by Dr. Timothy J. Maggs, © 1999
Statistics claim that 80% of all Americans will, at some point in their life, suffer with low back pain. For the 20% who have never experienced the likes of this, don't get too comfortable. With man evolving from a 4 legged creature at one time in our distant past to a 2 legged, 20th century, cosmopolitan athlete, no one can assume that the finger of bad luck won't point at them, especially when we add the sport of running to our activity list.
Low Back Syndrome
Low back syndrome encompasses many different conditions, but the one common thread between all of them is pain, stiffness, soreness or radiation somewhere between the mid-back and the butt. All of these symptoms suggest strongly that something is wrong. Through experience, I've learned that most runners apply the "American Dream" approach to resolving the problem; they hope the symptoms are gone by morning. Others, however, apply the "Helpful Neighbor" approach; "it's probably just (I love the word 'just') an acute spondo-hypo-lumbago-whatever, just like I had, and my doctor, who's the absolute best in the whole world, said to apply heat, relax and it will probably go away on it's own. No need to worry". Needless to say, and trust me on this one, neither of these 2 approaches offer much hope for the future of a runner. And if any other uninformed recommendations are made by the well-intentioned but clinically inept, please walk away. Please don't debate, question or discuss. Just smile, thank them and walk away.
Low Back Protocol
When suffering with any type of low back involved condition, the first step is to identify the cause of the symptoms. All peoples' backs are similar to their fingerprints; very unique. And if you never identify the uniquities of your back and spine, you'll never develop the appropriate treatment and therapy that you need to correct and improve your condition. For example, any symptoms can be a result of congenital problems (abnormalities in the back that you're born with), pathological problems (some disease process that's going on), some structural imbalance (the most likely cause) or some repetitive motion condition which causes muscles to contract and spasm causing discomfort and pain. But, you can be sure that your back pain is due to something. And, the specific cause requires a specific treatment, especially if wellness and long term correction is your objective. Most importantly, forget the"specialist" who recommends only some medication to alleviate the symptoms. This will never solve your long term problems.
Of all the tests which can be done to determine specifics with low back conditions, I rely primarily on the x-ray to give me the critical information needed. Obviously, a thorough history as well as a good physical exam will assist any practitioner in developing a working diagnosis. But, without standing x-rays of the low back, any "specialist" is shooting in the dark if they make an attempt to identify the problem.
Solutions
The very first objective any practitioner should have is to rule out pathologies, or disease, as a causative agent of low back pain. I remember several years ago, I had a middle aged patient with vague low back pain enter my office. I went through the standard protocol, and after x-raying him, we learned he was suffering with an abdominal aortic aneurysm. It's the first and last time I saw an abdominal aortic aneurysm as the cause of low back pain, but due to the fact I did the correct testing, we were able to find out that he didn't belong in my office. He was in surgery within 2 days and the surgeon told him if he'd gone another 2 days without knowing this problem, he'd probably be dead. That's how important it is to know if you're dealing with a pathology or a structural problem. And if your doctor doesn't want to take x-rays of your low back and you have low back pain and haven't had them in the past few years, consider a doctor who will take them.
In most cases, however, the cause of the pain is structural in nature. With typical structural imbalances, some area of the body is always vulnerable to an increased level of stress. With the stresses of normal life coupled with the demands of running, it's not unlikely that most runners could have low back problems at some point in time. How to deal with them now becomes very important.
Once a thorough history, exam and standing x-rays have been done, it's important to have a doctor who can interpret the results and communicate them to you. Even though this sounds like a simple task, my experience is that it is few and far between who can do it all. Cherish the doctor who will make you feel confident in what he or she has found and help to manage you through both the acute and chronic phase.
Finally, a good chiropractor, osteopath who prescribes manipulation or good massage therapist is usually required to determine all of the above and correct it. For any runners who can't find the person who'll guide them through, feel free to contact me and I'll help you get the best help possible. The key is, never ever give up.
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