pain has disappeared. Please understand that while those treatments will help reduce inflammation they do nothing at all to change the physical anatomy of your spine. Your pain will surely return. Most people do not wake up one morning with debilitating back pain (although I do get reports of that all the time) so you will not wake up tomorrow with a sudden cessation of all your pain either. If most people report having had pain for several months or even several years it will take a period of time with proper treatment for the pain to fully and properly resolve and during this time you must be an active participant in your recovery. Sitting back and passively waiting for an epidural injection or medication to cure the problem will not work (although these treatment options are sometimes necessary to begin the healing process in severe cases). We should focus our time on things that will actually change our physical anatomy such as stability training, stretching, balance, posture and body awareness.
Hopefully this gives you some insight to understanding low back pain. Remember no two people will experience the same symptoms even if they technically have the same diagnosis. No two patients should therefore undergo the exact same treatment. And, be careful when you get up from your computer after reading this; at least 50% of you are walking disasters!
Christa Gurka, MSPT