Chances are very good that your back is hurting as you are reading this very post. Why do I say that? I say that because 70-85% of the population in this country will suffer from back pain at some point in their life. In fact, at this very instant, it’s suspected that 31 million Americans are suffering with back pain! Only the common cold beats out back pain for trips to the doctor. Most importantly, back pain is the number one cause for people over 45 not being able to do what they want. Whether it is work or play, back pain keeps them down.
If you are experiencing back pain now, you must know the cause of your pain to treat it correctly. The first step to finding the right treatment for your low back pain starts with finding the right doctor. Important questions to ask yourself include:
1) Did your back pain come from a trauma?
2) Do you have a history of cancer?
3) Have you had any recent infection or fever?
4) Is your pain acute (new) or chronic (old and recurring)?
5) What treatments have you tried?
6) What works and what doesn’t work long-term?
Types of back pain:
Back pain can be as simple as a minor sprain/strain or as complex as a metastatic cancer. Don’t worry about the serious one yet; thankfully most back pain is non-organic in form, meaning that it comes from mechanical problems instead of more serious causes like infections, inflammatory arthritis, tumors, etc. However, it is very important that you choose a doctor who can at least recognize each of the more serious, although more rare, causes of back pain and make the proper referral for you. Regardless of whether you visit your family medical doctor or chiropractor, each of them should identify the serious causes of back pain and make the proper referral since neither one of them specializes in these more rare causes of back pain.
Treatment options for back pain:
Treatment for back pain varies greatly. Just stay up after 11:00 one night and watch the infomercials. Millions of people search every day for the “cure” for back pain. Either they search to relieve their own pain, or they search to find out how to make more money. Back pain is prevalent enough that it resides on the minds of a significant number of people at any given time. Although the purpose of this post is NOT to offer medical advice, I will provide a summary of the most common treatment options:
1) NSAID’s (non-steroidal anti-inflammatory drugs) – This includes drugs like acetaminophen, ibuprophen, aspirin, etc. These drugs target the inflammation process specifically. (Look for a post in the future about how to beat inflammation without drugs, but it’s too big of a topic for this post). If you read the label you notice that these drugs are for “temporary relief of minor pain.” Sure, these drugs can temporarily relieve the pain; however, they do not either correct the cause of the inflammation nor the mechanical malfunction or injury that initiated the inflammation. In my opinion, these drugs should only be used to ease your pain while you are trying to actually fix the cause of your back pain.
2) Prescription Medications – These medications require a trip to your medical doctor or doctor of osteopathy. I’m not here to meddle in your medicines, frankly I don’t want to. This topic is between you and your doctor. But once again, the purpose of these drugs is to reduce your symptoms, not fix the problem. My opinion is the same with these drugs as with the NSAID’s.
3) Chiropractic Care – Chiropractic care has been around as long as medicine, is licensed in all 50 states, and has shown to be much more cost-effective than the traditional medial route. Blue Cross/Blue Shield recently performed a study where chiropractic care was shown to be 66% less costly than traditional medical treatment. One study revealed that 87% of patients gave their chiropractic treatment a rating of 8/10 and 56% gave their chiropractic treatment a perfect 100%! Obviously I’m slightly biased to this treatment, but that’s what I do and I see it work. Chiropractic treatment helps restore the normal motion of the back pain causing joints! Many chiropractors also incorporate physical therapies and nutritional treatments that aid in helping reduce or eliminate back pain quickly and helping to keep it away.
4) Spinal Decompression – I have been using spinal decompression in my office for over seven years. I have seen tremendous results when this treatment is properly applied to the correct candidate. The goal in spinal decompression is to reduce disc bulges, herniations and degeneration. Most of my spinal decompression back pain patients also have radiating arm and/or leg pain. Most of these patients have also had an MRI performed to rule out any contraindications to this treatment. Most of these patients are also being co-treated with a pain management doctor and/or a surgeon. This is more serious treatment for back pain because it’s a more serious cause of back pain. You can watch videos about spinal decompression treatment and results at http://chirooklahomacity.com/t2/document/1spinal_decompression.
5) Physical Therapy – This treatment focuses on reducing inflammation and pain while stretching and strengthening the injured muscles. In my opinion, physical therapy has outstanding success post-surgery. I think that’s where they really shine. In fact, physical therapy combined with chiropractic care can help the patient tremendously. This is also why I incorporate physical therapy treatments with my back pain patients.
6) Massage Therapy – This treatment helps the patient relax while reducing muscle tension, spasms, and inflammation. The right massage therapy compliments chiropractic treatment very well. This is why we have full-time, licensed, massage therapists on staff.
