Resolve Low Back Issues Part 7: What Happens When You Need To Seek Care?

Our intention with this series on Low Back Pain has been to inform and empower you, or your loved ones, to take action and realize that movement can help, as well as, prevent low back pain. That your low back pain is not a life sentence.

While all of this information is useful and should be utilized before, during, and after a Back Pain episode, the reality is that some people will need to seek care.

You have had a front row seat to one pillar of our care, the education and exercise component. When seeking care for low back pain, putting your faith solely in one person, and relying on them for everything is not advised and will severely hinder your progress.

YOU (YES, YOU) HAVE TO PUT IN THE WORK, TIME, & EFFORT!

As a Sports Chiropractor that treats low back pain every single day…we see it time and again in our patients… If home care is not adhered to and a person does not take their situation seriously and put in the effort, back pain will take forever (or it seems that way) to resolve.

Today we are going to give you another up-close look at our care process, this time what we actually do here in the office. Our goals are to (1) Determine the cause of your pain/injury (2) Provide care in the office that helps you toward your goal of running, golfing, sleeping, moving again…pain-free, and (3) Give you the tools and education to help yourself.

We structure our care around 3 pillars: Soft Tissue, Joint Motion, Exercise. We have exhausted our opinion and writing on exercise, please refer to parts 1-6 for direction. Now, lets briefly take a look at what care looks like inside the office.

SOFT TISSUE CARE

JOINT MANIPULATION

 
 

For additional tips on how YOU can relieve back pain, fill out the form below and grab our FREE tips sheet with 12 ways to help you relieve back pain and maintain an active lifestyle.

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Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.



Resolve Low Back Issues Part 6: Self-Care - What You Can Do For Low Back Pain

Over the last 5 weeks, we have discussed everything from what low back pain is, most common causes, some of the most common myths associated with low back pain, and when to consider imaging studies (x-ray, MRI, CT) due to red flags that lead us to something more severe being the cause. We even covered a few tips to help when you find yourself traveling for work or vacation.

We have been building up toward the actual care of low back pain, but wanted to fully educate on how common low back pain is, what we know about low back pain at this time, and help you focus on life outside of back pain.

Today, we are going to do just that.

When we look to decrease disability from low back pain, and encourage and support patients back to an active lifestyle, this is done in two ways. EDUCATION & EXERCISE. We have already discussed the education component. Now it is time for exercise. Below are 5 ways to help manage and prevent your low back pain with exercise and stretching routines that can be done at home, the gym, or even at the office.

Side Bar -> If anyone gives you a hard time, or tosses a laugh in your way for stretching at the office, I will leave it up to you to either invite them to join (because they need to do this too), or, wait until they start having an issue with low back pain and then pass them our card! Seriously though, invite your co-works to join in, make it an office party, it will be fun.

Fix Your Low Back With 5 Exercise & Stretch You Can Do At Home or At Work.

STEP 1: Get Out Of Bed With Our Morning Routine.

After a good nights sleep, it is common for our muscles to want to remain in bed. Because of this, early morning activities can challenge our bodies more than they are ready to handle, resulting in a nice low back strain injury. If you are already dealing with low back pain, you know that morning stiffness can prevent you from even rolling over, not to mention actually get up out of said bed.

 
 

STEP 2: Desk Sitters - Get Up & Move

While things are improving, the seats we subject ourselves too in our cars, on the train, and at the office are just comfortable enough to keep you seated for an extensive period of time, but provide little support to keep you from tightening up in the process. Start this NOW -> Set an alarm on your phone that goes off every 1-2 hours. Walk around the office, hand deliver a message, and then take 30 seconds and perform these stretches.


STEP 3: Pre-Workout Hip Mobility

We are going to assume you have a daily routine of some exercise? If you do not, reset, and start adding some exercise to your life, no other method is as impactful on helping your low back issues. Once you get to the gym, or home if you prefer, go through a GOOD HIP MOBILITY routine. We know that the more we improve the mobility of our hips, the less our low back has to work…overwork.

 
 


STEP 4: Post-Workout Core Strength

The same goes for core strength as hip mobility. The stronger our core, the less our low backs have to work. Now…I don’t mean getting down on the floor and performing a half-hearted set or some sorry excuse for crunch/sit-up type exercise. We are talking functional here. Planks, Side Planks, Plank Rolls, Heavy Farmer and Suitcase Walks, as well as The Big 3.



STEP 5: Strength For Life

Most people who have dealt with low back pain have since, and forever will, shy away from true strength movements. But let me just plug that as humans, you should be able to squat as well as pick something heavy off the ground without fear of hurting yourself. As you work on hip mobility and core strength, you have to start working in squats and dead-lifts. Start with these modifications and work on control and endurance.

