Sunday, May 1, 2005

Back Pain: Solving the Riddle

by Timothy J. Maggs, DCIssue:May 2005
Chiropractic Products

Is it time to rethink our approach to back pain?

Pain sells. Pain has spawned an entire industry that brings in billions of dollars per year. From over-the-counter and prescription drugs to pain-management centers, many people are desperately looking for answers. Traditional medicine is ill-equipped at solving the pain riddle, because—as most chiropractors know—pain is a result, not a pathology. When pain gets its own diagnosis codes (724.1—thoracic pain, 724.2—lumbar low back pain), it is clear that those in charge might not know what is underlying.

While there are many varying viewpoints on back pain, it is important to recognize the vast difference between the conventional, medical approach and the viewpoint of this author. It is time that the entire health care community admits and recognizes the inadequacy of the current approach toward back pain.

Q: Why is back pain so prevalent?
Medical Approach: Every day, the spine and back muscles must maintain balance with weights whose load is magnified many times. When you lift something, your body acts as a lever—and the farther that item is from your spine, the greater the load is on your back. If you lift 10 pounds, that item may be 3 feet away from your spine. That translates to 30 pounds of weight that your spine has to carry. When you are sitting and leaning forward to use a computer, the load force of your upper body is two times greater than when you are standing upright.

Maggs: We are all architectural structures. As we age, the many contributing factors that dictate our Structural Fingerprint® , such as heredity, age, weight, height, condition, prior injuries, shoes, mattress, job, and diet, predispose all of us to imbalances, joint fixations, and muscle weaknesses. These defects, at some point, produce pain. Until we detect and correct these defects, we will never truly address the cause of back pain. If left unattended, degeneration of joints prevails.

Q: What is the best way to prevent back pain?
Medical Approach: The most important thing is to do what you always do. Most back pain results from changing your routine, which is why weekend warriors run into trouble. Taking an aspirin or an over-the-counter pain reliever before you exercise or lift things is sometimes recommended. Or have a cup of coffee; caffeine is thought to help prevent back pain.

Maggs: Back pain, first of all, is a result, not a condition. In most cases, back pain is the result of poor conditioning, coupled with other contributing factors. The best way to prevent back pain is to understand your Structural Fingerprint® , then make it a lifetime habit to work hard to improve and maintain your structural balance, joint mobility, and muscle flexibility. Americans cannot live a life of poor conditioning and think their structures will survive without notice.

Q: What is the role of exercise?
Medical Approach: Aerobic exercise is most important, because there is no blood supply to the discs of the spine. You need motion to increase the diffusion of chemicals within the discs, to flush them with fresh oxygen and other nutrients, and remove the lactic acid that builds up, which causes pain. If you work at a desk, get up and walk around every 20 minutes. Yoga and other exercises that stretch back muscles are especially helpful because stretching these muscles makes them work better mechanically. Strength training is trickier because many people have bad form and wind up hurting their backs. But, with appropriate training, lifting weights can strengthen back muscles.

Maggs: Exercise is crucial for a healthy back; however, there is a specific role for exercise. It follows structural balance, joint mobility, and muscle flexibility. To attempt exercising—especially as we age—without first addressing these other factors will inevitably lead to back or other structural injuries. Once balance, mobility, and flexibility are present, exercise now becomes the gift of life for someone, as it truly creates a happier and healthier person. But you cannot do one without doing the rest; a great life requires all.

Q: How should back pain be treated?
Medical Approach: Back pain usually remedies itself in 3 to 5 days, but most people will have a recurrence of the same type. Pain relievers help, but you really need to stay active; bed rest should be avoided. If your back hurts, ice it to reduce inflammation. Acupuncture helps some people, possibly because back pain usually lasts only a few days, no matter what you do.

Maggs: Treating back pain has to stop being the goal. Usually, pain comes on as a result of ignorance with regard to proper conditioning. The health care community endorses waiting until back pain comes on, almost like it is some alien creature that needs to be killed any way that you can. As a society, we need to address this issue long before back pain presents itself. It all begins with better conditioning of the body, beginning with an understanding of a person’s unique structural needs.

Q: Should I see a physician?
Medical Approach: Most people only need to go if their pain lasts more than 3 weeks, but you should see a physician immediately if you are also suffering from leg pain, or have problems with erections or bowel or bladder function, since nerves in the back control them. X-rays rarely are useful because they do not show soft-tissue damage. A magnetic resonance imaging procedure may be warranted, but only after your physician has taken your health history and tested your reflexes and muscle strength.

Maggs: The answer is yes, but not necessarily for the back pain. Again, a structural plan should be created long before symptoms arise. The parameters that most conventional doctors function under (leg pain or problems with erections or bowel or bladder function) represent a relatively low percentage of back-pain sufferers. Those conditions that are a result of disc herniations causing nerve impingement are less than 1¼2 of 1% of all back-pain sufferers. X-rays are mandatory on a structural examination to determine the biomechanics of an individual. However, when back pain comes on, a patient should ask the question, “Why?” and then do whatever is necessary to find the answer and correct the underlying problem.

Q: How do shoes affect back pain?
Medical Approach: High heels can cause you to hyperextend your back—but if you already wear them, stick with it. Problems often occur with women who wear sneakers for their commute, then change into heels at work. When you change the mechanics of your footwear, you change the way your foot hits the ground, and that can stress the back.

Maggs: The feet are the most important component of the entire kinetic chain, as they are the foundation of the structure. Most people pronate or have flat feet, while a significant portion of the remaining population supinates, or have high arches. When structural balancing is the goal, the best results come when the medial arches of the feet are symmetrical.

In our office, we fit 95% of all patients with custom-made orthotics, as this is an important part of the master plan to help a person have a better life. An imbalance in the foot’s arch will aggravate weight-bearing joints in the body and never allow a person to realize maximum balance and maximum function of his or her structure. This predisposes one to a greater vulnerability to injury and an acceleration of degeneration in those joints under the most stress. Custom-made orthotics can be created to provide postural support, protection from heel-strike shock, and much-needed comfort.

Additionally, if people wear running or walking shoes, they can benefit from shoe-and-orthotic options that are available to the health care profession in a wide variety of styles.

Look for the Source
Pain is usually a result of not identifying the underlying imbalance. We, as a health care community, must stop treating pain as a condition. It is our job to motivate and educate the public to identify their unique structural qualities, and then to encourage them to continue keeping their structures working well for the rest of their lives. It is that simple. CP

Timothy J. Maggs, DC, specializes in sports and industrial injury management and is a graduate of the National College of Chiropractic. He writes and speaks at numerous engagements.

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