In February of 2017, the Annals of internal medicine guidelines were published regarding back pain treatments. Their message was that the non-pharmacologic and non interventional treatments were more effective, and safer. Conservative non drug
back pain recommended treatments include exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation).
Most users of chiropractic care felt that finally, the medical communities premier journal is supporting a profession that has proven its worth over the years to athletes, to working people and the general public. Other methods that may work were also mentioned as well. They were very specific about limiting pharmacologic methods since it caused the Opioid epidemic and has never been shown to be effective for long term problems in the lower back.
If you read the recommendations carefully, as a casual reader, you may already use exercises, or Yoga, and find that it is helpful, but does it work? Whether something works is of course in the eyes of the beholder, however there is a theme that runs through many of the pain control ideas; movement and the brain.
Methods such as manipulation, Yoga and rehabilitation exercises as well as Tai Chi are based on movement, while bio feedback, cognitive behavioral and relaxation is about teaching the brain and causing it to learn new tasks. Tai Chi is about slow rhythmic movement patterns while allowing for cognitive relaxation through movement.
The brain will learn many good and bad movement patterns, often as an adaptation to our body style. We are all built differently and body style typically runs in families. It also is the basis for many people who suffer from back and neck problems, sciatica, plantar fasciitis and many other gait related issues. The brain adapts through neuroplasticity which happens very quickly in children and much slower in adults, which is why some rehabilitation regimens may not be fully effective for months, depending on the problem.
The best approach for back pain is a multifaceted approach that is the norm for today’s practicing chiropractic physicians. The recommendations that were offered last year in the Annals of Internal Medicine unfortunately, leaves the patient in charge of figuring out which movement method is best for them.
Chiropractors often use multiple methods to evaluate and appropriately treat the condition, and will customize the care to you. This is quite different that the protocol driven care found in most physical therapy offices that offer care to a body part, instead of recognizing how the body is integrated. An integrated approach is going to be the best and most cost effective approach to figuring out why you hurt.
The most effective rehabilitation for lower back problems should include the following
- Personalized care and understanding of someone’s body style during the initial history and an active evaluation of the person.
- Manipulation of the spine and extremities when needed to further restore movement patterns.
- Corrective exercises to retrain movement patterns and strengthen areas of the body that are functioning poorly.
- Myofascial treatment of the fascial system.
- Analysis of the feet and correction with foot orthotics if necessary.
Doctors of chiropractic are physicians who take a holistic approach to back problems and the most effective ones will use active evaluation and active treatment regimens which personalize care. This approach can often mitigate future problems such as knee or hip problems, sciatic pain and even plantar fasciitis, which are problems due to movement.
Methods you should try only as a last resort include
- Surgery that reduces motion through the spine.
Most chiropractors are now assuming the role of primary spine practitioner. This means they are your best choice for conservative care of the musculoskeletal system.
Whom you see first will determine your experience with a healthcare problem. For all things back related, see your chiropractor first.