LOW BACK PAIN INFO - PART 2
4. EXAMINATION
In part 1 of this series, I talked about how imaging can show things that are not causing your pain, which can lead to diverting attention away from the real problem and may cause unnecessary surgery. That being said, a thorough, nit-picky physical examination by someone with experience treating varied back ailments is imperative! Even if an exact diagnosis cannot be made, a good hands on examination will tell a practitioner many things. There are many things to look at, but the first thing is to rule out any serious pathology such as heart problems or cancer that could be causing the pain.
Following is a list of things that should be considered during a back evaluation. Please note this list may not be totally complete.
· Rule out serious pathology
· Discuss onset, nature, progression of the pain
· Discuss what makes it worse or better
· Discuss what happens over 24 hours
· Discuss where on your body the pain occurs and how it affects you
· Discuss if the pain seems centralized, in one spot, radiates or moves around
· Discuss how it affects your functional activities
· Neurological screen
· Movement screen
· Range of motion screen
· Strength test
· Provocation tests
· Asymmetry of muscles or movement
· Palpation and skin glide
5. TREATMENT
The Medical Community Guidelines for treating low back pain developed through randomized control trials are as follows:
· Start Treatment Early – less than 4 weeks from onset.
· Manual Therapy (manipulation, mobilization, massage) but combined with active therapies – manual therapy with exercise gives better results than either manual therapy alone or exercise alone.
· Exercise-varied according to the problem but often trunk stabilization, trunk coordination, strengthening and endurance. The medical community now believes that whatever movement activity a patient will actually do is best for that patient. (Interesting!)
· Walking – but again walking combined with exercise has shown better results.
· Traction-showed few short or long term benefits and is NOT recommended as a single treatment
· General Education and advice -strongly recommended for understanding pain, home exercise and self-management, as well as provide positive reinforcement of likely recovery
· Counseling – if needed
6. ADDITIONAL TREATMENT OPTIONS
Other treatment modes available, not mentioned much in the general medical guidelines, which I have found to be successful in varied combinations include:
· Cold and Heat
· Modalities such as ultrasound, varied forms of electrical stimulation (non-painful) and diathermy (a form of deep heat). (Perhaps a bit old fashioned but combined with manual therapy and the right exercises often effective in reducing pain and inflammation.)
· IASTM (Instrument assisted soft tissue mobilization)- a physical therapy technique using specialized tools to treat soft tissue injuries, breaking down scar tissue and adhesions, reducing pain, and improving range of motion by stimulating healing and blood flow through targeted strokes on muscles, tendons, and fascia.
· Cupping – an ancient form of alternative medicine that involves placing special cups on the skin to create suction. This suction is believed to increase blood flow, relieve muscle tension, and promote healing in the treated areas.
· Acupressure or acupuncture
· Myofascial relief techniques – including use of rolls, balls, active movements
· Qigong
· Tai Chi
· Gentle Yoga
· Anything else that helps
7. THOUGHTS AND ADVICE ON BACK PAIN DERIVED THROUGH PROFESSIONAL AND PERSONAL EXPERIENCE
In this section are the points I really want to set forth…
ONE SIZE DOES NOT FIT ALL -Treatment should be based on each individual’s unique symptoms, lifestyle and time availability and not be cookie cutter for all. In my experience finding the correct treatment usually takes some to a fair amount of trial and error. (Less trial and error when working with someone attuned, knowledgeable and experienced in finding what is causing the pain and treating low back pain.) It should be a joint effort between patient and therapist.
(Personal story #1…After a year of significant back and hip discomfort I could not make go away myself, I finally went to an orthopedist. An x-ray showed some age related narrowing of spinal joint spaces but nothing else. The doctor swore the physical therapist in his practice was amazing. This therapist’s examination consisted of having me lean forward and backward. Three seconds, if that much. That was the full extent of his examination. He had an aide give me a standard, pre-prepared set of exercises (all of which I had already tried) and applied the same modalities I told him had not worked in the last year. After two wasted visits I went back to the drawing board for myself. He had not listened to me as to what had not worked for me. I had gone to him for expertise I felt I did not have at the time. I then took the matter back into my own hands and signed up for several clinical courses for back pain with techniques I had not been familiar with. I was able to put together a new plan of action that worked and continues to work for me for that problem. Best of all this added many new “tools” and techniques to my practice to help others. I keep taking more courses regularly on the subject. Win, win all around.)
