Back pain; A new study helps confirm why Myofascial Release improves the quality and cost-effectiveness of care.
The healthcare professions have addressed back pain for years, yet the problem continues to grow, as well as the dollars spent on this phenomenal problem. In my book, Cheating Mother Nature (2), it suggests this is an international multi-billion dollar problem that has many people selling and promoting treatments that may or may not work.
For an American public who is more frequently paying more out of pocket with high deductibles and higher copayments, they want more value in the care they receive and want their healthcare practitioners to have a better understanding of why they hurt and how they finally get out of pain.
As I tell many patients, there are many disciplines suggesting they have the answer, yet the problems come back over and over. If we are so good at what we do, why are our results so uneven. This is a very honest realization most healthcare practitioners never ask themselves about the effectiveness of their stretching or other methods, hoping the next seminar, the next technique will help them treat the problem better or give them something else that may possibly work better. When they fail, they perform the MRI which leads to injections and even surgeries that are of limited value, expensive and may actually cause other problems due to their invasive nature. The problem is not the technique, the exercise, or the procedure; its usually the thought process. The technique or the intervention is merely a tool, but how and when you use it can make all the difference. You can give everyone a paintbrush, but not all of us are going to produce great art. The truly desperate opt for surgeries which further alter the mechanics, and not necessarily in a good way. If you have any doubts, ask Tiger Woods who is on his third back surgery.
Perhaps, that is why in the 1990s, I explored many soft tissue methods such as Active Release Techniques, Graston (Instrument assisted soft tissue), Barnes, and I have even developed my own methods of treatment which are highly effective.
The most effective thing I have learned as a health care provider is to step back and look at the person, the way they move, and the way they function before I use any of these methods. From this, I also developed my own protocols for actively evaluating movement and function. This has been invaluable to patients in that it helps us figure out which areas or tissues are causing the problems which make your back hurt. Too often, practitioners treat, stretch, release, stimulate, heat, exercise, and adjust patients without understanding the reason they hurt. There are a number of schools of thought who are now teaching screens and tests that evaluate movement and neurological patterns to justify the eventual intervention, which improves outcomes.
A recent example of this is a runner who we saw who is 17 years old and finding herself in chronic pain from running. She had seen another doctor who stretched, adjusted and treated her for a few years but the problems continued to return, and she constantly was being injured. She had difficulty doing a squat, yet she was staying out of the winter track season to recover so she could excel in the spring. The patient had orthotics, but only in certain shoes, and they were not worn all the time, or in her track shoes, since they did not fit. She had flat feet which were in constant pain, her neck was always tight. Upon closer inspection, it was clear that the symptoms were being treated, rather than the problems which were one of movement, poor movement patterns and neurological habits, and chronic tightness. Our evaluation helped both of us see that her injuries were more than just injuries from running; they were patterns of movement and weight-bearing that worsened the harder she worked and they needed to be looked at differently, before attempting to work on her. I have no doubt this young lady will have a much better season this year than last. We just needed to look at her problems differently and explore a better way to address it.
If you are wondering what this has to do with the title of this blog, Back pain, she had that as well.
An important new study which included Dr. Antonio Stecco (1), one of the more commonly cited researches in the continuing development of the science behind Myofascial Release suggests that spinal manipulation is more effective when used with myofascial release. While patients of our office already know the importance of this hands-on approach, it is good to see that more studies continue to be published showing the necessity of procedures such as fascial release because, without it, movement patterns cannot improve, since the fascia guides movement, not the muscles.
You can read more about the study here
Fascial Manipulation® for chronic aspecific low back pain: a single-blinded randomized controlled trial.
The therapeutic approach to chronic aspecific low back pain (CALBP) has to consider the multifactorial etiology of the disorder. International guidelines do not agree on unequivocal treatment indications. Recommendations for fascial therapy are few and of low-level evidence but several studies indicate strong correlations between fascial thickness and low back pain. This study aims at comparing the effectiveness of Fascial Manipulation® associated with a physiotherapy program following guidelines for CALBP compared to a physiotherapy program alone.
There is of course more to this story of how we improve the quality of treatment of the lower back. In women who have had abdominal surgeries such as C sections, this is an even larger part of the pain puzzle because not only is the fascia in the back affecting the way they move, but the actual scar and what is underneath the surface is being realized as a major determinant in who suffers from chronic back and neck pain and since it affects the way they move, even their knees can be affected as well.
To cost-effectively approach back pain, the old idea of doing stuff to the painful part is beginning to be seen as a questionable approach, especially since the results are inconsistent. Most of these therapies are based on research done on dead people (cadavers) in labs, and not on the living. In a recent book on the movement of the human body called “What The Foot”, the author echo’s what Cheating Mother Nature said four years ago in that we need to become enlightened practitioners and look at the living, and the way they move and approach movement which is life, and the patient responds with improved mobility, less or no pain and they have a better understanding of how to help themselves.
An effective approach to back pain should come from the feet up, observing how a patient moves, understanding their body style and their adaptations to their inherited mechanical uniqueness, and the provider should custom tailor a program that may include manipulation, myofascial release, neurological retraining, movement coaching, foot orthotics when necessary and exercises.
1. Fascial Manipulation® for chronic aspecific low back pain: a single-blinded randomized controlled trial.
Branchini M1, Lopopolo F2, Andreoli E3, Loreti I4, Marchand AM5, Stecco A6.
2. Read Cheating Mother Nature, what you need to know to beat chronic pain, available through Amazon.com and other booksellers.