Back pain continues to be the number one thing we find limiting patients from living their best life. This has been true for a long time and it’s fair to assume that you, your parents and grandparents have all dealt with back pain at some point, What is interesting is how the management of the same back pain has evolved over the years.
Your grandparents likely managed lower back pain by just toughing it out (because let’s face it, they are way tougher than us!), the use of pain medications and often times even unnecessary surgeries. The generations that followed were pushed into traditional physiotherapy and chiropractic which was giving decent outcomes using things like electrotherapy, stretching and hands on massage/mobilization of the direct area of pain. These results were generally found to be temporary. The diagnosis was something along the lines of “mechanical low back pain” and it was believed that things will get better with time and before long we would get back to what we were doing. This lead us to where we are today.
As health care evolved to become more patient centered, clinicians and patients were demanding better results and a firmer understanding of the exact cause of what is happening. Good practitioners today know that there is really no such thing as “non-specific lower back pain”. There is a reason your back hurts and a detailed assessment should be able to determine exactly what that reason is.
We have had the most success treating back pain when we use a modern approach involving movement screening to help identify where things go wrong. Void of trauma or specific blunt injury we need to understand what went wrong in the daily movement process that lead us to back pain – Movement matters! Our spines are resilient powerful structures and the idea that “sleeping funny” caused you to have debilitating lower back pain is not going to cut it anymore. Sure the poor postures that you slept in could have been the trigger, but something was wrong well before then to get you to this point.
Successful assessment and treatment of lower back pain needs to look at movement as a whole. The notion of looking at lower back pain in isolation is no longer considered adequate. Treatment plans for patients with chronic low back pain that focus on a single structure often result in poor outcomes.
Movement assessments encourages us to look beyond the site of pain and focus on dysfunctional relationships that are likely putting unnecessary strain on the structure in question (in this case the lower back).
Still with me? Here is an example from clinic last week. Patient “John” presented with left sided lower back pain radiating into his left buttocks. He said that pain began after shoveling. John is a healthy 47 year old man and avid runner, he is in great shape and reported no falls or trauma related to this back pain. It was easy to see the muscles on the lower left side of his spine were tight and tender to touch, this also went down into his glutes. He had pain when bending forward but was ok when bending backwards. Now, we could theoretically stop here, We found some muscles that are tight and some joints that are irritated. We can stretch these muscles out, mobilize the restricted joints and John will likely feel and move better after treatment. But is that a long term fix? Probably not, we treated the symptoms, not the cause. If the assessment stopped here, we are doing John a disservice.
Obviously, we pressed forward with the assessment. We looked and movement as a whole. Stepping away from the lower back we noted decreased internal rotation on the left hip compared to the right as well as decreased left ankle mobility. He also walked on the inside of his left foot (pronation). Traveling upwards we noted that John’s mid back did not rotate well when turning right. Things started to add up as to why john is having back pain!
Left sided lower back pain – started with a standing and likely a rotating movement (Shovel)
Tight (or over worked) muscles through the whole left side of the lower back/hips. So the question became, what is causing these muscles to work so hard? Where is the inefficiency in movement?
John’s left hip did not internally rotate well (think of rotating your left hip to the right, towards the mid-line). John’s upper back did also not rotate well to the right. SO where do you think all of John’s rotation come from when he trys to turn right? The lower back! This is the overuse pattern, the lower back is being forced to make up for the lack of mobility/strength in the area above and below it causing it to overwork and spasm. Releasing the tension will be a temporary fix, unless we correct the dysfunctional movement in the hip and mid back the lower back will continue to have to pick up the slack, overwork and become tight/painful again. Can you see how in this example treating the symptom (lower back pain) is not the answer? This is why movement matters.
This whole approach can be applied to shoulder pain, knee pain etc. Rehabilitation has evolved and your clinician needs to evolve as well. Our approach at OMNI is to always be at the forefront of learning and applying the most successful treatment methodologies to help are patients get better.
Early intervention is key!
This is where it gets difficult, pain is pain. Generally when a patient limps into the clinic with lower back pain it hurts to move, muscles are tight and there is a varying degree of inflammation around the spine. Now this makes it difficult to answer the question, “What is the cause of this patients lower back pain”. Realistically, accurate assessment is limited. We are in the acute symptomatic stage of lower back pain. Bend forwards, bend backwards, lift one leg – it all hurts! So any assessment is probably going to elicit a lot of false positive tests. This is why we encourage patients to seek an assessment BEFORE any large flare ups or to return for an assessment after we have dealt with the acute pain. If you have a nagging injury that isn’t debilitating, then that is the perfect signal to get assessed. Logically, if there wasn’t some sort of faulty movement, the nagging pain would not be nagging, it would resolve and stay better!
Our team at OMNI is here to help – Please feel free to drop in with a question or book an appointment if you think we can help!
Dr. Anil Kaushal