“Doctor said I need a backeotomy”
Based on the World Health Organization, over the course of your lifetime, you have a 60-70% chance of having lower back pain and each year, 15-45% of individuals experience an episode of lower back pain. Of course, it is more common in older adults when compared to children, but the highest occurrence rates tend to be in individuals 35-55 years old. The WHO estimates that 149 million work days are missed per year due to lower back pain in the United States. The resulting financial burden is $100-200 billion dollars including about 2/3s of that to lost wages and decreased productivity. So, a highly common musculoskeletal problem that results in astonishing economic hardship...there has to be TONS of conclusive research on how to curb lower back pain?! eh….
The WHO reports several risk factors for lower back pain including obesity, occupational posture, depression, sex, and age, but in many situations, the cause is unknown and the diagnosis is obscure. To be completely honest, imaging can help, but very rarely directly correlates with a patient’s symptoms. If the lower back pain is compounded by pain in the lower extremity, the provider MAY be able to recognize patterns that match a level in the spine to better guide treatment. Although back pain can be extremely debilitating, the source of the pain is not likely to be serious. Hence, imaging does not necessarily correlate with symptoms. I have seen people with pristine MRIs swear their back was broken in half. On the other hand, I distinctly remember one gentleman that had a bout of back pain but returned to play basketball fully at a high level although his MRI looked “like a bomb went off,” per his physician.
Bulging discs/”slipped discs,” more specifically, are found in 30% of asymptomatic individuals in their 30s. The likelihood of a bulging disc WITHOUT symptoms increases 10% every decade. That means, an 80 year old individual has an 80% chance of having a disc bulge. Some consider these to be a normal part of aging, just like wrinkles. Like anything, these can become symptomatic and you may have had NO IDEA it has been there allllll along. For example, I have a torn meniscus but the only time it bothered me is when I was catching 2-4 baseball games per week over the length of a season. When I’m not squatting for 3-4 hours, NO PROBLEMS! That tear is there but asymptomatic 99% of the time.
Regarding treatment, there are numerous studies looking at small muscles in the lower back(multifidi), core specific exercises and manual therapy including joint manipulations. Also, there are classification systems developed to cluster specific groups of symptoms and treatment guidelines. This is likely a result of the complexity of back pain and the difficulty in developing a specific diagnosis. More recently, research into mindful exercise such as Tai Chi and Qigong have showed promise over core specific exercise. Additionally, therapy including a more psychological approach focused on pain education, mindful reduction of the fight-or-flight response, and graded exposure to previously “fearful” activities has gathered steam. If you read our previous blog “What is Pain?” then you’ll recognize some of this. As with most chronic conditions, studies are finding a much larger psychosocial component in lower back pain including previous experiences and fear than previously thought. All that being said, physical therapy is effective at improving lower back pain and decreasing limitations, but it is not a one size fits all approach. In most cases, it is a good idea to modify your activity, stay as active as you can, and gradually re-introduce previous activities.
Overall, lower back pain is extremely common and although it can be debilitating, it is very rarely medically serious. I do not mean to say it does not suck...a lot, but more so the pain is not typically associated with a serious pathology. It does suck. I know, I’ve been there. Research shows it is important to seek care quickly and avoid bed rest. At Rogue Rehabilitation, we have extensive knowledge of numerous techniques for pain mitigation including joint manipulation, which can have a neurophysiologic impact on decreasing pain and dry needling, which new research has shown impressive decreases in pain threshold, overall pain, and opioid use. Reducing pain is highly important, but returning to normal activity usually involves exercise. I try to treat the lower back as I do other parts of the body...look for contributing factors including muscle imbalances and strength deficits, hip and/or thoracic spine stiffness, correlate those with observation of painful functional activities, work on normalizing the imbalances and retrain the movement patterns for pain-free functional activity.
If you or a friend/family member have lower back pain and want some guidance, contact us at Rogue Rehab!