By Dr. Greg Lusk, DC
As you can imagine conversations around low back pain are quite common in the office of a chiropractor. While we are trained to diagnose and treat muscle and joint related conditions throughout the entire body, pain in the low back area is the most frequent complaint bringing patients through the door. In addition to any therapy we can provide, education plays an integral role in helping clients understand what may have contributed to their pain, what structure(s) may be causing it, what needs to be done to resolve it, and finally what should be kept in mind as they aim to prevent a recurrence. That being said, patients often have some misinformed beliefs about low back pain that need to be addressed as these beliefs can have a real influence on how they feel and how easily they may recover.
It’s important to know exactly what tissue is causing the low back pain. There’s no arguing the fact that this would be nice to know but research does not support our ability to determine this in the majority of cases. Once serious causes have been ruled out, which can largely be done with a good patient history, the many tests we have to stress different structures in the back are not good at isolating the cause. Even when there is imaging (i.e. x-ray, MRI) that shows an abnormality it’s often not definitive what the source of pain is. Instead, we have to take all clinical information into account, decide a course of action, and evaluate the outcome of that trial. As a result, "Mechanical Low Back Pain" is often the best diagnosis available, in all its vagueness.
Imaging, such as x-ray or MRI, is needed early for proper diagnosis and treatment. There are definite indications for imaging, such as suspicion of fracture or cancer, but serious causes of low back pain account for less than 5% of all cases. Also, if low back pain is accompanied by progressive neurological changes in the legs or is not responding to an appropriate trial of care, imaging becomes warranted. However, most low back pain does not present this way. Unfortunately, getting imaging done early can have a negative effect by identifying and attributing value to abnormalities that are not clinically relevant. In extreme cases, this may result in unnecessary surgery but the far more common negative effect is the patient’s belief that the finding is important and “bad”. Research repeatedly shows that a high percentage of healthy, pain free individuals have abnormal low back findings with imaging so it’s vital to make sure they’re clinically relevant, not just present.
The severity of back pain correlates to the amount of tissue damage present or the degree of injury. With respect to back pain this simply is not the case. Pain is a very complicated phenomenon that is affected by many things including, but not limited to, tissue damage, previous injury history, perception of threat to daily activities (i.e. fear), and ideas of what may have occurred. It is not uncommon to see a client in severe pain be remarkably improved in a few days, which far exceeds the rate of normal tissue healing. Therefore, tissue injury cannot be the only factor at play.
Being an informed patient not only assists recovery but may also help prevent the undesired development of chronic pain. This article is for general information purposes only and is not to be taken as professional medical advice