LOW BACK PAIN: Will it ever go away?
June 3, 2013
What better way to utilize a night of insomnia than to write about one of the most common reasons people seek out chiropractic care.
It is estimated that 85% of the population will experience low back pain in their life time. I honestly think this number is too low, but I'm not about to embark upon another study. Regardless, low back pain is a big issue for many people, both young and old, fit and out of shape. And the repercussions are pretty significant. Millions of dollars in wages are lost due to the inability to work. And billions are spent on low back pain treatment. The Feb. 13 issue of The Journal of the American Medical Association said that, adjusted for inflation, the cost of low back pain and neck pain treatment is now $86 billions dollars per year, a 65% increase since 1997!! Additionally, the yearly average individual cost is $6096. And that study only looked at the timeframe between 1997-2005, so it has most certainly risen. The article concluded that we are spending more on low back pain per year than on cancer. Unbelievable! There is something wrong here.
Based on my clinical experience and education, my opinion is that most low back pain is due to inactivity, poor body mechanics and too much sitting. And most low back pain can easily be treated with conservative care. The terms, disc herniation, bulging disc and degeneration sound very scary to most, and if your doctor does not explain what that means, you look to the internet and friends for the answer and typically you do not get the correct information. I need to correct myself. Some medical doctors do explain degeneration and bulging disc, but unfortunately their explanations are often incorrect which leads to even more fear. I don't think medical doctors are giving inadequate or incorrect information on purpose, but rather, they are not very well educated in treating musculoskeletal complaints, just as I am not trained to treat heart attacks. Another issue that perpetuates the fear of low back pain is the over use of x-ray and MRI to "diagnose" your pain. You cannot diagnose an image. If an MRI shows a cancerous growth, yes, it can be diagnostic, but it cannot, in any way, diagnose pain. A bulging disc on MRI may not be the source of the pain. And an x-ray that shows degeneration cannot say for 100% certainty that that is the source of your pain.
A 1994 study in New England Journal of Medicine (NEJM), researchers sent MRI images of 98 "healthy"backs (these people were not experiencing any pain), to various doctors, and asked them to diagnose them. 80% of the MRI interpretations came back with disc herniation and bulges. In 38% of the patients, there was involvement of more than one disc. Remember, the MRI's were of pain free backs. Approximately 85% of low back pain has no definitive diagnosis. So what does all of this mean?
As I said at the outset, I believe that most low back pain is due to poor physical conditioning, inactivity, poor body mechanics and sitting too much. But what exactly is causing the pain? As the NEJM study said, 85% of low back pain has no clear cause, that said how can you know exactly what treatment you need? Surgery fails more than it succeeds and if it does help the low back pain, other issues often arise. Drugs can dull the pain, but I have never met anyone who is deficient in ibuprofen, Vicodin or Flexeril. Physical therapy is sometimes useless and chiropractic treatment can be useless as well. That leaves us in a conundrum, but it also leaves us with a lot or different opportunities to address what is often a very easily treated condition.
The fact that I am a chiropractor, my first line of action, is of course, to see me. I feel that I have some of the best tools to help someone dealing with back pain. My number one priority is to do a thorough exam to rule out conditions that I cannot treat and once that is satisfied, education is absolutely the key tool to conquering the issue. The more you know the more empowered you will be and the more control you will have. Fear and uncertainty, with out a doubt, can make something simple, seem impossible. You may be thinking that if 85% of all low back pain has no clear pain generator, how am I going to be able to educate someone.
I tend to focus on the poor biomechanical aspect of low back issues. Abnormal stress on joints or any tissue in the body will cause changes. Sometimes the change is good and necessary, such as improving cardiovascular fitness by slowly increasing the amount of time you spend engaged in it, or the strength you gain with a sound resistance training plan. The body needs to adapt, it is always striving for homeostasis. We sweat when we are hot, shiver when we are cold. That is homeostasis. Our joints and muscles are no different. They change too. Wolff's law says that under load, bone will adapt to the applied forces to either become stronger or if too much, break down. Muscles adapt by why of creep and hysteresis. Which is basically a change in length and tension over time. Wollf's law, creep and hysteresis are what cause problems if the changes that are made are due to abnormal forces.
My approach is to help correct the abnormal forces. And the abnormal forces are often strength imbalances in muscles due to habitual activity, such as always leaning to the right when you sit. Sometimes things you are doing that seem to be good for you can actually be perpetuating the problem. Sit-ups are big issue and they need to be stopped! If you have low back pain you have no business doing a sit-up, ever. (I will write about them at another time). Other possible causes are as innocent as the way we sleep and the sports we play. I could go on about ways we are creating the problem, but there is no need to because the solution is typically removing exacerbating factors and correcting muscle and joint imbalances. Because bone, over time (Wollf's law), can change shape, the abnormal shape of bone cannot be corrected, but the joint and musculature can be optimized. And that is where I have a lot of success. A combination of muscle work in the form of various massage techniques, joint mobilization and the work that you do can make dramatic changes and typically, relatively quickly. Long lasting results are often a work in progress, but I'm confident that if I can take the proverbial hammer out of your hand, ("Doc my head hurts and I dont' know why" as you stand there hitting your head with a hammer) that low back pain can be part of your past for good.
Dr. Zetter
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In the middle of every difficulty lies opportunity. ~Einstein
