By Dr. R. Greg Lusk, DC
When we experience joint, soft tissue (i.e. muscle, ligament, tendon), or nerve pain, we've become conditioned to expect an anatomical diagnosis from a healthcare practitioner, which speaks to the structural source of our pain. A low back "disc bulge", a "sacroiliac joint sprain", a "pulled muscle", and a "pinched nerve" in the neck are a few such examples. While there is value to labelling the problem as being from a specific piece of our anatomy, which aids in treating in the appropriate area and not being misled by radiating or referred symptoms, it often doesn't tell the full story. Particularly with respect to our backs and necks, it is not easy to specifically say which tissue is the pain source as our diagnostic tests are poor at selectively stressing only one type of tissue at a time. Also, imaging such as x-rays and MRIs often come back normal or have findings that may or may not be part of the problem. As a result, a vague diagnosis such as Nonspecific Mechanical Low Back Pain is very common as it is all encompassing with respect to possible mechanical sources. However, adding a functional diagnosis often clarifies the clinical picture and offers much more value to the pained individual.
What is a "functional" diagnosis? It is the process of identifying movements and/or activities (i.e. functions) that produce or aggravate symptoms, as well as those that may reduce or even abolish symptoms. Patients will often be asked about these activities in an attempt to discover consistencies. Using low back pain as an example, does bending forward, sitting, getting up from sitting, and/or washing dishes cause pain? If so, bending the spine forward (i.e. flexion) is an "intolerant" position which produces pain as it is a consistent biomechanical position in all of these activities, versus the neutral low back position where the back is relatively flat with a slight curve inward toward the belly button. Conversely, does standing, walking, and/or lying on your back make the back pain relatively better? These activities all share spine extension (i.e. bending backward) as the more dominant position, thereby making spine extension a "preferred" direction. The opposite scenario is also possible, with spine extension being aggravating while flexion is relieving, while at other times the situation isn't entirely clear. To aid your healthcare provider in determining these mechanical sensitivities it can often be helpful to keep a record, or diary, of your pain. When symptoms are present or elevated, record the activity you have been doing so the relative spine biomechanics can be deduced.
In addition to any therapies or approaches that may be provided to a patient with low back pain to help with symptoms, which includes medication(s), spinal manipulation, exercises, acupuncture, massage therapy, among many others, knowing the intolerant and preferred spinal positions plays a crucial role in recovery. It empowers the patient with information so they can stop "picking the scab" and perpetuating their pain. Furthermore, the preferred direction of spinal loading is often relieving to pain, completely resolving symptoms in some cases. Exploring spinal loading directions and sensitivities in a clinical setting can form part of the patient assessment and guides patient recommendations. Arming someone with an independent method to control and possibly remove symptoms can help expedite recovery and provides a tool for preventing recurring episodes in the future, as there is a greater appreciation for the effects of directional spinal loading.
This article is for general information purposes only and is not to be taken as professional medical advice.