The Science Behind Treating Chronic Low Back Pain

 

When low back pain persists for more than 3 months it is officially chronic. Many of my chronic low back patients however, have suffered for 2 or more years. Many of them have given up on ever overcoming their condition.

Almost inevitably, patients only suffer chronic low back pain because they have never encountered a practitioner that is willing to treat them properly.

Chronic low back pain should never exist. It is ALWAYS the result of NOT RECEIVING PROPER TREATMENT.

Many doctors and therapists are happy to give temporary relief to their patients and accustom them to continually seeking care for the foreseeable future. And often, the notion of depending on your doctor/therapist for the rest of your life is encouraged.

In this article I hope to show some of the science behind the proper treatment of chronic lower back pain. 

I pick chronic pain because it is usually trickier to fix than short term back strains. And it requires more work than simpler forms of low back conditions.

WHAT CAUSES CHRONIC LOW BACK PAIN?

The following are nearly always present in chronic cases of low back pain.

  1. degenerating, bulging or herniated discs
  2. weakened core muscles
  3. inflexible hips
  4. harmful work and recreational habits (i.e.: bad sitting posture, bad lifting technique, etc)

If your approach to eradicating low back pain does not address all of the above, you will not overcome the condition.

Obviously, a practitioner cannot strengthen your core for you, nor achieve flexibility for you or change your work habits. This will be something you will need to do.

Hence the lack of popularity for the type of program that involves patients doing exercise rehabilitation. It is much more appealing to pay someone to fix you. And because of the temporary relief given by passive treatments (i.e.: massage, manipulation, physiotherapy modalities, drugs, etc) they are often the “go to” solution.

Because the human body thrives when it is strong, flexible and active, no chronic pain will ever disappear without those elements. And obviously, this type of therapeutic approach is mostly comprised of the patient doing the work. 

So the bad news, you are going to have to work and change your lifestyle if you truly desire to put low back pain behind you. The good news is… you can overcome even years of chronic low back pain.

YOU SAID SCIENCE. WHERE’S THE SCIENCE?

When the lumbar spine is in a chronic state of pain, the disc is almost always involved. Even if it is not bulged or herniated, it can be applying pressure to the bone immediately above or below (or both). Over time, this can cause micro stress fractures in this bony region — known as the endplates — and with that comes pain.

What causes this excess pressure? Poor posture, poor lifting techniques as well as lack of movement (sedentary lifestyles) are major causes. Spines transfer stress very well if they are used appropriately, but improper use will change the way stress goes through this unit and micro damage accumulates either in the disc, the soft tissue surrounding it or the bones of the vertebrae themselves.

With pain comes the instinct to be less and less active and to reduce range of motion. As a result the lumbo-pelvic hip complex looses flexibility, co-ordination and strength.

Unfortunately, this causes secondary pain such as muscular strains in the low back and hips. Also, this inactivity tends to exacerbate the original low back pain as well. Essentially, the biomechanical chain is not only weakening but the lack of flexibility and co-ordination means that every time you lift or perform a sports motion, the joints in this complex are experiencing more and more wear and tear.

http://www.drparenteau.com/files/2014/11/weight-lift-low-back-5-1uhbndh.jpg

Your muscles, ligaments, tendons, fascia as well as joint cartilage are parts of a complex machine. And like any other machine, there needs to be co-ordinated interaction between all moving parts. And as a living biological system, too little or too much stress will be harmful.

Once you have had the exact cause of your pain diagnosed, a customized program of exercise rehabilitation, hands-on treatment and ergonomic changes is the most effective and evidence-based method to cure your back pain. Even if it has been a part of your life for years.

See our exercise rehabilitation section of the clinic’s website for pricing and scheduling details.

