Managing Low Back Pain
The statistics on low back and its impact on society are indisputable. Just for starters, low back pain affects 70%-85% of Americans at some point in their life and is the 5th leading cause of doctor visits in the United States. It is also the leading cause for lack of activity in adults under 45 years of age. Additional risk factors to developing low back pain include smoking, anxiety, depression and certain psychological profiles. Newsweek reported that Americans spent over $85 billion on the evaluation and treatment of low back pain in 2005, up from 52 billion in 1997, according to a study published in The Journal of The American Medical Association (JAMA). The costs on our economy are staggering from both an expenditures standpoint as well as lost work days, reduced productivity and long-term disability!
Not only are we spending more and more on the treatment of low back pain, but a greater number of Americans are reporting low back pain. Another study published in JAMA performed at the University of Washington and Oregon Health Science University found that the average cost per adult patient increased from $4,695 in 1997 to $6,096 in 2005! Newsweek magazine stated “Despite a growing array of sophisticated drugs, diagnostics, physical therapies, and surgical techniques, the millions of Americans battling back pain may not be any closer to getting that quick relief than they were 20 years ago. Several recent studies indicate that even with the latest in high-tech medical intervention, effective treatments for back problems remain elusive. And in any case, the price tag is staggering.”
So what are your options, what is the real cause of low back pain and how do we as individuals and a society deal with such an enormous problem? The answers to such questions are not simple or easy, but there are definitely some basics that can make a significant impact on these statistics. And while everyone is unique, it only makes sense to start with simple and safe options before progressing into more expensive and invasive treatments. Newsweek stated that “high-tech imaging tests, for example are a major money drain when it comes to treating back pain” and “patients want (imaging) and think it will discover the answer for why they’re having pain that can be fixed.” In reality, one of the most important principles to emphasize is that pain and anatomy are not always directly related. For instance, research studies have shown that many MRI reports reveal “abnormal findings” in functional and pain-free adults while correspondingly, many patients with significant low back pain or symptoms such as sciatica, have minimal MRI abnormalities that explain their symptoms. What this means is that low back pain is not merely an anatomical issue and finding an anatomical “cause” does not guarantee a “fix”! Low back pain relates more to “function” than anatomy, so let’s take a look at how to maintain function, minimize your susceptibility to low back pain and discuss treatment options.
First, prevention is the place to start, but that requires proactive measures before developing pain! It involves good physical fitness, regular stretching, weight management good posture, proper sleep positions and healthy daily habits. Deconditioning of abdominal, core and low back muscles is definitely a predisposing factor to low back pain, even if everything else is healthy and normal! Second, just like taking care of your teeth, regular check-ups and “maintenance” can play a huge role in minimizing episodes of low back pain or even preventing them altogether! How would your car run if you never changed the oil, checked the tire pressure, rotated tires or had the front end aligned? Do you buy a house thinking that you won’t have some type of ongoing maintenance while living there over the next 5, 10 or 20 years? Your body and spine are the same. The older you get, the more maintenance your spine and body need; failing to maintain things properly only results in bigger problems later and we don’t get the option of “buying new tires” or “changing the oil” in our spine! If you are truly interested in optimal spinal health, then baseline x-rays are also imperative to identify overall spinal health, hidden complicating factors and underlying conditions that may be completely asymptomatic. For instance, degenerative disc disease, also know as spinal arthritis, can be entirely silent for years or decades. Even when symptoms do develop, the most common complaint is early morning stiffness and achiness that typically improves and often resolves with normal activity. This leads to a false sense that “nothing is wrong” when in reality, your spine is progressively deteriorating. In spinal health, the old adages of “seeing is believing” and “a picture is worth a thousand words” are absolutely true!
So what treatments are most effective and what do the statistics show about various aspects of low back pain? To start with, there are conflicting studies about whether back pain is “self-limiting,” which means the “pain” goes away with rest, home care or limited treatment. Recent studies indicate that patients with back pain often stop seeking treatment within 3 months but 90% still have pain and associated disability 1 year later. This is because back symptoms often “come and go” without a clear explanation. How is this possible? It relates to what we discussed earlier about back pain being a functional problem and “function” can vary significantly without obvious explanations. For those poor souls that end up having recurrent back pain, it sometimes seems like nothing will ever solve the problem and they are cursed for a lifetime. Even worse, layman’s terms such as I threw my back “out”, I slept “wrong”, “slipped disc”, “pinched nerve” and “bone out of place” convey false images and perceptions that keep people from understanding what really happens and the true nature of low back FUNCTION! If you want to learn more about these terms, come to our come my class on How To Eliminate Low Back Pain & Sciatica.
So where do you start if you suffer from recurrent low back pain? In such cases, professional evaluation is certainly indicated. Chiropractors specialize in the anatomy and function of the spine, so they are at the top of the list to help relieve back pain naturally without the use of unnecessary drugs or surgery. In fact, the Agency for Health Care Policy and Research (AHCPR) endorsed “spinal manipulation” as a preferred treatment of acute low back pain. Chiropractors specialize in spinal manipulation or “adjustments” designed to restore nerve function, joint motion and maintain spinal health although the type of “adjustment” can vary greatly from doctor to doctor. A good chiropractic doctor will complete a thorough history and examination to determine the suspected “cause” of your problem before determining an appropriate course of treatment. As previously discussed, spinal x-rays are tremendously important in determining overall spinal health, spinal imbalances, arthritis and a variety of complicating factors. I also use x-rays to evaluate leg length balance and cross-reference these findings with the patient history and examination to determine if a heel lift would help normalize pelvic balance and spinal function. Advancement in axial traction has lead to new treatments such as spinal decompression that I have found to be an excellent treatment for disc problems, arthritis and certain types of chronic low back pain. I also evaluate strength of the low back muscles with MedX equipment to determine if spinal rehabilitation is indicated with chronic low back problems or recovery from some injury like an automobile accident.
There are many other conservative treatment options such as massage, acupuncture and physical therapy that can be excellent treatment options depending upon the “cause” of an individual’s low back pain. The challenge with any episode of low back pain, especially recurrent problems, is to determine the most likely “cause”; hence the paramount importance of completing a thorough history and examination with a spinal specialist. In more severe cases, I will refer patients to a medical specialist such as an orthopedist, neurologist or physiatrist. These specialists will often order specialized imaging studies such as MRI for further diagnostic clarification, prescribe medication, or even make referrals for additional types of treatment. If conservative treatment does not achieve the desired results, it may be necessary to consider more invasive treatments such as spinal injections or a variety of surgical techniques including neurotomy.
Early assessment and prevention are clearly the preferred method of dealing with low back pain and spinal problems. Regular maintenance with both professional services and self-directed activities are critical components of maintaining spinal health and function. Patients with chronic or recurrent problems require comprehensive evaluation and more extensive treatment to achieve the best possible outcome. Please contact our offices or visit www.LifeSourceHP.com if you would like more information on our services or treatment. We offer a complimentary health consultation to discuss your individual complaints and determine if one of our services would be beneficial for your particular problem. In February 2011, we are also offering a Stop Back Pain special worth checking out.
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