The Problem of a
Low Back Problem

If you watch much television or have paid a visit recently to a family medical

doctor for low back pain, the information you're getting may be a flawed. For

example, you've probably been told that back problems are not very serious

and that the problem is quickly cured with simple treatments, such as going

back to work or taking an aspirin. One commercial recently aired, shows a

patient bent-over in a stuck position, who is apparently cured by taking two

aspirin. These advertisements convey the message that back problems are

trivial and that cures come in a bottle.


The reality is far different. Few studies show that taking pills does any good at

all. More importantly, they tend to mask mechanical problems of the back that

need mechanical types of treatments. Most back pains are problems of the spinal

joints, either moving too little (fixation dysfunction), or too much (instability).

These small problems grower bigger when you consider the spine is the lifeline

of good posture. You really cannot do too much with a bad back. You may not

be able to work, play, or even sit for longer than fifteen minutes. This can have

far reaching consequences for everyday life and its enjoyment.


By treating these minor aches and pains as signals of something wrong that

needs to be properly diagnosed and corrected, is the best way to manage this

type of injury. When these problems are ignored or improperly treated, it's only

a matter of time before the minor sprain turns into a disk protrusion, and

eventual degeneration or arthritis. With arthritis there will be substantial limits

on the function of the low back. With lack of function comes reduced quality of life.


My treatments involve spinal adjustments, which are designed to correct the

misalignments of your low back vertebrae, and improve the range of motion

of the individual spinal joints. When joints are functioning normally, then the

nervous system will be less irritated. Your back muscles will become more

relaxed and less painful if the joint is not irritated through improper position or excessive motion.


By addressing problems when they're small, future disability may be avoided.


A Natural Solution To Back Pain

Getting your health back after a spine injury can be problematic if you do not

approach it holistically. What is meant by holism? In general it is caring for the

person as a whole vs. individual parts, and using techniques that assist different

bodily systems. It can be treating the mind as well as the body. It is well known

that depression is an important risk factor for back pain.


When dealing with a mechanical spinal problem, the doctor needs to consider the

condition of the disks and ligaments, scar tissue, muscle strength, posture,

movement, and alignment. A simple prescription, while effective at reducing

pain, is not a good solution in the long run. For example, the scar in muscles that

is formed after injury when NSAIDs (ibuprofen) are used is much weaker. The

patient needs to also consider the side effects of stomach or gastrointestinal

bleeding that can come with long-term use. Leaving joints problems to sit for

years while masking the pain, will just make future rehabilitation more difficult

and less effective.


Pain is a signal for your body to avoid certain movements and can be very

protective. While muscle pain is good during rehabilitation, if there is ligament

or joint pain, then you're pushing it too hard.


Exercise and stretching without attention to joint injuries, will also not work over

time. It's hard to maintain exercise when there is joint pain. Chiropractic care

can keep the spine and other joints flexible while you also approach the other

aspects of spine function with specific exercises and stretching.


Maintaining a healthy body weight is also part of any holistic approach. If you're

overweight, this adds tremendous stress to your spine. In some cases it may be

important to first get your weight down, before commencing an exercise

program, or weight training.


In addition to proper weight control you have to also consider sound nutrition in

terms of vitamin and mineral consumption. Most patients need to do better at

eating green leafy vegetables, fresh fruits and other nutritious foods. One has

to avoid harmful fats, and chemicals/preservatives that are often present in

highly processed foods. Supplements such as manganese and glucosamine

chondroitin may help joint health. Although there are few studies on exactly how

effective these supplements help, the downside or side effects are quite minimal.


A doctor of chiropractic can advise you on integrating a holistic approach with

spinal joint care, strength training, flexibility, and sound nutrition.


Low Back Pain and
Failed Back Surgery

Back surgery is quite common in the US with hundreds of thousands of

operations each year. Sometimes these are laminectomies and diskectomies

and other times the spine is fused together so certain joints no longer move,

a critical spinal function. The conservative medical approach/thinking is rest,

medications, exercise, and physical therapy. If these fail, then epidural injections

are often used. If there is little relief, at this point in the patient's course,

chiropractic care is usually not considered, and many patients follow the medical

trajectory toward surgery.


Although most surgeons wouldn't consider an operation to be effective for back

pain, most patients think this is the primary concern for the surgeon. In reality,

the surgery is more indicated when the nerve root is compressed and there are

neurological signs such as muscle wasting, foot drop, or numbness. If back pain

is the primary problem and not leg pain or numbness, then surgery should

generally be avoided.


