Lower Back Pain, A Progressive Approach:

 

Lower back pain interferes with activities of daily living causing great distress, disability and even depression. The old fashioned advice to, "take it easy" or, "rest the back" is flawed and not based on current evidence.  In fact, those who are able to maintain function and return to normal activities will have better long term outcomes.

 

The modern approach to acute lower back pain encourages relative rest, ice, mobility exercises, and the general advice to try to carry on with normal activities. The modern approach to lower back pain also dispels common myths.

 

Facts:

-Most people will experience lower back pain at some point in their life.

-Many people have disc herniations and disc bulges and are asymptomatic.

-Very few cases of back pain require bed rest.

 

 

Common Myths of Lower Back Pain

 

Myth: I should rest my lower back when it hurts.

It is important to differentiate between relative rest and absolute rest. Absolute rest is when one stops working and performing activities of daily living and is relegated to the bed or couch. Very rarely is this recommended. Relative rest means carrying on with normal activities including work and  basic daily functions. In fact, most people feel  better when they are mentally and physically active.  While movement is encouraged, one should avoid overly strenuous activities. A chiropractor or physical therapist should give mobility exercises and home care advice to facilitate healing and get the patient past the intial inflammatory process.

 

Myth: I need an X-Ray and MRI.

X-Rays primarily show bone structures and joint spaces. They are useful in ruling out fractures and other diseases which may impact the bone.

They should not be used to analyze how, "off" someone is. Most humans are not symmetric beings. This is obvious on X-Rays of most humans.  All humans experience degenerative changes in the joints, usually starting in the mid 30's. This too shows up on X-Rays. These normal imbalances and normal degenerative changes should not be used to convince you that your spine is abnormal.

 

X-Ray and MRI are absolutely necessary when fracture, infection, or a mass is suspected or when an individual is just not improving. Your doctor will ask a number of questions during the history to determine the urgency of imaging.

 

Myth: I should forget about running, golfing, taking out the garbage, shovelling the driveway, etc.

Your goals should always balance risk vs. reward. A lower back pain patient who has had an active recovery and has been doing core exercises diligently should have very few limitations in life. Patients who have been mismanaged in physical therapy or from a chiropractor and told to, "forget being active" will likely fulfil that goal.

 

Myth: My discs are like exploding jelly donuts and I need many many sessions of  traction to suck the jelly back into the donut.

This is just not true. The discs of the spine are not like exploding jelly donuts and the presence of this disturbing image in one's head will likely prolong healing time.

In fact, many MRI's will still show the disc herniation after the patient is pain free.

Traction and spinal decompression can be a useful part of disc related treatments. However, false claims and excessive treatment plans are sometimes associated with this treatment modality.

 

Myth: My back pain is from a vertebrae popping out of place.

This is not anatomically correct. The spinal column and its surrounding ligaments and muscles are strong structures. Muscle weakness, muscle imbalance, muscle spasm, stiff spinal joints, and sedentary lifestyle can lead to the feeling of stiffness or being, "out" or, "off" but it is generally not due to vertebrae being out of place.

 

Myth: Hot packs and hot soaks are the best for acute lower back pain.

It feels counter intuitive to apply ice to painful areas with the fear that it will tighten it up and make you feel stiff. Heat alway feels better when applied however can lead to subsequent hours of increased inflammation and pain. I have heard numerous reports from patients about hot tub soaks followed by significant increase in pain levels. Ice is not only analgesic but can help control inflammation.

 

Myth: Advil and Allieve (NSAIDS) are safe to take long term.

The current consensus from the medical community is to take the lowest dose for the  shortest amount of time. Just because a medicine is available over the counter does not mean it is safe. Chiropractors are in the unique situation to try and help people without the use of pharmacologics or, helping people wean off after a few days of use.