I have had a special interest in the low back for 45 years. It is obviously related to my chiropractic training and background, and it is also personal for me.
What is different about my approach to the lower back? First, I am trying to establish a useful and accurate diagnosis. What is wrong? What tissues are creating your pain? I start by asking, “Can I touch your pain? Can I find motions that reproduce your pain, and/or relieve your pain.”
And then, what can YOU do, in your day to day life, to quiet that pain? Can you change how you move, how you sit, how you exercise, in order to change your chronic pain patterns. It is amazing how few back pain sufferers know what to do (other than meds) to quiet their pain.
Why is this so important? If you have had pain for more than a couple of weeks, your nerves are sensitized, fired up, and irritated. First, you have to stop movements that further irritate them. Second, you have to find simple exercises or movements that quiet those nerves. Call it a lifestyle change, rather than exercise, if you prefer.
What is the goal? The goal is to make your pain minor, to get it out of the center of your life. The goal is for you to be independent, and not need me, and not need narcotics. It is not optimal to get a steroid shot every 3 months, see a massage therapist weekly, get a chiropractic adjustment every week or month. Some may need this, but you need to first learn how to take care of your own back.
Why is the diagnosis so often missed? Medical practitioners tend to pay too much attention to X rays and MRIs, and don’t know how to assess via a history and physical exam. Too many PTs, chiropractors, and osteopaths focus on what is out of alignment in the spine, and don’t realize how misalignments are usually a compensation. Too many soft tissue specialists, LMTs, PTs, and Chiropractors, pay attention to what is tight, and hope that releasing that will solve the problem. The low back is mostly about stability. The core is critical. But building core endurance is so often done wrong, making the problem worse. For starters, don’t hollow your abdomen, don’t do sit ups, and quit stretching your hamstrings.
My most successful patients don’t expect me to fix them. They do choose to participate by helping themselves. When you come to me, you are going to get homework, not just an adjustment. I prefer to solve problems, and not treat my patients forever. One of the beauties of quality chiropractic care is that I can come up with a diagnosis, and immediately treat it, ideally with self-treatment, and see whether that makes a change. I hope this article gives you hope, and a different view.