More than 80% of us will experience lower back pain at some point in our lives. Frequently it’s self-limiting, meaning that within a week or so it will go away on its own. Frequently however, recurring bouts of acute pain and chronic lingering pain plague us, limit our activities, and cause real discomfort and disability.
While some practitioners still treat back pain with bedrest, we now know that rest beyond the time when you really just can’t move because of pain, is detrimental, causes deconditioning, and increases the chance of your problem becoming chronic and difficult to manage.
Similarly, while diagnostic tests like x-rays, CAT scans and MRIs are outstanding tools for ruling out more serious causes of back pain, we now know that these tests reveal a very high rate of false positives. As a result, therapists end up treating x-ray findings like disc degeneration and arthritis, that are frequently incidental, and do not address the underlying cause of back pain. These incidental findings frequently have more to do with aging then they have to do with understanding the real cause of someone’s pain.
Today’s gold standard for managing back pain is the use of a functional approach to both diagnosis and treatment.
Frequently what’s underlying a painful condition is muscle imbalance or spinal instability which over time puts undo stress on your muscles, nerves and joints. When those structures can no longer take the stress, they begin to break down causing pain, more dysfunction and disability.
These changes in function can be caused by old injuries which never fully healed, injuries that weren’t rehabbed properly, repetitive motion injuries, inactivity, poor posture, incorrect exercise, and unhealthy habits like sitting at a desk and working at a computer for too many hours at a time.
The functional approach to diagnosis begins with an orthopedic and neurological examination. This helps me to rule out more serious causes of disease, and also begins to reveal what your problem is. Next we do what’s called a Functional Movement Assessment. During this part of the exam I perform a series of movement tests to assess your muscle balance (tightness or weakness), and your motor control (spinal stability). This usually reveals where the real root of your issue lies.
Interestingly, your movement dysfunction is frequently not in the same part of body as your pain, but somewhere above or below…and your pain is simply a compensation for a more underlying problem elsewhere. For example, ankle stiffness, hip instability, or a weakened core can affect the lower back, and instabilities around the shoulder blades or tightness of the upper back can contribute to neck pain or headaches. Without treating those areas of dysfunction, the chronic injury can never fully heal.
The first part of your care entails teaching you what to avoid so you don't continue to irritate your problem. Frequently avoiding simple movements will go a long way in relieving your acute pain.
Treatment in my office often includes spinal manipulation. Manipulation decreases pain, increases range of motion, creates a reflex neuromuscular effect, and keep spinal joints, discs, nerves and muscles healthy. Gentle, non-force manipulation can be used when traditional manipulation is not appropriate. I also use various soft tissue techniques to treat injured tendons, ligaments and muscles and to restore normal myofascial movement.
While you're in the office we’ll also do some specific exercises to rehab areas of dysfunction. These exercises are based on the specific issues that we found during your functional movement assessment. You’ll also be given exercises to do at home, which we will regularly assess and modify as you begin to get stronger.
It takes time for the body to change, but adhering to the rehab program will usually bring very satisfying results. This kind of active care, where you do much of the work on your own, reduces your reliance on a practitioner. This strategy has been shown in many studies to be more effective than passive care where you see a practitioner to “fix you,” without doing more rehab on your own.