Low Back Pain – What You Need to Know
Have you got low back pain? It’s common. Don’t fear. Don’t be afraid. You can gain mastery of your low back.
The advice you’ll get from doctors, therapists, or chiropractors can be confusing or even misleading. They’re not deliberately trying to mislead you. They might just be thinking about lombalgie back pain from a limited perspective.
Before you make a commitment to a treatment program, begin by understanding some of the key facts about your pain and the low back. There’s always a lot you can do for yourself to gain control over your situation. Even if you need the extra help of a chiropractor, physical therapist, or medical doctor, your treatment will be that much more effective if you’re also doing all you can to help yourself.
I spend a lot of time explaining low back reality to my patients. You can get a head start. Here are the some of the key ideas I wish all my patients understood:
- Pain is an experience that takes place in the brain, not in the muscles, joints, or discs. This doesn’t mean that pain is “all in your head”. Pain has a tangible basis in the signals that are coming in from your body. Change the signals, and the experience of pain will change. Or change the way the brain processes the signals, and the experience of pain will also change.
- The brain creates an interpretation of pain based on all the input coming from the body – all the muscles, joints, ligaments, organs, etc. What that means is that only rarely is there a single site in the body you can point to and say “Aha! There’s the cause of the pain.”
- Doctors often identify the intervertebral disc as the source of low back pain. This violates principle #2 in the paragraph above. But it’s not entirely crazy, either. Discs are subject to a lot of stress, and they’re rich with nerve endings – nerve endings that can send pain signals into the brain.
- Nearly everyone over 30 – those with low back pain and those without – has some wear and tear of the intervertebral discs. And if you have an MRI, you’ll see it. The radiologist might call it degenerated, herniated, or bulging, or use some other term.
- Since nearly everyone has some disc damage, the appearance of your discs on an MRI doesn’t correlate exactly with the amount of pain you’re in. It’s a very tricky diagnostic situation. You can have really bad discs but little pain, or only slightly damaged discs and a lot of pain. You can also have pain on the opposite side of your disc bugle, or at a spinal level above or below your worst disc. The MRI shows the architecture of the disc – it isn’t really diagnostic.
- That means that most people are wasting their time having an MRI.
- There’s a lot of scientific research about the use of spinal adjustments (also known as spinal manipulation) for low back pain. In many of the research studies, it turns out that adjustments are helpful, though in other studies, adjustments don’t show much benefit. It’s a very tricky area to research since there are so many variables – the types of low back pain patients being studied; the type of adjustments given, as well as their frequency and the overall duration of treatment; if other treatment is also provided; etc., etc., etc.
- There’s almost no evidence that adjustments (manipulation) causes harm in patients with low back problems.
- Surgery for low back pain, on the other hand, has been less rigorously studied than adjustments. And like the study of adjustments, this type of research is extremely tricky to do, and shows a variety of results.