A proper program will have you start with very basic exercises and stretches. Yet, the goal of our protocol is to slowly and safely evolve you to being able to safely perform compound movements such as deadlifts, squats and olympic type lifts. Prioritizing safe technique and NOT excessive heaviness, lifting in these fashions will allow you — and your lumbopelvic hip complex — to be able to lift, work and play all the while keeping your back strong and healthy.

Contact us if you are interested in more details. Thank you!

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What Does A Chiropractic Adjustment Even Do?

“Doc, what does an adjustment do?”

I have been asked this a thousand times, so I am going to give you, the would-be patient, a quick low down on joint manipulation.

First, much like medicine, nutrition and chemistry have been with us for thousands of years, so has joint manipulation. For example, the ancient Chinese used it to correct for pain and inflammation. As humans are wont to do, if something works we keep doing it.

And we perfect it.

Over the millennia we have scientifically understood and improved spinal manipulation. Modern day chiropractic is not the chiro of one hundred — or even twenty — years ago.

“What is a joint manipulation?”

Easy answer: unlocking a locked joint.

When we suffer an injury — either a sudden injury, or a slow, over use injury — the sophisticated neuro-muscular system will use postural and structural muscles to lock a joint down. Preventing full and free motion.

Unfortunately, the body tends to over do this response. As a result, other nearby joints suffer as well and the problem can grow. For an easy demonstration try walking around without bending one of your knees. You will be forced to change how the whole body chain works in order to compensate for one single locked joint.

Likewise, when a spinal region is locked down, the problem affects secondary regions, making pain and dysfunction grow. A practitioner identifies the affected region and delivers an accurate and quick (but gentle) manipulation to make the joint move through its full range. By sneaking up on your body, your brain doesn’t have the chance to prevent this motion. And this proves to your Central Nervous System (CNS) that the motion is not only possible, but safe and pain free. This retrains your neural pathways and removes the “lock down.”

It can take a few visits to properly retrain the brain, but it is highly effective. And in some conditions (e.g.: facet imbrication) it can even be accomplished in a single visit.

Manipulation also breaks down scar tissue in joint capsules and surrounding soft tissue. Further enabling proper, fluid motion. For a real look at our manipulation practice, click the video below:

“How many people need manipulation?”

Most people will encounter an issue in their life time that will greatly benefit from joint manipulation.

Headaches: According to the American Headache Association, tension-type headaches are, by far, the most common form of headaches. They can be as debilitating — and even more so — than standard migraines. Fortunately, most tension-type headaches are due to tension and restriction in the neck region of the spine. As a result, manipulation is an integral part of treatment for this ailment.

Low back pain: One in four North Americans will suffer a bout of lower back pain in their life time. And low back pain is the most common cause of worker’s disability for those under the age of 45.

Several government studies over the past few decades have shown joint manipulation to be superior to surgery, injections and prescription medication for treatment of low back pain. The Agency for Health Care Policy and Research (AHCPR) of the US Department of Health and Human Services released a 1994 study stating that joint manipulation was a safe, inexpensive treatment that was more effective than standard medical approaches. It was not done by a chiropractic association but by a government assembled panel that included 23 diverse specialists comprised of medical doctors, chiropractic doctors, nurses, experts in spinal research, physical therapists, an occupational therapist, a psychologist, and a consumer protection rep.

The Ontario Ministry of Health (government) commissioned study is the largest standing study on low back pain treatment. Dubbed the “MANGA Report” it made the bold statement of recommending chiropractors as the first line of care ahead of medical doctors!

Several other studies have been done, nearly all of which have come to the same conclusion: for certain injuries, manipulation is the least expensive and most effective treatment.

Now, that being said, not all ailments require manipulation. For these other injuries and pain conditions we use a variety of physiotherapy techniques as well as exercise-based solutions and soft tissue treatments. You need your practitioner to think outside the box and apply the treatment best suited for your problem.

If you’ve tried everything else but have yet to have joint manipulation, please give us a call. And we can discuss whether or not an adjustment would be beneficial for your condition:

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To see the wide ranging services we provide, click on the image below for our YouTube Channel:

Our Manual for “How To Sit Properly”

Many office workers feel they are doomed to low back pain because they sit for a living.

