Will I Ever Get Off the Back Pain Merry-Go-Round?

Many of you have experienced first hand how overwhelmingly difficult eliminating back pain for good can be. As a physical therapist, we often hear about failed attempts to get relief from different treatment options, including chiropractors, personal trainers, and even physical therapy.  I think the majority of the problem for these people is twofold.  The first problem comes from not identifying the root of what is causing the problem.  The second issue lies in incorrect treatments that will not provide lasting relief.

The first problem is caused in part by diagnostic testing that doesn’t tell the whole story.  A physician may look at a CT scan or MRI that shows “arthritis” and presume the only path of treatment is rest, medication, or pain management.  However, current research (see our previous post from June - Get PT first) shows manual therapy and exercise (sorry, but yes- exercise!) produce the best results.  I remember just this winter a patient coming into our clinic frustrated by many failed attempts with multiple trials of treatments.  The same patient suddenly had resounding success when the correct problem was identified and addressed. So what was the difference? Back pain diagnostics can be misleading when the injury is only part of the problem causing pain. Let’s go back to that pesky “arthritis” example. Say your MRI shows a degenerative disc, DDD, or stenosis (all common types of arthritic conditions). These injuries often put additional stress and strain on otherwise healthy tissues in your back.  If the whole system is not addressed by treatments, your back will continue to be irritated and painful.

The key here is choosing a Physical Therapist who takes the time to not only listen, but who also does a thorough examination to fully understand the problem.  Finding the provider who has gone the extra mile by obtaining advanced education and certifications ensures that this critical exam is performed correctly.  Our unique body of knowledge combines both anatomy and neuroscience, making PT’s the first choice in musculoskeletal injuries.

So now let’s talk about treatments- exercises and all! I can remember in the not-so-distant past, research told us the “gold standard” for treatment of back pain was to simply show patients a home exercise program.  Well, for any of you who went down that path… let me know how that worked for you.  For a lot of us PT’s, intuitively, that just didn’t make a lot of sense. The current research, which is referenced above and in other articles, shows us that exercise needs to be specific and targeted to gain the lasting benefits patients are looking for, and that usually doesn’t happen handing out home programs.  These articles also show us that the exercises alone aren’t as effective as when they are coupled with manual therapy.  

So, you may ask, what is manual therapy?  Mostly, it’s just what it sounds like.  A PT uses their hands and occasionally tools to cause a change in the function or mobility of your soft tissues (muscles, ligaments, and other connective tissues).  Sometimes, restrictions in these tissues are the cause of the pain. Sometimes they restrict as a response to the pain.  Either way, if not addressed, these tightened tissues will complicate and perpetuate the problem. The issue here is that manual skills are not easy to come by and can be quite detrimental if not performed properly.  Look for a therapist who is at least certified, or preferably, someone who has gone through an extensive fellowship.

Now the 500-pound gorilla in the room… exercise!  For some you, exercise falls into a natural course of treatment.  For most, I’m going to assume it seems counter-intuitive to exercise when you’re hurting. I think this comes from a common misconception often applied to exercise: “no pain, no gain”.  In the realm of rehabilitation, exercise has a much broader meaning. It involves neuromuscular re-education, it addresses imbalances in muscles that support certain joints of the body, and it builds endurance instead of strength.

I know… this is a lot to take in all at once.  A lot of this goes beyond the scope of this post.  The most important thing to take away is this: If the muscles surrounding and supporting your back aren’t working together in a fluid pattern, they’re adding to the problem.  Be sure your therapist addresses the cause of pain, and then watch your treatment finally begin to work.