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!

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Why Don’t We Care More About Our Health?

We don’t smoke to prevent getting lung cancer. So why don’t we do more to prevent other illnesses?

 

 

In this blog series, I’ve talked about why diets and exercise routines fail, which essentially comes down to discipline and goal setting. But recently I have realized there is a deeper issue. Why don’t we care more about our health? It’s an interesting concept to take a step back and objectively look at, so I’ll share my perceptions from a few different angles.

“We’re fighting for insurance. There is nothing wrong with this, it’s vital, but it is not healthcare.”

Most of you don’t know this, but I am very involved politically with chiropractic and health care in general. I served on a student national board for the American Chiropractic Association, I was the chapter president of the student California Chiropractic Association as a student, and currently serve as Secretary of the Nevada Chiropractic Association. I have lobbied congress members, Senators, and state legislators, and I have testified at our state Capitol before senate committees. I say all this to explain that I have seen the fervor in which we as Americans have fought for healthcare. It’s a passion for many people and arguably a selling point on which candidate we vote for or support the most. Never in history has healthcare been such a hot topic for Americans politically. But the irony to me is that what we are so fervently fighting for is not actually healthcare. We’re fighting for insurance. There is nothing wrong with this, it’s vital, but it is not healthcare.

 

I don’t care if you are for universal healthcare with a national single payer, state single payer, or if you’re for privatizing health care across the board, this is not meant to be a political post, ostracizing one side or the other. The reason I bring this aspect up is that we have become blind to what actual healthcare is. We have allowed insurance companies to dictate our care, we have allowed them to control how much we pay, we have allowed them to dictate how much a doctor can make (or not make), we let them tell us what we can and can’t see a provider for, and we have been told preventative care is not covered. We have essentially lost our understanding of healthcare.

“As we age, our bodies naturally just don’t respond like they used to without exponentially more effort.”

So, what is healthcare and why don’t we care more about it? Let’s back up and talk about what is health? I’d love to give you a great quote here, but it cannot be wrapped up into one sentence. To me, health is the ability to use your bodies’ fullest potential. As we age, our bodies naturally just don’t respond like they used to without exponentially more effort. A great example is Jaromir Jagr, whom is a 45-year-old professional hockey player. His ability to still play such an intense game at the highest level and still be incredibly effective, despite his age, is nothing short of amazing. But his ability to play at this level does not come at a small cost. His daily routine is incomprehensible for most people, even his teammates. He often works out 4 times a day, and will even skate or workout after games. He has a strict diet and ensures that his body is well taken care of. Some say he defies his age, I say he has figured out how to optimize his bodies’ output at any cost. Is this health? Technically speaking, absolutely! I am in awe of his dedication, it reminds me of Jack Lalanne whom was still doing instructional videos well into his twilight years.

 

Ok, great, now you feel even worse about yourself thinking about Jaromir Jagr who can still out work 18 year olds, and Jack Lalanne who was in better shape at 88 than you are at 40. Well, let’s not go that far and feel bad! I use these examples to show that our bodies are inherently capable of being pushed farther than we realize. You may be wondering where I am going with this, but I assure you it all ties together, bear with me!

“They Simply Care About Not Being Sick”

Health is in my opinion somewhat relative. Not all of us want to be a Jaromir Jagr or a Jack Lalanne. We just don’t have the time for one, and don’t have a purpose in pushing ourselves to that limit. But far too often, I see people on the far other end of the spectrum. They just don’t care about their health. They simply care about not being sick. Ah, the tying in moment… Let’s go back to the insurance topic, we are fervent in our fight to ensure that when we get sick, we have a way to get better. Again, 100% behind this concept. But we have lost sight of our actual health. Eating organic, eating at home, regular exercise, these are considered fads and unless you are posting pictures of it on Instagram does it even count? When did taking care of your body become a fad?

 

I encourage you to read the 2 part series “Why Do Diets and Exercise Routines Fail?” as I cover a lot of how to start getting healthy, so I won’t repeat myself here. But I want to delve just a bit further into this concept of healthcare. I am not one to say that if you just eat right and exercise all of your health issues will go away, or even be prevented. But let’s compare the odds. The number one killer in America is cardiovascular disease, best way to prevent it? Diet and exercise. Cancer is one that touches so many of our lives and is devastating in every way. Will diet and exercise cure or prevent cancer, or auto-immune diseases? Unfortunately, probably not for most cancers or auto-immune diseases.  This is why we need insurance and why we are so passionate when it comes to fighting for healthcare insurance. But similar to not smoking to try and prevent getting lung cancer, why do we continue to neglect our bodies in every other way to prevent ailments we can prevent? Jaromir Jagr and Jack Lalanne needed to push themselves to the furthest limit in order to be healthy based on their chosen lifestyles. Most of us are not like that, but again why have we gone so far to the other extreme?

 

If you’ve been around me or read other blogs, you know I like to keep things simple, maybe even to a fault. I’m not naïve enough to say simple exercise and diet cures everything. It doesn’t. But let’s begin to shift our thinking. I hear so often, “I need healthcare because I have diabetes and can’t walk”, “I need healthcare because I have congestive heart failure”. Yes, you do if you have those things, but if you are lucky enough to not have those conditions or other similarly preventable conditions, why not start preventing them now! We have again been conditioned to wait until we are sick or on the verge of being sick to address our health, this is just a terrible idea for your health, and your wallet!

 

Let’s finish this topic off with how chiropractic can help. It’s my opinion that chiropractic care falls under both realms of healthcare we discussed. It absolutely helps with acute and chronic pain conditions, especially in the spine. But utilizing chiropractic care to ensure that your body is functioning at it’s best biomechanically as you delve into the exercise world, will help prevent injuries that can keep you from exercising! Those little tweaks and strains can lead to bigger problems if they’re not taken care of quickly, so make sure you take care of your body!

You’ve got one life to live, and one body to live it in. Make the most of it.

I hope this was somewhat educational and wasn’t to sporadic. The take home point is that we simply are not looking at health in the right way. We absolutely need doctors, hospitals, and even insurance. I am so grateful for my medical doctor colleagues as the truth is that we can’t prevent every illness, and we can’t turn back time. But let’s start looking at healthcare as a lifestyle, not something we simply pay an arm and a leg for and then wait until we are beyond natural repair to seek help. What is your health preventing you from doing? Do you wish you could keep up with your kids running through the house, wish you could play with your grandkids, wish you could still play softball or just wish you could climb the stairs without getting winded? Start taking action now! You’ve got one life to live, and one body to live it in. Make the most of it.

 

Dr. Jon Parham
Chiropractic Physician