It seems like everyone has a cure or a solution to the problem of back pain, yet, the record for back pain treatment by most therapists, medical providers, and even some chiropractors sometimes is often less than desirable, failing to give us long term relief of pain. Can an underlying shoulder problem make your lower back spasm in pain? The truth about back pain is that most of the time, the back pain is merely the symptom. Why your back hurts needs to be properly diagnosed before offering an effective treatment option. There is growing evidence of a lack of understanding by the health professions regarding lower back pain. They understand that people are in pain and they understand how to recommend medication or treatment protocols, however, they do not understand why you hurt. This disconnect in care is likely why so many people in chronic pain have turned to opioids and other medications through pain management when other methods failed to relieve their pain. Treatments such as manipulation usually done by chiropractors (1) have been shown to have effectiveness in recent studies such as the Annals of Internal Medicine and chiropractors by their nature take a holistic, yet multifaceted approach to most back problems. Conversely, orthopedics had admitted having a poor understanding of back pain for years (2), with millions of unnecessary or unhelpful surgeries that may have made problems worse rather than better for back pain sufferers. While the chiropractic profession has the best record with lower back pain and highest satisfaction, there are still too many patients who do not get sufficient relief and we need to ask why? If you have been from doctor to doctor searching for the cure for your lower back problem, are they looking at you or at your lower back? If you herniated a lower back disc, is your healthcare practitioner trying to figure out why it happened or are they doing diagnostic tests and recommending interventions they hope will relieve the pain. This type of hit or miss try it and see if it works method often doesn't, and the patient eventually finds themselves in pain once again searching for the next method that may help. When patients do feel better, it is not unusual for the problem to return, or another problem that was related to the underlying problem to now cause problems such as foot or knee pain since the mechanism behind the back pain was never fully understood. While anyone in pain wants fast relief, finding out why you are hurting requires much more than looking at the area of pain. One of the most common reasons for lower back pain is the upper body. Of course, the core (the midsection of the body) is important, but did you know a tight upper body, tight shoulder capsules [caption id="attachment_4717" align="alignleft" width="403"] shoulder Joint Capsule[/caption] (they surround the joint under the muscles) and restricted upper back and rib movement can cause excruciating lower back pain and even cause a disc herniation? While it is not in the many articles you will see on the internet, the upper back must function with proper joint movement as well as your lower body including the legs, and hips. The pelvis if working properly with the legs and the fascia (the connective tissue surrounding the muscles and joints) should act as a huge spring, absorbing motion and distributing forces from the ground up as we walk and propel ourselves forward against gravity. People who are built asymmetrically often have problems with this mechanism called gait and may require foot orthotics (shoe inserts that help level the pelvis), exercises, or some other intervention from a healthcare provider to improve the way they move. It is also common for the upper back to become quite stiff over time, as our bodies work against gravity, compensating for body asymmetries, as we age. In the book Cheating Mother Nature, what you need to know to beat chronic pain (3), Dr. Charschan discusses Dr. Brian Rothbart's bio implosion theory. Basically, when the feet fall in or turn out (known as over-pronation), the body will adapt to this by leaning forward and the shoulders will roll forward too. This rolling forward is caused by the abdominal fascia and the hip flexors becoming tighter, restricting the movement of the arms, shoulders, rib cage, and neck. The end result is chronic neck tightness or stiffness, a distorted core (midsection), and over time, pain. After a while, the ribs will not move properly, and neither will the neck since much of our neck motion comes from the mid-back and lower back pelvic regions. This also affects the way we breathe, since effective breathing requires a rib cage that is working properly. Then, imagine, that each joint is supposed to move in a coordinated fashion but because of asymmetry, accommodation of the fascial system (the connective tissue that surrounds the muscles and organ systems and helps us move), and the aging of the joints, you lose that coordinated ability. Most of us notice only stiffness which we believe is "just normal" because of developed gradually over time. Finally, you either lift something or wake up with your lower back pain and you do not understand why. Is it the mattress, the back, something serious, tight shoulders, joint capsules, and upper body joints that are straining the lower body joints? Most lower