7) Epidural Steroid Injection (ESI) – This treatment is one of the most invasive and risky procedures mentioned. ESI’s are performed by taking a long needle and puncturing the lumbar spine around the area of pain. The purpose of these shots is to inject a steroid into the injured area to reduce the inflammation. This can be helpful in the more severe cases of back pain, but once again, in my opinion it is very important to correct the cause of the back pain while the patient feels better, instead of them going out and overdoing it and injuring their back more.
8) Spine Surgery – There are several types of spine surgeries. Sometimes spinal surgery is the only option. I refer surgical candidates when they present. Sometimes we co-treat and hope to hold off surgery, sometimes it’s an immediate trip to the operating table. Thankfully, we work with conservative surgeons who are not “knife happy.” I only refer to the best!
9) Acupuncture –I have to admit, I don’t know a whole lot about acupuncture. Some patients swear by it and some don’t. Acupuncture has been around for a long time and focuses on meridian, or “energy channels,” throughout the body. The thought behind acupuncture is that it “balances” these “energy channels.”
10) Exercises/Yoga/Pilates – Proper exercise has been shown to strengthen the core and back, thereby preventing back injuries. I do NOT recommend these treatments when your back is injured. Chiropractic care, physical therapy and massage are my first response. When we release you from you treatment, I recommend that you hire a very good personal trainer/instructor to help you strengthen your core.
11) Cold Laser Therapy – Cold laser acts on the cellular level to speed up the healing process. This treatment helps reduce back pain by decreasing the healing time. I use this when patients have inflammation, muscle spasms and pain.
I’m sure there are several additions to the list above but we will stop at this for now. If you have already tried all of the above methods with no relief, I might not be able to help you.
Dr. Carter’s Back Pain Relief Plan:
My approach to treating back pain is to first find out the cause. If the cause is due to an infection, inflammatory arthritis, tumor, etc., then my goal is to get the patient to the proper doctor immediately. Thankfully, this doesn’t happen very often because most back pain is mechanical. Secondly, some cases are “border line” cases which require co-treatment with other professionals. I regularly refer to medical doctors, osteopaths, pain management doctors, and surgeons. I have a working relationship with them where the patient always benefits. We take a team approach to helping the patient as much as we can. Thirdly, and most commonly, I take the following approach to back pain:
1) Consultation – This is where you, the patient, sit down and tell me your story. My goal here is to listen to you, really listen. New patients to my office regularly ask my receptionist how long this will take. Really, there is no good answer to this question. It’s quite simple though. I’ll take as little time or as much time as you and I need to determine the cause of your back pain. This can be as little as 5 minutes to more than an hour. Most consultations are around 10 minutes though.
2) Evaluation – This is where I do the proper medical and chiropractic tests to determine the severity of your back pain. I take the information you shared with me in the consultation and perform tests that help me to determine the cause of your back pain. These tests include standard measures of your vital signs, like your medical doctor would do, specific orthopedic tests to determine if there is any joint dysfunction, and neurological tests to establish if any nerve damage is evident. The results of these tests help me determine the severity of your back pain.
3) X-Rays –X-rays are a helpful diagnostic tool that helps me to rule out fractures, dislocations, tumors, infections, and more. Not everyone needs x-rays, but if you do, we take them, process them, and analyze them in-house. I make it a point to only order x-rays when medically necessary and to share those results directly with you, the patient, as soon as possible. Most times we can go over your x-ray findings the same day. Sometimes I need more time to study, analyze, and research the cause of a patient’s back pain. This can take a couple days.
4) Advanced Diagnostics – Some cases of back pain are just bad, that’s all there is to it. Some back pain is caused by serious injury. Some back pain is caused by repetitive stress. Most, if not all, patients with radiating arm and/or leg pain should have an MRI performed to make sure there isn’t anything on the spinal cord, spine or nerve root that could cause them further injury with the treatment. Also, x-rays are designed for bones, not soft-tissue. MRI is more specific for finding soft-tissue pathology. Sometimes we need to perform electrodiagnostic testing to determine the effect of the nerve damage. I only order these tests when medically necessary.
5) Treatment – Treatment begins only when we know what we are doing. This means steps 1 & 2 must be performed first, and sometimes step 3 and/or 4. My first goal is to not hurt you or make your pain worse. My second goal is to get you the treatment you need. Most back pain cases that I accept in my clinic receive a combination of treatments. These treatments may include one or more of the following:
- Chiropractic adjustment
- Massage and/or Manual Therapy
- Intermittent spinal traction
- Stretching exercises
- Strengthening exercises
- Spinal Decompression
- Cold Laser
- Trigger Point Injections
- Nutritional Counseling
So there you have it, back pain in a nutshell. This post is definitely not all-inclusive, but should help you out with your back pain treatment options. Look for more information in my future back pain posts.
Micah D. Carter, DC, CCST