Part Two of a Three Part Series
In the last blog, we talked about how low back pain in managed in the US. Today, we are going to discuss evidence-based and practice based measures of effective low back treatment. The evidence shows us that there are specific criteria to indicate which treatment is best.
Appropriate for a manipulation?
For acute low back pain, spinal manipulation is appropriate if :
1. the duration of the current episode is 16 or less,
2. there are no below the knee,
3. the FABQ (Fear avoidance belief questionnaire) is less than 19,
4. they do not have more than one hypomobile segment in their spine,
5. and they have adequate hip internal rotation (>35 degrees)
Therefore, the first step is to determine if the patient is a candidate or not. Depending on the severity of symptoms, patients with acute low back pain can be treated in one to two visits and they are typically pain-free. As stated above, a manipulation is appropriate for acute low back pain. But, we are NOT moving bones, we are not putting things back into place, we are creating a neurophysiological relaxation response. That’s what the nervous system needs to decrease it’s pain signals. Thus, the antihyperalgesia (decreased sensitivity to pain) produced by joint manipulation appears to involve descending inhibitory mechanisms that utilize serotonin and noradrenaline. When it’s hyperreactive, we need to calm everything down.
Then, the focus should be on breathing, moving, and simply getting back to normal. Diaphragmatic breathing will help to inhibit pain, so that is one of your most powerful things to do to inhibit pain immediately. Based on pressure changes, and some of the receptors in the viscera, when diaphragmatic breathing is performed, there is an inhibition of pain, but also an improvement in the reflexive stability, the sequencing, coordination, and timing of all of the core musculature. And that’s pretty powerful with acute low back pain, wouldn’t you say?
Using touch, or kinesiology tape for example, provides a sense of safety to the nervous system. We have 500 nerve cells per square centimeter skin, so giving input to the brain can be a powerful tool outside a visit to a rehabilitation .
Lastly, walking and addressing the movement issues that contributed to the problem in the first place is imperative in order to prevent this from happening again.
Is imaging necessary?
MRIs, Xrays, opoids are most often completely unnecessary and prolongs the period of time that you are experiencing pain. This is turn leads you to a chronic pain state, otherwise know as chronic sensitization of the nervous system.
The MRI that showed that you have a herniated disc is not the cause of your pain! Most often, it does not even correlate with it. Anyone over the age of 35 that gets an image is likely going to show degeneration, a bulging disc, or a herniated disc. Additionally, MRI’s are rarely interpreted incorrectly. Instead of looking at an image, it’s important to see how someone moves, how someone feels when they move, what is what’s provoking their pain. What makes their pain feel better?
I am speaking on behalf of many of my colleagues. It is easy for us to evaluate and figure out what’s going on and be able to give you an appropriate treatment. You need to find the right quality rehabilitation professional. I do want you to know that acute is very treatable and you don’t need opioids and images to help with that.
Stay tuned for part three….What is chronic pain and what can you do about it?