But most patients with leg pain will also have low back pain, and this low back

pain can be quite severe. The patients that have this continued pain or

numbness, are called surgical failures. The term for this is failed back surgery

syndrome. Entire medical conferences have been devoted to the topic/problem.

Patients are left with few medical options after a failure and re-operation is

especially problematic. The patient may be prescribed an opiate patch, or

perhaps an implanted spinal cord stimulator, or both. These devices send

electrical impulses through tiny wires that carry the signal to different areas of

the spinal cord.


Sometimes these approaches work but too often they don't. By their nature

they cannot correct a joint problem. If you had a joint/disk injury before the

surgery, it is likely it is still there. Post surgical cases should be evaluated by

a chiropractor to see if there is an underlying joint problem that the can be

adjusted specifically.


There may be some natural alternatives to electrical implants and long term

opiate medications for pain control. Certain physiotherapy, ice, exercise, and

massage can be incorporated into a comprehensive drugless management

program. Even counseling and behavior therapy can help to lessen the need

for medications. Usually patients can be safely adjusted after the initial surgery

has healed (about six weeks). It is important to consider all options before

repeat operations. Active rehabilitation combined with specific chiropractic care

can be the solution for many patients.


What Can You Do To
Prevent Low Back Pain?

One important concept in spine care is making the patient an active participant in their rehabilitation. It's important to change our sedentary lifestyles so that we not only get well, but also do things that prevent problems from occurring in the first place. But first, it is important to understand how back injuries occur. When we bend and twist and pick up things, tremendous forces are placed on the disks and ligaments of the spine. It's important for muscles to be coordinated and flexible so you have maximum strength to resist.


Hopefully you've begun an exercise program. One of the more neglected areas of daily spinal hygiene is stretching. By stretching the muscles that move the bones and joints, we make them more flexible. This can make you more resilient at resisting heavy or awkward loads.

The important thing is to do stretches correctly. In general you want to be warm when you stretch. If you're not too warm, then proceed slowly, gradually bringing more circulation to the area. After a long walk is a good time to stretch. You can also do stretches throughout the day, even in your office chair. Simple hand and shoulder stretches can be done at the computer, and can help to release tension in the shoulders and wrists.


It's helpful to hold the stretch for at least 40 seconds so that the muscles have a chance to respond and elongate, and do not bounce, or move in a quick or rapid way.


If you have a back or other joint injury, it's important that certain stretches are avoided, because they can further increase the stretch on ligaments. For example, you may not be able to touch your toes right now, but there are better ways to gain this flexibility than through toe-touching stretches. This is because bending forward can also aggravate a lower back condition. Instead you can bring the leg up to stretch the back of the thigh by placing the foot on a chair or table (acting as ballet bar). By keeping the low back in good upright posture, the back of the thigh is stretched while also lowering the stress on the spinal disks.


Paying attention to these simple preventive measures can be worth a pound of cure down the road.


Low Back Pain and Work Injuries

About 1/3 of patients with low back pain will consult a doctor of chiropractic. People who injure their low back on the job also often consult a chiropractor. One study (J Occup Environ med 2007;49:1124;Wasiak R, Kim J, Pransky GS) looked at these on-the-job injuries and how chiropractic care was used. In this report from Massachusetts, about 89% of workers initiated chiropractic care within 30 days of the injury and about half (48%) were done with their care in the same time frame.


At work and during lifting the lower spine and disks are especially vulnerable to injury. Heavy loads or simply awkward or stooped positions can be risks and should be avoided. Of interest, more people tend to injure their back in the first two hours of a work shift. This may be because the disks swell up with water during sleep and are more pressurized first thing in the morning. Or perhaps we're not as attentive to lifting with good form, first thing in the morning.

If you've suffered a back injury it's important to get checked soon so that you have the best chance for getting back on the job quickly. Bed rest and staying inactive are usually not healthy options for treating the low back. Inactivity can make back sprains worse by causing the muscles to weaken. Walking keeps pressure off of the disks and keeps the muscles engaged. If walking aggravates your pain, then it has to be avoided in the short term. Of course lifting following a back injury has to be limited. It's important to lift with your legs and to avoid twisting motions.


Chiropractic adjustments are designed to improve the mobility of the spinal joints, improve posture and decrease tension on the delicate ligaments and nerves. In many studies chiropractic care has exceeded the results seen with conventional medical treatments such as medications or surgery.


When a back injury occurs, commonly the vertebrae move out of their normal position from the stretch of the supporting ligaments. Simply leaving the ligaments in this stretched-out position may not be healthful in the long run. Since the ligaments are injured, the vertebral joints tend to move abnormally. This is called a mechanical back problem and is one of the most common diseases of the lumbar spine.