Updated: Back Pain, by Lisa Snow

lisa-snow       When people first experience back pain, there are so many treatment options that many patients understandably feel confused.  Some people feel that choosing between the various kinds of doctors is overwhelming, and reach for an over-the-counter pain pill instead.  The pain goes away…for today.  But then it comes back even stronger.

Ever wonder why professional athletes overcome severe back pain and injuries and are able to return to the field, while ordinary people often have pain for months or even years?  The key is getting immediate diagnosis.  Pro athletes are diagnosed within days (sometimes within hours) of first feeling pain, while the average person waits weeks, months, or even years.  Regular people are hoping the pain will “just go away” or “heal in time.”  While the pain may temporarily stop, this does not necessarily mean the back has healed!  It usually just means that a compensation pattern has developed—that some muscle that shouldn’t be involved in stabilizing the back has kicked in to help, which may cause further injuries later on.

            Regardless of which kind of treatment you choose, the most important factor in recovering from back pain is going to your doctor right away—within days.  If you’ve already had pain for months, don’t keep reading lots of other articles like this one!  Call your doctor and make an appointment today.

Step one is getting a correct diagnosis, which generally involves getting a physical exam, plus x-rays and/or an MRI.  Once you know for sure what is wrong, you can choose from the treatment options below.

Surgery

While most people with back pain do not need surgery, for the few people who truly need surgery, it can prevent further injury or disability.  If your pain comes and goes, or moves from place to place (for example, the pain moves from upper back one day to lower back then next), you are probably NOT a candidate for surgery.  Be sure to get 2-3 opinions before choosing this route.

PROS:

  • Covered by insurance

CONS:

  • Long recovery time
  • Not needed by the majority of patients
  • Does not strengthen the muscles that support the spine (you would need physical therapy for that)

Physical Therapy

PT is a great option for people who’ve just been diagnosed with back pain.  A good PT can help reduce muscle tension through PNF stretching and other techniques.  They can also release trigger points—small, painful areas of muscle.  Trigger points are spots in the muscle that are continually contracted (instead of moving through the normal contract and relax cycle).  A PT can also give you a list of which exercises are contraindicated and might make your condition worse.  PT is almost always covered by insurance, and any co-pays are usually money well spent.

When choosing a PT, look for someone who will work with you 1-on-1.  You just won’t get the same level of personal attention in a group PT setting.  The PT should also be doing a lot of hands-on work with you: stretching, manual therapy, coaching you through exercises, etc.  If a PT’s idea of a treatment is hooking you up to a stim machine and then walking out the door, it’s time to look for a new therapist!  (While stim is worthwhile for some patients, it should only be one small part of your session.  Note that patients with EMF Sensitivity should avoid stim.)

PROS:

  • Covered by insurance
  • Learn exercises you can continue using after therapy is over
  • Release trigger points
  • Reduce muscle tension
  • Strengthen the core to stabilize the spine

CONS:

  • Does not help realign the bones of the spine (you would need a chiropractor for that)

Chiropractic

Chiropractors (DCs) can help with more than just slipped discs; they treat a wide variety of back injuries, including herniations and subluxations.  Some back pain patients are reluctant to visit a chiropractor because they think it’s too “alternative.”  However, chiropractors attend a four year program just like any other type of doctor, and are subject to the same strenuous licensing as MDs or physical therapists.

Chiropractic adjustments help realign the spine, allowing you to regain normal posture.  Many DC’s believe that poor posture is a symptom of back injuries—not the cause!  When patients are educated about this, they are able to become more aware of their posture and develop healthier posture—without blaming themselves for an injury they did not cause.  This reduces emotional stress, which is essential to healing.  But the most important benefits of chiropractic are physical/medical.  Adjustments reawaken nerves that may have been dormant for months or years.  When a vertebrae is out of place, it can press down on a nerve, limiting nerve function.  This in turn has a negative effect on muscle strength, flexibility, and posture.  Chiropractic adjustments put the vertebrae back where they belong, reversing all of those problems.

