What are the best back pain treatments?
I am going to start by saying that this is a misleading question.
My problem with this question is that it assumes that there is only one kind of back pain, when in reality musculoskeletal reasons alone for back pain can be caused by muscular overload, disc injury, structural changes or nerve entrapment to name a few. This is not even considering that back pain could be a referral from the kidneys or as a result of a compression fracture or an inflammatory condition. In this article when I say back pain, I am referring to musculoskeletal back pain only for the purposes of keeping things simple.
This looking for a one size fits all method for treatment is why yoga for back pain is generally a popular class in many yoga studios. This makes sense, since back pain is quite prevalent. However, there is a catch. It is that while some back pain types love flexion, other types absolutely hate it. I deter my patients from going to generalize back pain classes during acute flare-ups because its not specific.
Once the back pain heals completely (>6 weeks post injury), this is the time to go to the yoga for back pain classes for lower extremity and back mobility and to prevent or prolong that back pain from returning, since natural history of low back pain tends to reoccur.
However, in the heat of back pain, the real question should be why am I having back pain?
Because only if you understand the mechanism, can you tackle the disorder in question with a multi-modal approach to provide the most efficient pain relief and a long term prevention plan. There is no, one, best method of treatment, but there are some pretty good conservative back pain treatments that are even better when combined.
Best back pain treatment hack #1: start with understanding the pathophysiology of your back pain
My goal as a practitioner is to make my patients their own health advocate.
As a patient you have the right and should aim to understand the etiology of your condition.
If you understand the disease process, you may understand the cause of this back pain. If the condition is flexion induced and you picked up a heavy box earlier that week, you will have a better understanding of your faulty mechanics which going forward will make you more likely to be conscientious picking up boxes.
You can and should play a big role in your own recovery.
Best back pain treatment hack #2: If you want to prevent injuries, listen to your body.
I believe, the saying of “no pain, no gain” should take credit for many perpetuating injury cycles.
If your back is feeling tight, stand up and stretch,
if your muscles are cramping drink some water, take magnesium or a warm Epsom salt bath.
If it hurts when you bend forward, stop testing it and bend back instead.
Does the symptoms persists after 24 hours? Go see a professional.
Always remember, a new injury is a lot easier to heal than an injury that has been seeping in for 20 years. Chronic pain is another long story of body’s faulty adaptive mechanism and it is much more complex than a simple acute injury.
Injury prevention is simple, a lot of it requires common sense. However, common sense is commonly ignored due to the fast paced life we live i which needs to change immediately! Your health deserves to be a priority.
Best back pain hack #3: Patient specific care is a must for implementing the best care
Know that no treatment relief lasts a lifetime and treatments should be tailored to your needs based on your current injury.
You are encouraged to take on a form of maintenance care that suits you.
The same way you are encouraged to keep exercising and eating healthy because although you have done it before, previous healthy behaviours does not protect the body forever.
It is also important to understand that the body is a cellular machine and as it gets older it needs more of a maintenance from you, in whatever forms that may be.
How well you need to take care of your body also depends on your occupation. If you have a highly physically demanding job, placing a repetitive demand on your body and your body will need more frequent care in return.
Although chiropractic/ is awesome, its not magic. You cannot expect to stay symptom free for long periods, but be sedentary, not pay attention to your mechanics or overload your muscles before they are ready.
Patient specific care means that every new injury is assessed with caution. Just because you had a discogenic low back pain in the past, does not mean that your current pain is from a disc. Every new condition must be reassessed, even with increased risk of certain conditions due to past histories.
Additionally, good care meets you at your goal, not the practitioner’s goal. After all, patient centered care is a big part of evidence based care.
Definition of optimal function changes person to person. There will always be patients who are pain based, just like there will always be patients who are proactive about health. There are patients who are ready to embody a healthy lifestyle and others who are not quite there yet. It’s important to identify where you fit in to this equation and accept the care you are ready to take on.
Best back pain hack #4:Multi-modal approach is better than a single method approach for back pain
When a patient comes in with intense low back pain, the initial treatment goal is to get the patient out of pain.
This requires understanding the complexity of the case and in my clinical experience how aggressive you have to be.
Complexity can be determined based on three factors:
1. Individual healing capacity:
An important part of recovery is individual healing capacity, but as a practitioner you provide the patient with the general recovery time because having a timeline is soothing for most. However, some people recover much faster than a provided prognosis and that is a body with a quick healing capacity. This has to do with your genetics, your risk of re-injury based on your job, hobbies, compliance to care and your nutritional status. Because healing is a multi-modal process and there are individual differences, it is important to find what is effective and sustainable for you and then implement a care that focuses on various aspects of healing. You can choose an effective strategy such as chiropractic care alone or you can combine couple of effective strategies such as anti-inflammatory diet/supplementation and an effective rehabilitation protocol to speed up the healing process.
2. Length of time you have been in pain.
The length of time you had the injury effects how fast you will recover. The most accurate currently available prognosis timelines are for acute care patients. One of the many reasons, chronic/long term injuries are less predictable and more complicated in terms of care is due to brains involvement when understanding chronic pain. Originally, pain is a protective mechanism, it is a way for your body to let you know that something is not right and needs to heal. However, as the body keeps asking for healing and the injury perpetuates, the pain becomes diffuse and loses its capacity to indicate the problem. Chronic pain becomes widespread and patient becomes sensitized to pain. Thus, in dealing with chronic pain the initial goal is no longer to get rid of pain completely, but it becomes to centralize and desensitize pain before dealing with the original injury which means recovery time is longer.
3. Damage by the compensatory injuries.
Moreover, when there is an injury at a local site, this causes compensation in other areas. Fortunately and unfortunately for us we are connected. This means you may have started with low back pain, but it eventually caused neck pain. The more local an injury is, the easier it is to treat it.
Depending on these three factors, you can identify how aggressive you need to be with care. An acute low back pain will heal completely in 4-6 weeks with chiropractic/passive care alone, whether you incorporate or not incorporate a nutritional or a rehabilitation plan. You can & should choose to incorporate additional approaches to speed up recovery and prevent further injuries, but the current episode will heal regardless.
However, if you have chronic pain or fibromayalgia incorporating all three aspects becomes crucial to recovery as the treatment is complex. In addition incorporating meditation or cognitive behavioral therapy is highly effective at this stage of care.
Good news is that musculoskeletal conditions always heal whether it is an acute or chronic condition, but we need to understand the changes in prognosis and timeline and how aggressive we need to be with care depending on the individual patient, injury timeline, age, occupation and compliance to care.
Patients rarely present with a single textbook injury. Each case is unique. Great care requires understanding individuality and taking every aspect of patient’s injury into consideration to provide a comprehensive wellness plan.
Dr. Laleh Maroufi
Your Health Advocate
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