Back pain is ubiquitous. And not only that, it’s everywhere! ;-)
The good news is you are not alone. The bad news, treatment for chronic back pain has less than a stellar reputation.
If you suffer from chronic low back pain, you know this is undoubtedly true. The clinicians that evaluate you and I and administer treatment not only have a poor record of success but they can?t even agree on the problem.
An Unusual Treatment for Chronic Back Pain
Have you ever considered cleaning your teeth as a way to mitigate your low back pain?
This article summarizes how bacteria normally found in the mouth can migrate to the spine (via the bloodstream) and perhaps cause bone swelling. This swelling seems to be correlated with an increase in chronic lower back pain.
A clinical trial was run in Europe to test the theory and showed really remarkable results. The article is a bit technical but explains how antibiotic?therapy?did?positively?affect the bone swelling, called oedema, by killing the bacteria.
Rather than jumping to an antibiotic treatment which does have some downsides (antibiotics tend to kill the good bugs as well) you may consider stepping up your oral health program a notch or two.
It can?t hurt. You may get three bonuses for the price of one.
- Cleaner teeth
- Fresher breath
- and treatment for chronic back pain.
But back to the standard of care for chronic low back pain today.
Why is it that the experts, the clinicians who have an enormous (and growing) population to examine, diagnose and treat, don?t get better results?
It is estimated that 80% of all people will experience low back pain at some time in their life! It is the largest contributor to job related disability and the second largest neurological disorder, second only to the headache.
The first hurdle is the analysis. Identifying the root cause of Non Specific Low Back Pain (NSLBP), which basically means there?isn’t?an obvious reason for the pain like a ruptured disc or broken bone, is crappy at best.
To the chiropractor, your NSLBP has got something to do with your spinal alignment. And a back-snapping session is next in line.
But studies suggest that spinal manipulation therapy is not very effective. You be the judge. If you like your chiropractor, by all means keep going.
But you might ask yourself, ?Why?hasn’t?all this treatment for chronic back pain actually fixed the problem?? It?s actually a pretty good question.
You must think you are getting good results but a lot may have to do with the placebo effect which is a very real phenomena.
You may just feel better after a bone snapping session because you think it should work. And you like your chiropractor. And your friends like him and go to him and say good stuff about him as well.
And you spent money on it. All this stuff tends to reinforce the placebo effect. It is really an interesting topic.
Controlled studies say another thing about the success rate of spinal manipulation therapy.
We?ll get into the placebo effect and pain management in another blog post or perhaps even a series.
Other Common Therapies Fare No Better for Lower Back Pain
The physical therapist may conclude your NSLBP is from your uneven leg length. She not only believes that this undoubtedly is the source of your low back pain but will also suggest it can be fixed as well.
She will suggest an 8 to 10 week therapy plan of core strengthening and flexibility programs with liberal application of heat, ultrasound and manual massage. And in the end she hopes to lengthen your short leg. I think that technically the adjustment is supposedly in the spine and pelvis which ultimately evens out leg length.
A lofty goal for sure.
I am sure she believes all this and is not trying to intentionally deceive. But this belief that mechanical perfection of our anatomy is required to be pain-free is a bit absurd. There are scores of people happily walking around with uneven leg length, crooked spines and hunched over shoulders and they don?t complain of lower back pain at all.
In fact, most people with scoliosis do not suffer from low back pain at all. If anyone should be in pain based on the ?mechanical perfection? theory, it is someone with advanced scoliosis.
There is just no correlation between anatomical variation and lower back pain.
While your mechanical imperfection may cause you pain, just because you have a structural imbalance doesn’t mean it is the source of your pain. It is the difference between correlation and coincidence.
Everyone Reads It Differently
Another PT may say excessive sitting has shortened your hamstrings which in turn pulled your pelvis into a forward tilted position. And this is why your back hurts.
The ?we sit too much and this is the source of many of our physical problems? has become conventional wisdom as of late.
Maybe. Maybe not.
The orthopedic guy will point to a bulging disc or damaged vertebrae that is pinching a nerve and causing your pain.
Is surgery in your future?
Don’t jump too fast for the surgery option. The statistics for success may sound promising and you are eager for a lasting solution.
But, and there is always a but, surgery results can really be skewed by the placebo effect.
Patients often?believe?their?surgery?was successful right after the procedure when the statistics are calculated. But six months to a year later may paint a different story.