Exercise is considered the best medicine for low back pain. While this is true and I strongly support this. Our actual goal with care is to get our patients back to these activities. But often, patients present in enough pain that they are unable to run, ski, bike, weight lift, etc. With that said, most can start with basic stretching and mobility until the pain is relieved. From there, exercise can prevent flair-ups, or at least decrease their intensity and length of the episode. Either way, low back pain has to have a component which includes YOU doing some, if not most, of the work.

Next week we will look at some of the traditional, as well as, new developments in conservative care low back pain. Until then, and if you are craving more reading, check out our ‘12 Ways..’ Tips guide to further help your low back pain.


Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.

Resolve Low Back Issues Part 5: You Are Not Your Image. (Red Flags & Imaging Considerations)

In part 4 of our Fix Your Low Back series, we discussed some of the most common myths and misunderstandings around low back pain, care of low back pain, as well as updating some of the old-fashioned thoughts. Today, we are going to discuss imaging and red flags as it pertains to low back pain and a couple of VERY IMPORTANT things you need to know.

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Imaging is a excellent diagnostic tool, when appropriate, to help ASSURE PROPER care.

Not-so-long ago, a patient would walk into a chiropractic office and get a standard set of x-rays; or they would schedule an appointment with an orthopedic physician and would be required to obtain an MRI before they can be seen.

This standard practice has fortunately been labeled as inappropriate, and national organizations such as the American Chiropractic Association and American College of Physicians have recently taken a strong stance against these practices.

CURRENT BEST PRACTICES

  1. Do not obtain spinal imaging for patients with acute low-back pain during the initial 6 weeks after onset in the absence of red flags.

  2. Imaging should not be utilized to monitor a patients progress.

WHAT WE KNOW ABOUT IMAGING NOW

There are two extremely important things to know concerning imaging…

  1. Imaging can be harmful. Radiation aside. Unnecessary x-rays and MRIs can bring to light ‘normal variances’ that are NOT the generator of pain, but are easy to blame. This causes what is being referred to as the ‘medicalization’ of low back pain.

    Example: Someone presents with low back pain, an image is immediately ordered, it shows a bulging disc or some other skeletal irregularity, and the blame for the complaint is placed on this without further discussion. This patient goes on to think that they are doomed to low back pain forever, that their ‘bad back’ will keep them from enjoying their normal activities, and unfortunately, they end up with a regular dose of over-the-counter and prescription drugs.

    Now, this is not always the case, but once or twice each month, a patient with low back pain presents to our office stating that they had a bulging disc in their low back over 10 years ago and have been in constant pain ever since. These cases have more to them than just pain, the overutilization and misuse of imaging leads to fear avoidance and catastrophizing. Both are always present in chronic low back pain!

  2. Through recent studies, we know that to a certain degree, lower spine degeneration and pathology are normal, AND NON-PAIN GENERATING, at almost all ages.

What is so important about this chart? Well….

These numbers represent the percent of specific age groups that had degeneration and disc pathology of the lower back in patients who had NO SYMPTOMS OR COMPLAINTS whatsoever.

Also, this was no small review….this study included over 3100 people!

In review, If we took a pain-free 40 y/o person with NO history of low back pain…

Almost 70% would demonstrate degeneration on x-ray.

50% would show a bulging disc on MRI.

Our take-a-way here… YOU ARE NOT YOUR IMAGE! They can play tricks on your thinking and make your back pain much worse just by you believing that what your image is showing is the end all be all of your pain.

With that aside, we do need imaging. WHEN INDICATED THROUGH A PROPER EXAM! Imaging is great for ruling out serious pathology.

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RED FLAGS

Red flags are indicators that let physicians know there might be something more serious going on. This can come from a simple history and exam and they demand attention and should be considered before care of any kind is provided. With that said, here is a small list of ‘Red Flags’ common with low back pain complaints.

  • History of Cancer.

  • Night Pain.

  • Progressive Neurological Symptoms & Weakness.

  • Pain Following Trauma (Fall, Auto Accident, etc.)

  • Sudden Loss of Bowel or Bladder Function.

  • Recent Weight Loss.

  • New Back Pain With Fever.

  • Failure of 4-6 Weeks of Conservative Care.

  • History of Recent Fracture of Suspected Fracture.

  • Family History & Signs of Osteopenia & Osteoporosis.

In summary, and I hate to keep harping on this, but your imaging results may not be as important as they are made out to be in regards to uncomplicated, and even chronic, low back pain.

  • Spinal degeneration, disc bulge, and other pathologies are often normal findings as we age and have not been proven to be pain generators.

  • Imaging early in the care process in the absence of red flags is NOT in line with current ‘best practice’ suggestions and guidelines.

  • Studies have shown that a thorough history and exam with your provider can provide information to determine the actual cause of your low back pain.


Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.