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.

Low Back Syndrome - A Simple Solution to a Chronic Problem

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.