By
Dr. Greg Lusk, DC
As
you can imagine conversations around low back pain are quite common in the
office of a chiropractor. While we are
trained to diagnose and treat muscle and joint related conditions throughout
the entire body, pain in the low back area is the most frequent complaint
bringing patients through the door. In
addition to any therapy we can provide, education plays an integral role in
helping clients understand what may have contributed to their pain, what
structure(s) may be causing it, what needs to be done to resolve it, and
finally what should be kept in mind as they aim to prevent a recurrence. That being said, patients often have some
misinformed beliefs about low back pain that need to be addressed as these
beliefs can have a real influence on how they feel and how easily they may
recover.
Belief #1
It’s
important to know exactly what tissue is causing the low back pain. There’s no arguing the fact that this would
be nice to know but research does not support our ability to determine this in
the majority of cases. Once serious
causes have been ruled out, which can largely be done with a good patient
history, the many tests we have to stress different structures in the back are
not good at isolating the cause. Even
when there is imaging (i.e. x-ray, MRI) that shows an abnormality it’s often
not definitive what the source of pain is.
Instead, we have to take all clinical information into account, decide a
course of action, and evaluate the outcome of that trial. As a result, "Mechanical Low Back Pain"
is often the best diagnosis available, in all its vagueness.
Belief #2
Imaging,
such as x-ray or MRI, is needed early for proper diagnosis and treatment. There are definite indications for imaging,
such as suspicion of fracture or cancer, but serious causes of low back pain
account for less than 5% of all cases.
Also, if low back pain is accompanied by progressive neurological
changes in the legs or is not responding to an appropriate trial of care,
imaging becomes warranted. However, most
low back pain does not present this way.
Unfortunately, getting imaging done early can have a negative effect by
identifying and attributing value to abnormalities that are not clinically
relevant. In extreme cases, this may
result in unnecessary surgery but the far more common negative effect is the
patient’s belief that the finding is important and “bad”. Research repeatedly shows that a high
percentage of healthy, pain free individuals have abnormal low back findings
with imaging so it’s vital to make sure they’re clinically relevant, not just
present.
Belief
#3
The
severity of back pain correlates to the amount of tissue damage present or the
degree of injury. With respect to back
pain this simply is not the case. Pain
is a very complicated phenomenon that is affected by many things including, but
not limited to, tissue damage, previous injury history, perception of threat to
daily activities (i.e. fear), and ideas of what may have occurred. It is not uncommon to see a client in severe
pain be remarkably improved in a few days, which far exceeds the rate of normal
tissue healing. Therefore, tissue injury
cannot be the only factor at play.
Being
an informed patient not only assists recovery but may also help prevent the undesired
development of chronic pain. This
article is for general information purposes only and is not to be taken as
professional medical advice
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