Doc, what is causing my low back pain?
Does low back pain bring you in to see your doctor? I know for me, that pain and limitation in my daily activities spurs me to get examined. With the prevalence of low back pain in our population today, I have many patient’s who want to know what is wrong with them. Here is where I will dive into the research to tell you why low back pain in medicine is a tricky condition.
So what do I mean by tricky condition? Remember I told that most of my patient’s come in to me asking what is causing my low back pain?The answer is anything but clear. The term pathoanatomy is how much of medicine is taught in medical school, physical therapy school, and many other schools for body workers. This term means that we are looking for an anatomical reason for what the patient is telling us.
For low back pain this would include looking at films to help us determine the cause of pain. It seems logical that this would point us in the right direction of how to best treat patient’s with low back pain. However, this is far from the truth. The research tells us that most diagnostic tests (X-ray, MRI, CT scan) when assisting in diagnosing the low back are of very little value. Why you might ask? Because of false positives. Many of these tests find so called “pathology” or abnormalities in patient’s who don’t even have pain!
That is confusing! Brian, you are telling me that if I go to my doctor and he orders an MRI and it shows degenerative disc disease but that the finding of DDD may not be causing my pain? Yes, my friend, you are exactly right! According to the research study by Savage et al1 it reported that 32% of asymptomatic subjects had had ‘abnormal’ lumbar spines (evidence of disc degeneration, disc bulging or protrusion, facet hypertrophy, or nerve root compression) and only 47% of subjects who were experiencing low back pain had an abnormality identified.1
If it were as simple as looking at an MRI to find the “cause” of low back pain, it would be much better cured and would not be such a burden to us and our medical system. Just the sheer fact that you can see a massage therapist, internist, orthopedist, spine surgeon, yog instructor, chiropractor, physical therapist tells us that there is no clear concensus on how best to treat patient’s with back pain.
Now, I am not saying that those diagnostic tests are not valuable, what I am saying is that often they are not needed on the first appointment to your medical provider. Say for instance that you go to your internist for an episode of low back pain, you may be prescribed a steroid, some pain medication, an X ray will be ordered and you will be sent to PT. If you add up the cost to you and the system of this approach, it will be exorbitantly more than going directly to your physical therapist.
Yes, that right, in the state of Arkansas, you can go directly to your PT first. What does that mean? It means no medications, no expensive diagnostic tests, no injections, no surgery and often a very effective non invasive way to get pain relief. We are trained to determine if your low back pain symptoms are of mechanical origin. There is a small chance that you may have a serious underlying issue that needs medical attention, but we are well educated in screening for those conditions and making appropriate referrals when necessary.
So you may be asking, if there is no specific problem in my back, then how do I get relief?This is where as physical therapists we are taught to subgroup patient’s with low back pain. Based on the signs and symptoms of your condition we do a thorough history to start to determine what are the factors related to your back pain. Is there mechanical stress from work, poor postures, anxiety or depression, is there signs of instability, are you having pain that radiates below the knee, are you in a chronic state of pain? All of these questions and of course our movement examination will allow us to determine a specific treatment plan for you! Your medical provider should be spending at least 15 to 20 minutes just talking to you to determine the best course of care to get to the root cause of your problem.
All the medication in the world will not help if you are constantly sitting with poor posture at work, or if you are bending and lifting improperly. It is time we expect our medical providers to look holistically at all the factors that are playing a role in our limitations, so we can have a multimodal way to attack those impairments so we can get back to enjoying our active lives in a pain free/reduced manor.
As always I am here to be a resource for you, I am available via e-mail at email@example.com or by phone call or text at 501-529-2010. I offer a FREE phone consultation to help guide you to a full return to the things you love. Please reach out.
Here’s to helping you reach your PINNACLE!
Savage RA, Whitehouse GH, Roberts N. The relationship between the magnetic resonance imaging appearance of the lumbar spine and low back pain, age and occupation in males. Eur Spine J. 1997;6:106–114.
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