Back pain- The Why and the How

Oh, back pain… For those of you whom have read my past few blogs had to know this was coming, I am a chiropractor after all! But seriously, back pain has literally become an epidemic in America, and across the world. It’s estimated that 80% of the population will suffer from back pain at some point in their lives and that at any given time there are approximately 31 million people suffering from back pain! Those are huge numbers. If you are one of those people, keep reading! If you’re not one of those currently suffering, well, the odds are not in your favor. But there are things you can do to not become another statistic! We’re going to touch on all of that!

 

Let’s start at the cause of back pain. There are so many causes, if I were to list them all, we’d be here for a very long time. So let’s focus on the usual suspects. Obviously, sports injuries, car accidents, falling off of the roof or off of a ladder are some basic obvious causes. Let’s skip past those for now and talk about the less obvious causes. Ligament sprains, muscle strains, mechanical dysfunction, abnormal foot biomechanics, posture, sitting, obesity, arthritis, kidney stones, gall stones, cancer, meningitis are all causes… Wait…Wait….Wait… I said we weren’t going down the rabbit hole of causes. But if you were to “WebMd” back pain you’d likely see some or most of these and possibly have a mild anxiety attack. I can’t tell you how many patients I’ve seen that nearly break down in tears hearing that their mild back pain from sitting too much, is not cancer or another awful disease they read about online. Always get checked out by a trained professional I.e. a chiropractor, physical therapist, D.O., or M.D.

 

Ok, let’s get back to causes that are actually common, treatable, and preventable for the most part! I want to focus on 3 main issues I see commonly, and instead of focusing on the name of the diagnosis, I want to focus on the mechanisms!

 

  1. One of the most common causes we see is repetitive motion injuries, or disuse problems. I know, I know, those are polar opposites. But they actually play hand in hand! I often see patients that perform the same motion repeatedly, whether it’s working an assembly line, scanning groceries, or even sitting at a desk but performing the same motion over and over (See where disuse comes into play!) Ironically, most people aren’t injured when they’re performing these movements, it’s when they go to move in a different way that their back gives out. These shearing movements, performed over and over create grooves or patterns that your muscles and joints begin to follow, so even a normal movement can cause spasming and painful joint restrictions. Disuse is similar as the muscles of your spine become dormant so when you go to sit up or move, there is little protection from those muscles and suddenly you actually can’t move!
  2. Lifting injuries are extremely common as well. I see crossfitters, Olympic lifters, recreational lifters all the time. These people are extremely strong and they know how to lift, but every now and then, adrenaline kicks in and getting those last few inches to complete a PR is worth compromising your back, until it isn’t… But I also see lifting injuries in moms, dads, kids, college students, grandparents, weekend warriors, desk jockeys, did I miss anyone? All it takes is a weak core, an improper movement at the exact right angle, lifting groceries, boxes, or even a pencil off the floor for the cute girl in the hallway. Disc bulges, strains, sprains, spasms, and joint dysfunction can all become factors in lifting injuries.
  3. Degeneration or arthritis is the third issue I see commonly. This is an interesting one because degeneration can be painful or show no symptoms. As we age, our discs naturally thin out, causing some amount of degeneration or arthritis. I’m sure some of my colleagues are already typing their response to this statement, but before this gets out of hand let’s simply look at the evidence. Often times, degeneration is not the exact cause or source of the pain, it’s is often associated issues of the ligaments, muscles, nerve fibers etc. This is why degeneration causes issues in some, but not others, it all depends on where and how severe the degeneration is. There is better evidence to indicate that pain and aberrant joint motion cause the degeneration in the first place. The reason I touch on this is that most people present with some amount of degeneration and it is not something to be ignored if present in an abnormal pattern i.e. not normal aging processes.

