Back Pain is not easy to assess for the therapist or diagnose for the physician, either medical or chiropractic, and can be even harder to explain to the client or patient. This is because there can be, and usually is, more than one factor causing the pain. If there is one dominant factor directly causing the pain, then this is addressed first. Decreasing the major cause of pain allows for greater range of motion which will facilitate the natural healing process of the body as well as allow the therapist to address the imbalance that caused the pain, if this is possible. Sometime the lack of integrity in structures leaves no alternative but surgical intervention. Fortunately, this is usually not the case.
Who do I see about my pain?
If your pain is locally sharp and disabling, it's my duty to refer you out to an orthopedic physician and I recommend that you pursue that course before you see me if those are the symptoms you are experiencing. Be sure your physician is paying close attention to your history and takes the time to perform manual clinical tests on you. MRI's are not enough. In fact, MRI's can present very clear but misleading images. In the case of herniated nucleus pulposus (HNP) they have a 25% false positive rate (1). Where the pain is being referred from and what structures are referring the pain (nerve, ligament, joint or joint capsule) can and should, in my opinion, all be tentatively identified before radiographs are ordered. Medication or injections to decrease inflammation may be options as well as, in severe cases, surgery. Most Physicians will prescribe the most conservative treatment possible.
If your pain is not is not disabling and the pain is local, chiropractic care has been shown to be very effective on acute conditions, especially within the first 6 weeks. A good chiropractor will educate their patient about their condition and provide them with advice about how to prevent the condition from returning, if that is possible.
If physical therapy has been ordered by your physician, it can be the best road to travel toward healing if the patient is compliant. This is because many of the causes of low back pain are due to weaknesses and imbalances that the physical therapist can address. The mantra "Everything heals in the presence of motion" is most relevant in the case of low back pain where inactivity is often one the greatest contributing factors to onset as well as one of the greatest obstacles to healing.
There is much controversy about the role of passive manual therapy, specifically massage therapy, with respect to severe low back pain. For example, in the case of HNP, it has been noted by some that massage is often engaged during the natural healing cycle in which the natural spontaneous re-absorption of the effused nucleus pulposis would have occurred with normal return to movement regardless of the techniques applied. I have to disagree. Is massage is not contraindicated for the pain I would encourage the patient to engage the services of a therapist. Skillfully applied massage will help decrease both inflammation and tension which will facilitate movement, which will in turn aid the natural healing process. Everything heals in the presence of motion - massage therapy can help you regain that motion.
Summer is short! So if you are having back pain, please schedule an assessment with me so we can find the right direction for you to heal the fastest.
References:
1. http://emedicine.medscape.com/article/1263961-overview
References utilized:
Hammer, Warren I. “Functional Soft Tissue Examination and Treatment by Manual Methods, 3rd Edition” Sudbury, MA Jones and Bartlett Publishers, 2007
