As a chiropractor, I sometimes hear my patients tell me that they started a new exercise to help their back pain only to discover that the exercise made the pain worse. Why would a certain exercise make one person’s back pain better but hurt someone else? Why does one person rave about a treatment for back pain being like a magical cure, but the same approach cause someone else to get worse? In this article I will:
- Explain why responses to treatments for back pain can be so different.
- Give you some practical tips for determining whether your doctor is the right person to treat your back pain.
Back pain has many causes. Because the spine is complex, when it hurts it is important to determine exactly what’s causing the pain. All too often I see medical doctors simply treat the pain and ignore the cause of the pain. Currently one of the common approaches in a medical office is to do nothing for six weeks. If the pain goes away, then it is assumed that everything is fine. Another very common treatment is to prescribe a drug to lessen the inflammation, pain or muscle spasms. It is no surprise that study after study shows that the standard treatments for back pain are pretty lame.
Because the spine is so complex, it is no surprise that there are many different treatments, and that the testimonies of their effectiveness are so varied. What works for one person doesn’t work for another. Most often the problem is not the treatment itself, but rather not matching the right treatment to the specific problem.
Back pain treatment is not a one size fits all. If a doctor’s approach to your back pain is, “Take this drug and let’s have you come back in six weeks,” get the heck out of there and find a doctor who can actually determine what is wrong with your back. It drives me crazy when the thinking about pain is so shallow. Here’s how that thinking often goes:
- Patient has pain
- Patient has inflammation causing pain
- Give patient something to lessen inflammation and the pain.
Let’s see here…what about WHAT CAUSED THE INFLAMMATION????? When you have pain, most of the time it is caused by inflammation, but inflammation is ALWAYS caused be SOMETHING. Guess what happens to the CAUSE when back pain is treated with drugs and time? Is it really that difficult to understand that if the cause of the inflammation is not fixed, the pain will return and will continue to get worse and worse? So, unless you want to experience your back pain over and over, go to a doctor who is going to determine what is mechanically wrong with your back and then fix it.
I’d like to say that only one particular type of doctor is guilty of this kind of lame thinking. Unfortunately, I have seen doctors of every profession practice like this. It doesn’t matter if the approach is a drug, a type of exercise, or a particular treatment. If everyone with back pain gets the same exact treatment, something is wrong.
So how do you determine if your doctor is top notch? Well first off, the doctor should have asked you a bunch of questions about your back pain. You should feel like the doctor understands everything about what you are experiencing. If you leave the doctor feeling like he or she did not understand your problem, it’s time for a new doc.
The doctor should do a thorough exam, in which you have to bend in many different ways. In the exam the doctor should actually touch your back and ask you questions as he/she palpates your back. If the doctor’s exam is brief, and he/she hardly did anything, and never touched you, it’s time for a new doc.
After a good history and exam, the doctor may need to order x-rays or some other imaging test. However, if the doctor x-rays everyone, it shows a lack of discernment and confidence. Once all the diagnostic information is in, the doctor should give you a very informative explanation of exactly what is wrong with your back. The explanation should also include the plan for treatment. You should know exactly what is wrong and how the treatment will fix the problem. If you are given a brief explanation that leaves you wondering what is wrong with your back and clueless about what the treatment does to fix your back, it’s time for a new doc.
All of this should lead to excellent results. The vast majority of back pain problems, if treated correctly, should respond very well. Weeks and weeks of drugs or therapy with not much change is a clear sign that the problem is not getting addressed. In my practice it is pretty typical to see people have 50% improvement within 2 or 3 visits. Obviously there are exceptions, but before I begin treatment, I tell those patients that are going to require a lot of treatment why and what to expect as we go. If we don’t see certain improvement at certain points along the way I stop the treatment, look for other causes, and even refer the patient to another professional if necessary.
The research on successful back pain is discouraging. However I hope this article illuminates you as to the reasons for the poor success rates. You ought to have a good handle on why the problem is not usually with a particular treatment, but instead the problem is with matching the right treatment to a particular problem. Back pain does not need to be a life sentence to chronic pain. Most back pain is easily fixed. If you or someone you know are not getting the results I have described, shoot me an email or put a comment here and I will dialogue with you about it.