You may think your 1st episode of a sore lower back will just go away on its own. Or, it got better without seeing a back specialist. But are these good approaches?
I thought I’d share a near taboo story with you as it relates to a recent experience of mine. I’m almost ashamed to admit as a chiropractor, but I’ve never suffered from low back pain until recently. Sure–the martial arts have left me with shoulder, knee, ankle, foot (including a random broken toe earlier this year), elbow and wrist problems as well as the occasional headache and neck stiffness.
But never an episode of low back pain.
My first one came pretty much out of the blue. Sure, I’d had a pull over my left glut region with bending over fully and really stretching out that I’d been meaning to get worked out with some aggressive soft tissue work like Graston Technique. And sure, most of the people I train with in ju-jitsu outweigh me by at least 50 pounds AND are more skilled than I am (not a good combination, in case you’re not able to figure that one out…at least for me).
But there was no single defining episode that kicked it off. And this is pretty darn consistent with what patients who have had his or her first episode of low back pain will tell me. Or at least that’s what they say if this is the first episode.
More often than not, the episode of low back back is not the first one the patient has experienced. Far too often, this is just one of many low back pain episodes that has occurred over the years.
For seemingly ever, we have viewed low back pain as a single discreet entity, although those of us that treat low back pain understand it differently. It is more of a continuim of occasional or frequent flare ups over the course of months, years or decades.
My personal belief is that these initial acute episodes turn into this recurring pattern because they were never properly treated in the first place. Or not treated at all because the victim thought it would “go away on its own”.
Understanding what happens when you ignore that initial episode, I have made sure that, for my initial flare up of lower back soreness I have gotten competent soft tissue treatment and adjusting from the other chiropractors in my office. My episode is not over, but I am confident that it began as a soft tissue problem–some tweak or thickening of my thoracolumbar fascia.
Left to heal on its own the mechanics would become altered, leading to some degree of joint dysfunction down the line. I am making sure that it is fully addressed NOW, rather than letting it go to progress to the “typical” pattern of low back pain that so many seem to experience.
This particular study seems to support this notion. Researchers questioned 589 people who were currently suffering from low back pain. They asked about having prior episodes of low back pain and, if he or she had a prior episode, how did the current episode compare in regards to pain intensity, interference with leisure and work activities, duration of episodes, and pain extending further into the buttocks or legs.
Their findings were very consistent with what I see in my office:
- In 73%; of respondents this was not the first episode of low back pain
- 66.1% reported their first episode lasted less than 3 months long
- 54% had experienced 10 or more episodes
- 19.4% had more than 50 episodes.
In those with recurrences, 61.1% reported that at least one aspect of the pain was worse in recent episodes.
- A mere 36.9% felt that this episode was better than the last
- 20.5% were worse in all aspects noted above.
- 8.6% were better or the same.
There was one last important factor teased out in the questions asked by the researchers.
In 3 out of 4 of the low back pain sufferers, the pain location changed during the episode. Most commonly, the pain first spread further before retreating back towards the spine during recovery. Again, a very common findings.
So what does this all mean?
First, as seen in other studies, early treatment may be critically important to prevent future episodes. My personal bias would be seeing a chiropractor that specializes in soft tissue treatments combined with adjusting.
Second, at some point insurance needs to consider treatment for low back pain (as well as many, if not most, musculoskeletal complaints) as ongoing. Currently, this is not the case. Treatment for most musculoskeletal complaints is considered short term and NOT ongoing. There currently is one middleman company that our office deals with that seems to think any type of ongoing treatment should not be authorized.
Great. Authorize the diabetic to take insulin for 6 weeks or the hypertensive patient to take a beta blocker for 8 weeks (just kidding–we shouldn’t authorize the use of beta blockers for blood pressure at all!). Or how about Lipitor just until your cholesterol drops below 200.
Did you seek care immediately after your first episode of low back pain, and, if so, from what type of provider?