Low Back Pain – Why it happens and how
Ever wondered why you get low back pain and how it occurs? Understanding this can be a step in managing your pain if you are a sufferer; of which about 80% of us are at some point in time. This suffering is at immense cost to the NHS; in particular, those cases that are poorly managed, due to incorrect referral, poor services, or lack of understanding and compliance of the patient.
Research is positive for all the therapies that support back pain care and I am very respectful to the gamut of professionals out there that are part of the package of care available. However sometimes we could work better together with the patient as the primary focus, and that is the focus in this month’s article.
What I hope to do here is, from a chiropractors viewpoint, make it clear where patients benefit from our services so that those who don’t receive it can make an educated choice of whether they need our services or not. Also what the best outcome of their back pains is, as pains like these can have a negative effect on lives and I often find they shouldn’t need to with the right intervention.
The back is a chain of joints sitting on top of a ring pelvis. If you can imagine the spine twisting like a rung out wet towel, then this is what happens when we get back pain. That twist is usually triggered by one joint, or muscle associated to a joint, which is the primary trigger in this twist. The pelvis is like a chassis of a car, which has its own twist along the hips line. As chiropractors we specialise in the diagnosis of which bone, or muscle and bone (as it’s never one or the other) involved in the lower back pain. This ‘misalignment’ causes pressure in the joint, tissue, disc, or nerve. And the degree of pressure in these small segments relates to how much pain we suffer, or the degenerative arthritis occurring in these spinal joints.
Many people think back pain happens, and then goes. I’d like to break that myth once and for all. In truth it is this that starts the mismanagement. A free check-up at our clinic will show anyone whose acute pain has diminished, that segments of their misaligned spine – where the body has lost normal motion – are still present, even if they are improving. This applies more often to the chronic sufferer (if you’ve had it more than once) and less so to the ‘one off’’ that only lasts a day or two.
Dysfunction of the bony structure in our spine, or any joint, is a process that occurs over time. This is due to changes in our shape, or weaknesses that occur over time due to: bad postural habits, emotions (the fight or flight response) or trauma. If this dysfunction had a cumulative scale of 1-10, a person suffering from chronic back pain who had an acute attack would be at 10 (some sufferers say 11!). This would drop back to maybe 7 or 8 as their norm. A pain free person would be at 0 or 1, but like a ratchet, many of us are tightening until we cannot take any more change. Then comes the sneeze, the shoe tying, or whatever catalyst that triggers that pain and, ‘voila’, it’s falsely the shoe or sneeze that’s to blame!
Once these parts have been specifically reorganised so the pressure between the vertebrae has been eased, people are often restored to a new sense of themselves, one that hasn’t been felt for many years. If a specific investigation into the movement of your bones hasn’t been done, then rest assured you are in some degree of adaption that is cumulative. No one else does this type of fine tuning and I often compare us to a dentist, where families join us, receive the acute frequent care package they need to put things right, then use the service when pain comes back again. Alternatively have an ‘MOT’ of maybe one check-up, regardless of pain levels, every 3 months.
I feel privileged to be in a profession that is having progressive, positive outcomes as evidence of our part in the management of back pain. And I am proud to say that in 2009 NICE (National Institute for Clinical Excellence – an institution that advices health centres on what therapies/medicines have enough evidence to be used in the NHS) advised GPs that chiropractors should be referred to if lower back pain persists longer than 6 weeks. Osteopaths are included in this advice, too. Add to this the patient satisfaction we receive (our in-house survey shows that 80% of our new patients come from other patient referrals, who enjoyed recovery through our services) and it’s a good recipe in the right hands.
Due to all this positive coverage, I am also proud to have completed our first ever application for chiropractic to be funded by the NHS and am awaiting the acceptance for my clinics. With this, our service will inevitably be curtailed somewhat and, like dentists, we will then be able to offer a simplified service offering quick sessions of chiropractic, along with more comprehensive care in a private setting. If a patient’s funds are tight then joining us through the NHS funded option may be a possibility. Thereafter, a self-funded ‘MOT’ of infrequent care will create your best outcome.
Hopefully I haven’t medicallised back pain in such a way that you have fallen into a stupor, but next month’s article will focus on the mystical!!
Kind regards in health,
Mike Noone, Chiropractor, BSc, DC