It isn't just about the "Pop"
One of the hallmarks that you could say defines the profession chiropractic would be the fact that we use a tool called manipulation, or what most people refer to it as, an adjustment. Our profession was created using this tool and soon the adjustment became the staple of the chiropractic profession. It defined what we did. It was and still is effective with decreasing back pain. We have evolved since the 1890’s, integrating new found science into our methods, combining a myriad of treatment methods to decrease pain and increase function. We, as a clinic, have decided not to define ourselves based off of one treatment intervention, but to define our clinic as patient centered, treating conditions of the musculoskeletal system using treatments that are most efficacious in patient outcomes. We don’t just care about how you feel right now, but how you feel 3 months, 6 months and 12 months from now. We FOCUS ourselves on HEALTH outcomes and not just severity of pain. We’re invested in YOU for the long term. As much as we may like you and want to see you, we don’t want to be seeing you every week for the next 2 years for the same problem. If you haven’t read my previous blog on the life span of low back pain and the conserative approach on low back pain, I encourage you to dive into that short read to bring you up to speed with this article. Here we are going to discuss how low back pain is now viewed, where does exercise exist in care, and efficacious ways to limit episodes of low back pain.
Research is coming out stating that low back pain recurrence is extremely high. And episodic low back pain should be viewed as more of an asthma attack, rather than a curable disease. Those of you who have experienced asthma attacks can tell you that asthma attacks can happen once in the span of a year or not at all. Since we’ve already established in the previous blog that 20% of back pain has a definitive structural diagnosis and that 50% of people with back pain is a result of something we call motor control (a fancy way of saying how we strategies movement with the amount of balance, coordination, strength, endurance and mobility we are alloted). Nontraumatic pain in the back can be described as rumble strips on the side of the road, which are there to alert you when you’re operating outside the lines. “Rumble strips” being pain and “operating outside the lines” meaning exceeding the limites of the structure we’re allotted. For some people, they are labeled with a herniated disc or degenerative arthritis and are informed that they will have to learn to live with this problem receiving medication, manipulation, or massage to make living bearable and surgery to really correct the problem. If recovery doesn’t ensue then most patients are labelled as having psychogenic pain (it’s all in your head). A recent study found that when observing asymptomatic people for tears in their disc and predicting future low back pain found that it wasn’t the individual that had the most structural damage that was predicted to have future low back pain and time away from work, it was the psychometrics or what the patient believed of their condition (1). Meaning, that it wasn’t the person that had the most structural pathology that had the most pain, it was the person who had a negative connotation with their findings that did…
The missing link seems to be education, advice to stay active and pursue a healthy lifestyle. When people understand their pain and understand hurt doesn’t always equal harm, they report significantly less pain and disability (2). What is more than evident is that Americans are at a level of 77% inactivity (3). Which is leading to an underpreparation of load exposures and overprotection creating frustrating bouts of low back pain. This is why we focus on self-management and autonomy. WE are the GUIDE, you’re captain. A recent systematic review and meta-analysis observed the role of exercises in the prevention of low back pain and found that it can reduce the occurrence of low back pain and disability, and a combination of strength training, stretching, and aerobic exercises performed 2 to 3 times a week is recommended (4). A Cochrane Collaboration review of exercises concluded that “there is strong evidence (Level 1) that exercise is more effective than usual care by a general practitioner for chronic low back pain.” (5). Furthermore, studies that compared individuals who received matched exercises to those who did not have matched exercises for functional limitations or symptoms had significantly better outcomes than those who were unmatched. (6,7)
We want to decrease as much of dependency on someone else to reduce pain, if we can give you the necessary tools and knowledge to avoid episodes or decrease pain when they occur, then that is a huge win. The cracking and popping is simply a means to an end. It is not the cure. It creates a window of opportunity for us to influence how your body operates and to change the software, ultimately changing the way hardware is used. It helps us get you to exercise without pain. Those of you that have worked with me know that I say “what I do on the clinic side can get you out of a hole, but resistance training on the gym side can take you to the moon”. We want to empower you to understand what pain means and tools to reduce symptoms. That means going on a hike without the fear of your knee causing discomfort or pain, more importantly how you view that pain and discomfort. I know if we can change how you view your pain and structural pathology, and the role exercise plays, then we can significantly reduce the chances of acquiring another episode of low back pain and the severity of that episode.
References:
Carragee EJ, Barcohana B, Alamin T, van den Haak E. Prospective controlled study of the development of lower back pain in previously asymptomatic subjects undergoing experimental discography. Spine . 2004;29:1112-1117.
Lee H, McAuley JH, Hübscher M, Kamper SJ, Traeger AC, Moseley GL. Does Changing pain-related knowledge reduce pain and improve function through changes in catastrophizing? Pain . 2016;157(4):922-930. 135. Fritz J, Söderbäck
CDC. State Variation in Meeting the 2008 Federal Guidelines for Both Aerobic and Muscle-strengthening Activities Through Leisure-time Physical Activity Among Adults Aged 18–64: United States, 2010–2015. https://www.cdc.gov/nchs/data/nhsr/nhsr112.pdf
Shiri R, Coggon D, Flag-Hassani K. Exercise for the prevention of low back pain: systematic review and meta-analysis of controlled trials. Am J Epidemiol. 2018;187(5):1093-1101.
Hayden J, van Tulder MW, Malmivaara A, et al. Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev. 2005;(3):CD000335..
Erhard RE, Delitto A. Relative effectiveness of an extension program and combined program of manipulation and flexion and extension exercises in patients with acute low back syndrome. Phys Ther. 1994;74:1093-1100.
Long A, Donelson R, Fung T. Does it matter which exercise? A randomized control trial of exercise for low back pain. Spine. 2004;29:2593-2602