Back pain is extremely common and up to 80% of people will experience it at some point in their lives. At any one time, 31 million Americans have back pain. The single leading cause of disability worldwide is back pain and it is also second only to respiratory infections in terms of missed work. Brace yourself for this next statistic. Americans spend at least $50 billion every year on back pain.
Clearly there is a problem somewhere in our system. Back pain is often times tossed into one category, without classifying the causes behind the pain. I believe this is one of the main reasons for the unsuccessful management of back pain around the world. Imagine this: 1,000 random people have unclassified back pain and chiropractic adjustments are done as a treatment. Let's say it turned out that 95% of them have cancer in their spine that is causing their pain and for many, the treatment did not help. Without classifying the pain, you would make the conclusion that chiropractic adjustments are not effective for treating back pain. Maybe the other 5% had disc herniation and all of them got pain relief from the treatment. Thus, chiropractic may be extremely effective for one type of back pain, and minimally effective for other types. Unfortunately this is how a majority of the scientific literature is done regarding back pain. There is no classification and blanket statements are made.
Diagnosing and classifying patients is an essential part of treatment. When properly classified, treatments can be more specific and outcomes will improve. This is what I strive to deliver with the functional model of care. Once red flags to treatment have been ruled out, doing a functional examination will lead to specific treatment protocols that can produce successful interventions. Instead of blanket treatments for every type of pain, classification allows for plans that suit an individual's dysfunction. Also keep in mind that ruling out red flags and making a proper diagnosis can typically be done with a thorough history and exam, without the unnecessary use of expensive imaging like MRI or CT scans. The overuse of these diagnostic tools can often lead to fear that can affect outcomes for many patients.
Mechanical low back pain (pain not related to serious issues) generally responds favorably to exercise. Too much rest can even be detrimental during an episode of back pain. Specific exercises may be given by your doctor to manage your condition in the beginning. A few days of rest may be beneficial but it is best to resume normal activities and some research even shows benefit to strength-building exercise for most mechanical back pain. Your doctor should reassure you that nothing is seriously wrong and that it is healthy to keep moving.
In review, back pain needs to be properly classified. Once this is done, most back pain can be managed with combinations of chiropractic adjustments, manual therapies, basic pain medications, and specific exercises. If a course of these treatments does not prove to be useful, only then should one consider more invasive interventions like injections and surgeries.
I hope this information gives you an idea of the effect back pain has on many people, and some ways to lessen the burden on both patients and the medical system in general. Always get your pain evaluated by a doctor.
Yours in Health,
Dr. Joel Ardner
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