Low back pain is a regularly occurring affliction among people world wide. On average, an estimated 80% of people will deal with a significant bout of back pain which causes them to miss work or prevent them from doing regular activity at some point in their lives. The economic impact of low back pain is said to be in the billions of dollars per year in regards to payouts for treatment and lost wages. Back pain is also one of, if not the most common reason that a person will seek medical attention. As a matter of fact, it is likely the reason you first came to my office, or are considering coming in.
These things all being the case, there are a lot of misconceptions and misinformation about low back pain that gets distributed by professionals in the industry, patients in the system, and beyond–often with negative financial and physical consequences.
My hope is that I can dis-spell some of these myths for you; So let’s begin:
1. Back Pain is a Sign of Something Serious – While low back pain can certainly be a sign of a significant medical problem, nearly 95% of the time or more, it is not. In the absence of significant trauma, numbness in the groin area, loss of bowel and/or bladder control, concurrent fever/infection, or previous diagnosis of cancer, the overwhelming majority of low back pain is a result of a muscle, joint, or nerve problem that will respond well to conservative care and time.
2. Once Injured, Always Injured – One of the more common things that patients who are coming to see me mention is old intervertebral disc injuries. I don’t mean to imply that this information is in and of itself clinically meaningless, but the fact of the matter is that these types of injuries typically clear up and cannot be identified on re-examination, and are likely not the cause of your current pain per se. In addition we are coming to find that these types of things that are identified by imaging are often quite normally occurring. Which brings us to the next point…
3. The Source of Your Pain Can Be Definitively Diagnosed by Imaging – With the advent of the MRI, imaging of low back pain patients has increased dramatically. The unfortunate thing we have come to find is that we cannot rely on imaging alone to diagnose the source of low back pain–so much so that some radiology clinics have taken to putting disclaimers on the bottom of their MRI reports stating that while they are obligated to report structural abnormalities found, the types of things they note are so common in the general population that it is impossible to determine them as the cause of a patient’s problem.
4. Back Pain is a Purely Physical Condition – Gone are the days of seeing the human body as a separate entity driven by the mind like a captain at the helm of an ocean liner. As it turns out the long-held dualism theory of body and mind–one that indicated that the brain simply receives signals from the body and responds independently–appears to be incorrect. What we are learning is that low back pain in particular has many psychological, social, and socioeconomic facets that contribute to the overall picture of those afflicted with it. Things like past experiences with pain, fear, depression/anxiety, beliefs about pain and how one’s body works, and even job satisfaction have more to do with whether or not, and how quickly one might recover than you would probably imagine.
5. Chiropractic Adjustments, Manual/Physical Therapy, Medicine/Surgery Cure Low Back Pain – Before I start getting hate mail from my colleagues and have my patients questioning their care, let me clarify myself. First off, manual and physical therapy modalities like the ones I (and many others) provide in our offices can offer a great deal of relief of symptoms with varying degrees of therapeutic benefit in terms of both length and magnitude of effect. That being said, they are not in and of themselves ‘cures’ for low back pain, but current guidelines recommend–and I would also argue for–their use as part of a multi-pronged approach to resolving low back pain, particularly in its initial stages. Medications like pain killers, anti-inflammatory drugs, and muscle relaxers can also play an important role in symptom management, but they will not cure your back pain either. To that point, I would heavily emphasize that–given the current evidence and problems our nation currently faces–that, prior to beginning treatment, the risk/benefit of opioids as a choice for pain management be highly considered if not abandoned all together. Lastly, I would urge you to exhaust all other options before considering surgery, and avoid spinal fusions all together as a means of treating low back pain as there is a mountain of evidence against the efficacy of the procedure with equally ample evidence of harm and the increasing need for future procedures.
In short, as it relates to back pain–knowledge is power. Keep the above things in mind when approaching care of your low back pain and odds are you will be just fine. Avoid practitioners who offer diagnoses of the what without the why, quick fixes, heavily rely on doctor-centered curative passive modalities (things they do to you vs. things you do for yourself), those who insist on getting images be they x-ray or otherwise, and those that offer lengthy treatment plans without specific goals–particularly if they seem to suspiciously match the approved limits of your health insurance policy.
Be sure foster relationships with those who encourage movement, healthy lifestyle habits, address the pyschosocial aspects of your condition, avoid body shaming, offer demonstrable explanations for your symptoms, and who ask you to take an active role in your recovery. These are the types of practitioners–be they chiropractors, medical doctors, nutritionists, physical therapist, acupuncturists, personal trainers or otherwise–that can, and will help you control your pain.