NOT TRUE!

There is an easy solution that will protect your low back from injury.

PLEASE download our FREE PDF manual that shows you how to sit properly! Our easy to follow steps will help prevent your lumbar discs from succumbing to injury.

MANUAL for HOW TO SIT PROPERLY

Lumbopelvic Hip Complex?

What is the Lumbopelvic Hip complex? Essentially, it is the key to solving most low back pain.

It is the body chain created by your low back, your pelvis and your hips. As you can see below, they are all interconnected. Many types of low back pain begin when the low back muscles are weak and the hips are stiff. Therefore, taking good care of your lumbopelvic hip complex is as simple as strengthening the proper core muscles and making your hips flexible.

In fact, most people with disc problems need to look at their injury through the lens of the lumbopelvic hip complex, and not zero in on the disc alone. 

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Your core muscles are made up of any and all muscles that attach to your pelvis. This means that besides the front and side abdominals, you need to strengthen your lower back and buttock muscles as well as the inner thighs, hamstring and hip flexors.

This type of global approach to core strengthening allows the pelvis to be under better control and therefore experience more resilience and less pain. And in order for lumbar discs to be healthy, the pelvis and hips have to be flexible. If not, whenever we lift something or move around, the leg bones pull the pelvis into positions that are harmful to the lumbar spine.

A good core exercise program incorporates an upper and lower body strengthening program as well as core muscle rehabilitation. Flexibility is also vital.

Another commonly overlooked aspect of low back care is the use of balance exercises. By challenging a patient’s balance, we train the body to control its center of gravity which is mainly manipulated by the lumbopelvic hip joint complex. A strong, flexible and co-ordinated lumbopelvic hip complex means a happier lower back.

Please watch the following videos for examples of patients overcoming low back pain through this type of rehabilitation.

 

 

Low Back Exercise

Low back exercises are like flossing daily, they can keep the doctor away!

The following are 3 basic low back exercises for people who don’t have low back pain and want an easy, daily routine to keep the chiropractor away:

1. Ball Extentions
get on your knees, feet against the wall
– roll the exercise ball into your lap
– drape your body over the ball
– slowly straighten your legs until top of your chest is OFF the ball, but your belly is ON the ball
– hands at ears
– bend forward until chest touches ball, then curl back to lift chest (NOT belly) off ball

2 sets of 15-20 repetitions

photo courtesy marin/freedigitalphotos.net

2. L Sits
lay flat on your back
– hands flat on ground next to your hips
– bend knees and bring them up to 90 degrees (perpendicular with floor)
– straighten legs out as much as you can and hold this position
2 sets of 30 seconds

photo courtesy marin/freedigitalphotos.net


3. Side Planks
use hand to prop yourself up on your side
– straighten legs and raise hips up to form straight line with your body
– hold for 30 seconds flip over and so same on opposite side
Do 2 x each side overall


photo courtesy marin/freedigitalphotos.net

Exercise Is Key To Treating Low Back Pain

Many low back pain sufferers jump from one treatment to another and never get relief.

They will try chiropractic, massage, physio, acupuncture, etc. And yet continue to suffer.

In the past 2 years I’ve had the privilege of teaching a “Low Back Recovery” class at the University of Victoria. I never cease to be amazed at how many people needlessly suffer from lower back pain.

As a chiropractor I believe in “hands on” treatment. Deep tissue work, stretching the patient and adjusting their spines are all very key in treating low back pain.

However, very often, the missing ingredient is exercise.

For the past 10 years, I’ve worked in an exercise rehabilitation clinic and have been able to add exercise to the other treatments I do on my patients. The results speak for themselves.

If a patient does not begin and continue a low back exercise program, they will most likely never get full relief:

 

 head image by giopuo