For those who have stuck it out through the past 7 articles about “How to Fix Your Lower Back Pain”, CONGRATS (and hi mom)
For those who are checking this article out first, lemme give you a quick rundown of what you’ve missed thus far
Article 1: Yoga
Article 2: Pilates
Article 3: Pharmaceutical mgm’t
Article 4: Acupuncture
Article 5: Chiropractic and Massage Therapy
Article 6: Red flags of back pain
Article 7: Spinal Surgery
Which leads to today’s final installment: Physical Therapy
I’m so very excited to share something I love so dearly with you all. It’s the reason I love having my wife help me with the pharmaceutical article and the same reason I had a picture of my daughter, Charlotte, in last week’s article. I get so very giddy sharing my love for amazing things and people with others. For this very special occasion, I wrote a limerick…
Remember when Jim was a sad sack
Because of his chronically bad back
Then went to PT
And shouted “YAHTZEE!”
Now he lifts, plays ball, and runs track
I promise, I’m a better therapist than a poet
I’m going to go ahead and skip the disclaimer, ok? By now, you know that I’m a PT and I obviously feel biased to how great it is (in antithesis to spinal surgery, for example)- so sit back and enjoy my very one sided article.
Let’s start at the very beginning, the evaluation.
If you were to see a physical therapist, the first thing that would need to be done is your evaluation. Here, a PT can assess that your pain is within their scope of practice (I.E. not acutely fractured, not due to metastasis, not an infection, etc…). To do this your physical therapist will ask you the PQRSTs
What increase your pain levels?
What decreases your pain levels?
Is the pain sharp? Dull/ache? Burning? Lancinating? Throbbing?
Where is it located? Does it radiate?
0-10 pain scale today, at its worst, at its best
When did it start? Worse in AM/PM?
MRI and other Imaging
There is no question how helpful an MRI or an Xray could be in ruling out serious pathology in the spine, however- despite being the gold standard, an MRI could be giving you misinformation that may confuse you as to the cause of your pain.
In a study with almost 100 pain-free individuals given an MRI of their spine, over 50% showed at least a bulging disc and some had much more serious disc injuries… WITHOUT PAIN! Did these people have magic powers where they were able to ignore the immense pain related to disc bulges? Of course not.
The truth is, MRIs tell you a lot about anatomy- but they don’t tell you about where the pain is coming from.
Even though you may have disc issues, this does not mean that if your disc is restored to its original position, you will be pain-free. Sometimes a facet joint, the outer-most joint of the spine, is the cause of your pain even though an MRI may suggest otherwise.
Anyhow, Pain is a completely subjective neurological response from your brain and no MRI has the ability to appreciate what the brain is processing
Ok- In depth history…Doneski!
Now we have a good history on file, we proceed with the physical examination
Here we look for what is causing the pain. As complex as the spine is- there are very few culprits to back pain. This means that many of the diagnoses about back pain may be making things more complex than they need to be. The bottom line is this: There are things that should be moving and there are things that shouldn’t be moving
We are looking for things that are off in the way you move so that we can zero-in on the cause of your mechanical pain (too much stress or strain on structures related to the spine). As mentioned in last week’s article regarding fusion surgery, when something isn’t moving well, the area above and below move more causing an issue- a similar thing happens in people without fusions where one segment (portion of the spine) is stiff causing another segment to move too much. Here, a PTs job would be to loosen the joint that is tight (WD40), and stabilize the parts that are moving too much (duct tape).
The basis of all treatment is right there, mobilize and stabilize. That’s it! A good physical therapist will combines parts and theory from massage therapy, chiropractic care, acupuncture, yoga, and Pilates to produce a plan of care focusing on that mobility and stability.
A good therapist should spend 1 on 1 time with you to give you the manual treatment you need to improve your overall mobility and then the supervised exercises to stabilize your spine.
A GREAT therapist should do that efficiently and with the goal of getting you involved in a more active lifestyle.
Shh, it’s a secret to everyone
Ok, I gave an inkling as to what PT can do for you. I even shared my thoughts and facts about other complimentary therapies. Now, I’m going to tell you something that will blow you away…
When it comes to lower back pain,
Yoga has its shortcomings with minimal dynamic stability training
Pilates does not take a specific segment view on stability leaving most people to focus on segments that are usually stable already.
Medication mostly masks pain and the ones that do help are not great for long term care
Acupuncture is great to relieve pain, but does nothing to improve mobility or stability
Massage therapy is very relaxing, but provides no stability training
Chiropractic care does amazing pinpoint accuracy mobilizing, but sends you on your way without the proper exercises to reinforce new movement
Surgery does little for strictly low back pain without sciatica-like issues accompanying it
Physical therapy is a combination of all these, but still has its limitations…
So what’s the secret?
The gentleman who runs the North American Institute for Orthopedic Manual Therapy (NAIOMT), Brett Windsor, had this to say about people suffering from lower back pain- Now mind you, before I continue, this man holds seminars and continuing education courses across North America where they teach people like myself the most up to date information on treating patients. This is what he said…
“Many people have ‘pain’ simply because they don’t move enough. In many, many patients, all that is required is advice to keep moving, get stronger and avoid sustained end-range positions (poor posture or over stretching)”
That’s it!?!? That’s what this 8 part series was leading up to?
Yep. Short and sweet. Keep yourself moving. It helps your spine and related structures. The best treatment for low back pain is often being proactive and making sure you are keeping yourself mobile during the “off season”.
All good things have to end
I had so much fun coming up with and researching all the topics we’ve spoken about over the past 2 months. I think it’s worth it to say that, yes, staying active is important and the best offense against back pain is a great defense by staying active, but if that doesn’t work give a call to a healthcare professional and see what they can do- and as I said last week, try your best to exhaust all conservative measures before even CONTEMPLATING the surgical option.
Ok, cool all done! Parting is such sweet sorrow. As always, leave a comment or share if you have thoughts or questions. Also, if you have a thought on what should be written about next, drop that suggestion below.
Dr. Daniel Davids PT