The placebo effect makes it very difficult to determine the true efficacy of different surgery procedures.
When you have made such a major commitment as going under the knife and spent a large chunk of change to boot, you are convinced it is going to work. And afterwards, the placebo effect reinforces your belief.
What About Ancient Chinese Medicine?
The acupuncturist will point to your yin and yang being out of whack and the need for balancing your qi. Or something like that.
Don?t get me wrong. I am not bashing the ancient knowledge of oriental medicine (OM). I believe there is a lot to learn and benefit from. And contrary to western medicine, OM does focus on prevention and lifestyle factors.
I will be the first to admit that I sought out acupuncture treatment many times through the years of my low back problems.
And I was certain that I got relief. I actually believed that it was the best method for acute relief of my lower back pain. I?wrote?about it in this post.
But a well designed study seems to contradict my belief in its effectiveness. And this study concludes a few extraordinary things.
First, it is a study to compare acupuncture, sham acupuncture (which is just pretending to the stick the needles in you) and physical therapy and their ability to mitigate lower back pain.
The first conclusion was that both acupuncture and sham acupuncture performed better than physical therapy!
Ouch! That has to hurt if you are a PT.
And the second conclusion was that acupuncture and sham acupuncture were equally effective!
What can you take away from this?
You decide for yourself but it sounds like:
- acupuncture?doesn’t?work for lower back pain management
- and physical therapy may not be the best treatment for chronic back pain.
Pain in general and low back pain specifically is a complex mechanism. The bottom line is that the clinicians you and I are working with today do not really know how to diagnose it. I touch on the subject in this video.
And without a good diagnosis, understanding the true root cause of a problem, it is impossible to treat it with any predictable success.
The researchers and scientists out there are beginning to get a handle on it but there is a chasm between them and you. We need the researchers and clinicians to get together and start collaborating on real solutions.
We need the knowledge to reach the practice.
Until then, treatment for chronic back pain will continue to be like throwing darts at a dartboard. Some winners. Some losers. And highly?dependent?on the skill of the dart thrower.
Other stuff you may be interested in.
Do you stretch before you run or begin any exercise? This was conventional wisdom for many years.
If you ever ran at a popular park, you should have a lingering visual imprinted in your brain of people leaning into trees and posts stretching hamstrings, glutes and calves. Everyone did it.
But then we started to hear that stretching a cold muscle was risky. You were just as likely to hurt yourself as provide any pre-workout benefit. If you were going to stretch at all, post workout seemed like a better and safer option.
But did you know that stretching before training or competing can actually hurt your performance?
Would you stretch before a 10K run if it would slow you down??How would you warm up for a Crossfit competition if stretching may actually weaken muscular strength output?
Read more about it.
Power Training for Old Folks
Some studies suggest boomers may benefit from power training over traditional strength training.
What is the difference you may ask?
Strength is defined as moving a load over a certain distance. Like dead lifting a weight from the floor to the top of your thighs (standing straight up).
Power adds a speed element to the lift. How quickly can you perform the lift?
If you lift it in 2 seconds and I lift it in 3 seconds, you demonstrated more power than me.
So why do we care about strength vs power?
Well first let?s just say that this is preliminary data and more studies are needed. But the researchers believe that the power component may be more beneficial to seniors in fighting off the effects of aging. The age progression looks like:
- First the slowing down of movement
- Then impaired movement
- Next functional limitations
- and finally full disability
So how do you use this in practice?
If you want to modify your existing weight training routine to a power routine, just speed up the pace of the reps. Lift the weight faster. Blast the bar off your chest when bench pressing. Do explosive push ups.
Plyometric?Jumping is great for power.
Remember this only applies to the concentric phase of the lift, when your muscles are contracting. So for a pushing exercise like the military press, this is when you are pushing the weight overhead. Still keep?a controlled pace during the eccentric phase or when the weight is being lowered.
The opposite is?true?for a pulling exercise like the deadlift. The concentric phase or when you want to increase the rep speed is when you are lifting the?weight?off the?ground. Continue to lower the weight under control.
Check it out and tell me what you think.
I will be trying some speed reps myself and report on it in future posts.
Please comment about any treatment for chronic back pain that you have used. I am interested to know your results.
Featured Image by ? Can Stock Photo Inc. / pressmaster