On most Sunday’s, I will have emergency new patients who have lower back pain or multiple complaints of lower and upper back pain. While I do my best to put the fire out in their most painful area, often, especially with chronic problems, it can take days to resolve the pain fully and improve how they function to reduce the likelihood of a recurrence in the future. The recent study, published in the British Medical Journal echoes what was said in the Annals of Internal Medicine in 2017; most treatments for back pain fail to relieve or resolve the condition. Lower back pain in this most recent paper suggests that only one in 10 back pain interventions work which is an awful record. This includes interventional which may include surgeries, and therapies and non-interventional which may include medications. The Annals of Internal Medicine offered a list of things that can work in 2017. Chiropractors use a number of them to successfully help back pain patients and your best chiropractors will holistically look at the patient and ask about everything before treating the patient. Chiropractors have been given high levels of confidence compared to other health professions for their methods of relieving or resolving back pain. Most healthcare providers image and medicate with surgeries being a final option and they often send most patients to physical therapy with a script for protocoled care which often fails to solve the patients’ problem. The one thing common in methods that relieve back pain is movement. In the case of chiropractors, they use manipulation and mobilization, myofascial release, exercises, foot orthotics and some use other methods to reduce pain and improve mobility. The key to success if understanding the patient and figuring out why they hurt. In the medical world, patients will be given a cursory evaluation by their doctor, usually at an urgent care, receive cocktails of medication that has proven not to work and then, as their problem becomes more chronic visit someone else for therapy, injections, chiropractic care, etc. Most patients may spend weeks or months experiencing treatments that do not solve the problem and even when the pain improves, it returns over time because the mechanism behind why you were in pain was never addressed. Is it any wonder that protocols to where you hurt instead of why you hurt often fail? Worse, insurance is often a middleman that gets in the way by using networks, deductibles, pre-certifications, and other methods that can cause people to delay needed care. It is not unusual for a patient who has already experienced ineffective care in their network to pay cash for a more effective plan of treatment. You can read the article in the NY Times below to understand why most treatments for back pain fail, although as a practitioner who helps many people improve or resolve their back problems by looking for causes and then treating the mechanisms of your pain, see my thoughts after 40 years of successfully helping back pain patients. What Works for Low Back Pain? Not Much, a New Study Says Resolving Lower back pain requires you to understand the cause. When a patient calls with acute lower back pain and wants fast relief, I do what is necessary to help relieve their pain. Patients usually can move and feel better, but it is not unusual for them to have a difficult night ahead of them due to inflammation that improves with movement. Inflammation can take days or weeks to resolve, and they may not realize they are moving and walking better because they continue to hurt. There is no magic pill, but you can improve someone’s back pain by first taking a good history and then a good evaluation to understand why they hurt. You must understand what is unique to them and how this uniqueness may be behind why they hurt and explain to them as you evaluate them what is behind their pain. Everyone is different and applying treatment to a lower back using a protocol often fails. This may be why the current study shows the record of back pain is so poor. As discussed in my book Cheating Mother Nature, What You Need to Know to Beat Chronic Pain., many of the traits behind why you hurt have been with you since childhood. Dr. C’s rules for proper back pain diagnosis. Get a detailed history of their back problems including other problems that may have improved or resolved over time. Any abdominal or other types of surgeries in the past and did their problems begin after or before those surgeries? Active scars from abdominal surgeries such as hernia, c-section, or other abdominal surgeries may be a cause of back pain. How did this episode occur? A family history of back or similar problems indicates the problem may be related to inherited traits. A thorough evaluation from the ground up. Connect the dots and see if there is a pattern behind today’s back complaints and the other less urgent problems they have been living with. Treatment must improve function and movement, which reduces pain and improved function reduces the likelihood of future episodes. Work with insurance if you can, but patients may need to pay out of pocket to get the care they need. Once there is an understanding from the data that I share with the patient of why they hurt, treatment is performed to patient tolerance to improve mobility and function. When patients are in pain, they may only hear every 4th or 5th word I am saying. Then the care on that visit is designed to improve mobility, level their hips with the use of foot orthotics which improve how they feel and function and have them follow up with a second visit to document improvements in pain and function. Exacerbations happen. Even with the most careful treatment methods, inflamed joints can be aggravated after that visit by; Prolonged sitting in the car or at home. Muscular structures that re-tighten as the body re-adapts. Patients will readapt to how their body functions after their visit. . Resolving chronic malfunction on one visit will never happen, however, some patients notice they feel great the day after the visit and worse the next day due to many factors they may not understand. Our recommendation is to communicate your concerns and show up for the following visit. Often, the patient is less sore, and able to move better but may believe they have not improved even though they had. Barometric pressure often exacerbates pain and the effects are often felt a day or two before it begins to rain or snow. This is because we are 60% water and a low pressure system can cause areas that are swollen to swell more. There are some studies that are not conclusive on this but our office is often behind schedule on rainy days due to this phenomenon. If you markedly improve and believe your problem is solved, great although one visit is unlikely to do more than temporarily relieve the problem. Be sure to follow up with your doctor. By following the directions to walk and move after your visit, you reduce the likelihood of a exacerbation and most patients get out of bed and move better the next morning. The back may still hurt due to inflammation but movement and improved function is progress. Resolving the cause and reducing the likelihood of a reoccurrence. Resolving your initial lower back pain is important so you can again function at work and at home. It is likely that your back pain may have only been the tip of the iceberg. The shoulder, knee, foot wrist neck, and ankle issues all may be part of the malfunction that resulted in the back pain episode. Just like with electricians or plumbers, sometimes you just need a healthcare provider with a license to help you feel better because they can be more objective about why you hurt. Many older patients have damaged joints and degenerated discs because they were not given good advice when they were younger. You have one body and the replacement parts are not as good as the original parts so be sore to take care of it through the years. Your chiropractic physicians recommendations are designed to help you feel and function better while resolving the current episode and preventing future episodes of back pain. We recommend that you Follow the doctors course of care both in frequency of care and with the recommended exercises given to you to help you recover faster. If foot orthotics were recommended to you, continue to wear them as recommended and replace off the shelf inserts every 6 months. Make chiropractic care part of your healthy lifestyle with periodic visits, similar to how you would visit your local dentist. Prevention is always better than acute episodes of back pain that are painful, interrupt your lifestyle, and can become larger problems years later. Need help today? Book online now.