 

Unfortunately, some doctors of chiropractic know everything imaginable about the spine…but aren’t as informed about exercise or nutrition.  For best results, choose a chiropractor who has also studied corrective exercise (or is open-minded about it) and can communicate effectively with your physical therapist or personal trainer.

PROS:

  • Covered by insurance, but may be out of network for some people
  • Realign the spine
  • Reawaken nerves
  • Regain normal posture

CONS:

  • Does not directly address rebuilding core strength (you would need a corrective exercise personal trainer or physical therapist for that)

Acupuncture

Like MDs and chiropractors, acupuncturists complete many years of graduate school and are subject to tough licensing standards.  Acupuncture is outstanding for pain relief, sometimes working as well or better than pain medications.  It works by balancing the body’s energy system, allowing the body to better heal itself.  In Western medicine, we know that muscles work like circuit-boards, with electrical impulses travelling along nerves to turn muscles on and off.  Acupuncture takes this knowledge and puts it to practical use.  The tiny acupuncture needles—which usually do NOT hurt when they are inserted—are like little electrical conductors that allow the body’s own energy to flow where it’s supposed to go.  Validated by thousands of years of experience as well as controlled, modern research studies, acupuncture is a great addition to your overall health care plan.

PROS:

  • Covered by insurance, but may be out of network for some people
  • Reduce inflammation
  • Relieve pain
  • Can be safely combined with chiropractic, physical therapy, or other modalities

CONS:

  • Does not directly realign the bones of the spine (you would need a chiropractor for that)

Corrective Exercise with a certified personal trainer

If you have chronic or severe back pain, seeing a trainer without pursuing any medical care is definitely the wrong approach.  However, working with a personal trainer in addition to getting medical treatment can speed healing and help you ease back into sports, dance, or daily activities like taking care of kids or playing with your dog.  When added to chiropractic or physical therapy, Corrective Exercise can help reduce back pain and make you less likely to reinjure your back.  Many back pain patients have unwittingly learned “wrong” movement patterns.  Because their back hurts, they favor those muscles, and use the incorrect muscles to do everyday movements like standing up from a chair, reaching down to pick things up from the floor, or reaching overhead to put something on a high shelf.  Even after patients regain full strength and 100% range of motion, they may still have pain or dysfunction.  For years, this baffled doctors and PTs alike.  Now we know this is because after regaining strength and flexibility, patients must take the additional step of re-learning the movement patterns using the correct muscles.  Although some physical therapists include this as part of their program, sadly many do not.  Corrective Exercise trainers can fill this gap and make sure you make a complete recovery.

Be sure to choose a trainer who has advanced certifications that are specific to corrective exercise, such as the Functional Movement Screen, TRX Sports Medicine, CHEK Institute, or a CES corrective exercise certification.  (Having all of these certifications is unnecessary and would be overkill.  Just try to find a trainer who has at least one of the specialty certifications listed.)

PROS:

  • Rebuild strength & flexibility
  • Improve core strength and stability
  • Relearn functional movement patterns
  • Extreme convenience: trainers can come to your home, your building gym, or a gym in your neighborhood

CONS:

  • NOT covered by insurance
  • Does not address realigning the spine

Put it into practice

Having back pain can be scary, confusing, and overwhelming, but it doesn’t have to be.  You are not alone.  The majority of Americans will experience back pain at some point in their lives, and many intelligent, experienced professionals are ready and waiting to help you heal.  Don’t stress out about which kind of doctor or practitioner to go to first.  Just pick someone qualified and pick up the phone.  Go for that first appointment.  Don’t put it off till your symptoms worsen.  If you love that first doctor or therapist, great!  If not, there are plenty of other options.  Don’t give up!  There’s no reason you can’t start feeling better and getting back to all the activities you love.

 

Missed last month’s column? Read it now:

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What Should People Look for When Hiring a Personal Trainer?
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