 

So now you’ve gotten a crash course in back pain. Great, now you’re just as confused as before, just armed with some nice medical terms to use in your next game of scrabble. Well, that was partly my intent! Let me explain… Back pain is extremely complicated. The sources are vast, the complicating factors are all over the map, and figuring out what to do next is like trying to decide what your 2-year-old wants for dinner. It’s vitally important that you get a proper diagnosis from a provider as your spine is extremely complex, and there are many, many conditions that can be causing you pain. So obviously, my answer as to what to do once your back hurts is obvious, let’s talk about how to prevent the back injuries you can.

 

Exercise and stretch, in that order.

 

If I was more brazen I’d end this blog with that line. Obviously, it’s a gross generalization, but it’s true. If more people exercised(properly), stretched, maybe ate a little bit better, their back pain would be significantly reduced. Let me share a story. I used to work in a multi-disciplinary clinic as a physical therapy aide. We regularly met as a team to review cases and the lead doc would put up X-rays of new patients that none of the rest of us had seen yet. One new patient, a 90-something year old lady, no real complaints was our description. When we saw her X-rays, we couldn’t believe what we saw. Her neck was fused or nearly fused at every level, it was a jumbled mess! I honestly thought it was a joke, thinking there’s no way this person is walking in the door let alone “stiff and sore”. But she had remained incredibly active through exercise including water aerobics, dancing classes, walking every night, and light weight lifting. She made a decision to not let arthritis and degeneration control her.

 

So where does chiropractic come in to play? Im going to start simple and expound from there. Chiropractic care, (including the adjustment or manipulation, soft tissue/myofascial work and therapeutic exercise) helps primarily with 2 things:

  1. Pain relief
  2. Biomechanical dysfunction

 

Wait, that’s it? Well, yea… But let’s focus on everything that falls into those two categories. Pain relief is fairly straight forward, who doesn’t want proven, safe, natural pain relief? Don’t get me wrong, if you’re at a 10/10 on the pain scale, some pain killers are probably going to be on your mind. It is outside of my scope to really discuss pharmaceuticals, but I will say this much. When I’ve broken bones and had surgeries, I’ve taken pain killers. I do my best to limit how much I take, but when you’re in that kind of pain, sometimes you either need a bottle of vodka or a couple of prescribed meds. But I digress… Even at a 10/10 on the pain scale, if the cause is biomechanical, getting chiropractic care can help. So, let’s focus on the biomechanics. So when your body is not moving properly, or maybe you were in an accident or had a sports injury, your body needs to be taught how to properly move again in such a way that will spare you from future injury or pain. Biomechanical dysfunction can be a cause or an effect. As a cause, it can be that just over time, you didn’t learn a motion properly or maybe you have a structural issue that is affecting your biomechanics. As an effect, when we are in pain from say, a herniated disc, a sprain, a pulled muscle etc. our bodies will compensate to allow us to attempt to continue to function. If our body compensates for long enough, our brain begins to think this new method of movement is now normal, despite the lasting effects it can have. So as you can see, affecting biomechanical issues includes the common issues you hear about from sprains, strains, pulled muscles, etc. to the more intense conditions like herniated discs.

 

I know this was a longer blog, but I wanted to get some important info out there. My approach to back/spine care is simple. I do an extremely thorough exam, I not only want to know what exactly is going wrong, but I want to make sure there is nothing systemically wrong (i.e. cancer, kidney stones etc.). Once I know what is going on, and that I can help, I treat the  condition through adjusting the joints, myofascial work (like a massage, but not), and finally with exercises that will both strengthen the area, but more importantly will teach you how to use your body as a unit, not just one muscle at a time. As a simple caveat to all of this, I will openly admit that my care has limitations, and even when the source is biomechanical, there are times that these issues don’t respond to conservative care. I often refer to surgeons or other medical doctors whom have a different set of tools and methods than I do that may be required. I do believe in trying a conservative approach first, and the evidence supports this belief, but the reality is that some patients have conditions that are simply not treatable with conservative care. I hope this gives you some insight into what is really going on with your back, and how you can fix it! Always find a good practitioner to assess your spine and find one who has the goal of helping you get out of pain and wants to teach you how to care for your condition on your own, rather than coming in 500 times!