back pain sufferers are unaware of why or how this is happening to them, and unfortunately, neither are their doctors. Recently, a patient experienced this phenomenon; As she explained, she went to bed perfectly fine and the next day, her lower back was painful and she had difficulty getting out of a bed without pain. Her usual ritual would be to take some Alieve when she had pain and then go to bed. When she came into our office, she had problems standing straight and felt like her hips were under pressure. A careful evaluation revealed tight anterior shoulder capsules (the soft tissues surrounding those joints) and severe stiffness into the mid-back and rib cage. She also noted her hands felt like they were going numb. Even though she was in pain in her lower back, her lateral and rotational hip movement was normal, however, her upper body was stiff, and her shoulders were rounded. Relief came from stretching the joint capsules which were very tight, loosening the pectoralis minor muscles and the mid to upper traps. She noticed immediate relief and after about a half-hour, the tingling in the arms went away. Another patient we had not seen in a few years had a badly arthritic shoulder which also had a shortened joint capsule. She had discontinued the recommended shoulder capsule stretches and over time, learned to live with the pain and stiffness which worsened over time. She also woke up with lower back pain which markedly improved with stretching the shoulder capsules and improving upper back mobility. More is now being written about movement being a huge part of why we hurt, especially in the lower back. Evaluating lower back pain based on a superficial history has over the years lead to poor decisions by patients and their doctors on things they can do to get relief resulting in billions wasted on treatments, exercises, and other regimens that failed to solve the problem for many lower back sufferers. How should your healthcare practitioner evaluate you? From the point of view of this healthcare practitioner, all healthcare providers must look at the patient first, how they walk, move, and use active testing to see how their body works against gravity and what their capabilities are. Sometimes, a test as simple as a squat can yield a lot of information about why you hurt. Dipping on one side or the other with rotation can show a foot-related core stability problem. Rotation and dipping can explain why you have knee problems since this shows your core not only does not stabilize but also is loading the knees which can lead to chronic leg, foot, and knee problems. Not being able to get down far enough can reveal tight calves, while poor balance while doing a squat can reveal a stiff upper body. As a healthcare consumer, it is important to understand that back pain does not simply show up one day as there is a functional reason that begins with movement. Many back pain sufferers who do not respond to the many treatments or exercises may not have a back problem, but do have shoulder problems that are not symptomatic. The condition of adhesive capsulitis does not just materialize one day, but occurs after many years of compensation restricting shoulder movement, often with just "normal stiffness", which is often a precursor to a painful condition. Unfortunately, the problem with symptoms is that they are not the problem, but a message from the body that something is not right. The problem is finding out what that problem is, and it often has little to do with where you hurt. While there are many other provocative movement tests that should be done to accurately evaluate why someone hurts, unfortunately, there is no one standard and only a select few providers have learned about active evaluation and test - treat - test protocols, which are rapidly becoming the gold standard for evaluating and successful treatment and rehabbing painful problems. Since many painful joint and back problems are now being recognized as problems of movement and the fascial system, wouldn't it make sense that an examination for the root cause must be active? Some systems exist, such as Grey Cook's Functional Movement Screens, FAKTR, and we have developed our own system based on years of practice experience. Back pain is essentially a movement problem. It needs to be evaluated and treated that way for the best outcome. A comprehensive approach using joint manipulation, myofascial treatment, and exercise retraining offers the best and most cost-effective path to freedom from back pain. Since we are all unique, each patient must be uniquely assessed and treated accordingly. Using protocol-based care which is common in physical therapy and even in some chiropractic circles is not enough; thinking and understanding first, and then offering treatment based on that understanding and then proving what was done that day was effective (treat - test - treat) offers the best likelihood of a resolution of the problem. We are mechanical beings, requiring mechanical solutions. http://journals.lww.com/spinejournal/Fulltext/2015/09010/Do_Participants_With_Low_Back_Pain_Who_Respond_to.5.aspx http://theeagleonline.com.ng/back-pain-still-remains-a-puzzle-for-orthopedic-doctors-expert/ http://www.amazon.com/Cheating-Mother-Nature-What-Chronic/dp/1461128471 You can schedule an evaluation online today using this link.