· ONE AND DONE PROBABLY NOT - In my experience back pain is rarely a one time deal that can be permanently fixed. I find it tends to come and go more often than not. It is my belief that one should really take the time, effort and trials, with or without help of a professional, to find out what makes your individual pain go away and how you can manage that yourself. You then follow that routine until the pain is gone and you feel like you again. When comfortable you may be able to slack off on your program. If your pain starts to come back, you get back to your program again. Learn what you can do to prevent it from coming back. BE AWARE that it is coming back before it starts to get too bad and do what you must to keep it from progressing. What worked the first time should work again -IF- it is the same problem. (If it is a new problem, you may need to start the learning process again to find what works for the new problem.)
· IF IT IS NOT WORKING, DON’T WASTE YOUR TIME AND MONEY – Yes, you need patience and most likely nothing will work immediately. It may take a few weeks to assess what is helping and what is not and improvement most likely will be gradual but keep in mind there are some lucky times when there actually is a quick fix. If that is the case, you do not need to read further.
However, if you have been subjecting yourself to a procedure or doing an exercise routine or going to therapy or a chiropractor for weeks and months or even perhaps years without significant results with hope of a “breakthrough,” I can almost assure you it isn’t going to happen. If whatever you are doing isn’t working, it ISN’T WORKING. STOP DOING IT!
(Personal story #2 -I worked a short time for a doctor who did deep needling. My job there was to give a hot pack and massage to make patients feel better after the very painful and expensive needling. One woman who came in in a wheelchair had been coming for almost 2 years. Every week she told me the doctor said she was going to make a breakthrough soon. I wanted to shake her and ask her why she was still coming and subjecting herself to this painful procedure without any results. While the needling did work for some, it clearly was not working for her.)
So, yes, you may need to try many things and give it a reasonable amount of time but if it is not helping you within a reasonable amount of time – try something or someone else!!!!!!
· IF IT IS WORKING, THEN KEEP DOING IT – On the other hand, if something is working for you, by all means - continue to do it. You don’t have to listen to friends and co-workers or even Dr. Internet who think they have the perfect solution for you. Only you have been in your body. You know what feels right and what does not. You can tell if “it” works or not. Don’t be afraid to listen to your body and use your OWN JUDGEMENT. (Even when doing physical therapy in general, for any issue, use your judgement. Therapists give an educated guess as to how many repetitions or how intense an exercise should be for you. It it doesn’t feel right for you, alter it - but do let them know.) You possess intuitive self- healing/preventative powers. You do. Make use of them.
(Personal story #3-These last 2 blogs on back pain were sparked from the following story a good friend told me. Right before her wedding, my friend experienced some back pain. She did a short course of physical therapy and was discharged with a home exercise program. Nine years later a teaching assistant in her second child’s kindergarten class had the same last name as the therapist she had seen. In speaking with the assistant, she learned that the teaching assistant was the wife of the therapist she had seen. My friend gleefully told the wife that she was still doing the exercises he had given her and that she remained pain free. The next time she ran into the therapist’s wife, the wife told my friend that she mentioned their conversation to her husband and her husband said that she didn’t have to do the exercises anymore.
Before I write “NO. DON’T STOP,” (and I will,) I want this audience to know that my friend is now in her seventies and continues to do these few exercises every morning. She has had no back pain episodes since before her wedding that I know of. How many people do you know in their seventies that have no back pain? I am not sure I know of any. I definitely advise her, “YES, keep doing those exercises! They are working for you.”)
Thus, I think it bears repeating. If something is working for you, keep doing it for as long as it is working or your judgement tells you to.
In closing these 2 blogs on back pain, I hope I have given you some new information and awareness of what is out there and some encouragement to self-advocate when seeking help for your back pain. I am happy to answer any questions you may have on this subject via email. Feel free to contact me at fnogeept@gmail.com.