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Resolve Low Back Issues Part 4: Most Common Myths Of Low Back Pain

Few musculoskeletal conditions have a cult-like following of myths as Low Back Pain, many of which have been said by various healthcare providers across all specialties. To help clear the air, let's take a look at the 5 most common misunderstandings and myths that we encounter in our chiropractic clinic that could actually make your low back pain worse.

Before we get started…

These myths and misunderstandings are not aimed at making low back pain seem 'made-up,’ it is a very real and challenging condition. These myths are just folklore passed down from old, unsubstantiated in the research, ways of thinking. Our truth is that, if you believe one thing and that makes you feel that your low back is wrecked for life, they a long road of pain is what you are in store for. We call this fear-avoidance and catastrophizing, the medicalization of a condition. We will touch more on this when we cover imaging next week. But a big part of recovering from low back pain is believing that you can get better. It may sound silly, but no more ridiculous than believing these myths below!

NUMBER 1: Your back pain is from a misalignment, bone out of place, or a ‘subluxation.’

We don’t practice this way any longer, stop using explanations from this era.

We don’t practice this way any longer, stop using explanations from this era.

These are common descriptions patients and doctors alike will give when describing their back pain.  The most common being...you threw your back out, and it is now misaligned...commonly spoken by chiropractors of a generation ago or current doctors, chiropractors, and physical therapists that have not caught up with current research.  The truth to this is that your spine is a dynamic structure designed to move, what we ACTUALLY find is that the pain you are feeling is often associated with immobility, or areas of the spine that should be moving, but due to tight muscles and previous injury, may not be moving well or correctly anymore.  Spinal manipulation or an ‘adjustment’ is designed to restore normal motion to these restricted areas.

A bone did not shift out of place and therefore needs to be put back in! That’s not how it works.


NUMBER 2: Arthritis is the root of all evil!

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Arthritis is like wrinkles on your face…lets just keep it nice and say they are signs of wisdom. Truthfully, if you live and play hard and long enough, we will all experience some degree of degeneration.  However, and please understand this, it is a natural process and does not necessarily equate to pain! When conditions present that are more challenging, using arthritis as the ‘fall guy’ is the easy way out for a provider and an often acceptable answer for the patient.


NUMBER 3: “But…I have scoliosis and a short leg” that is the cause of my back pain.

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Just like arthritis, scoliosis and an actual short leg (1cm or shorter than the other) are comfortable areas to place blame when someone presents with back pain.  Both can absolutely lead to dysfunction, and if unaddressed, pain and discomfort. To a certain degree, uneven leg lengths and spinal rotation/curvature are normal variants, meaning most people have these at a mild level and are unlikely to be a pain generator. For most (not all) look to place the blame elsewhere.


NUMBER 4: Rest is what I need to recover, right?

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The days of ‘take 2 of these, rest, and call me in the morning’ are long gone. You likely have a relative who spent a good amount of their life with back pain that limited some or all of their activity. When you see a case like this or someone who is much too young to be experiencing recurrent back pain, it may seem like the right thing to do is rest up for a while. Fortunately, we now have stacks of research that supports the fact that bed rest is the worst (top 3 at least) idea when it comes to low back pain. The new adage is ‘Movement is Medicine.’ When someone presents to our office, we are not only just trying to relieve pain, but to relieve pain SO THEY CAN GET OUT AND MOVE. Even walking, WALKING, has been shown to reduce low back discomfort and be a great tool to prevent future occurrences.

NUMBER 5: Slap a brace on it & it will be fine.

Brace low back pain long term & you should join the circus with that thinking.

Brace low back pain long term & you should join the circus with that thinking.

This is excellent advice if you are looking to weaken your core muscles completely. Did you know that powerlifters use the belt to their advantage to complete amazing feats of strength not to brace their low back, but to give their stomach something to press in to, creating intraabdominal pressure (think bracing your stomach if someone was to punch you) that stabilizes the spine from the inside? Our bodies are amazing, it has its own ‘weight belt’ built in. Using straps, belts, or any other contraption like this for extended periods of time tells your body that you do not need it to do its job anymore. This core weakness and inability to naturally brace yourself through muscle control —> LEADS TO CHRONIC LOW BACK PAIN.

In summary, things change. Our treatment methods and your outlook on your condition must change. Every single one of these five myths is still spouted today in an office somewhere near you. Knowing the validity of that is often more important than the care you receive. While in certain circumstances, these can be valid reasons for low back pain. For most, especially those who come through our Cottonwood Heights, Utah Chiropractic and Rehabilitation clinic, we want a better answer. One that helps address and correct the dysfunction. One that promotes confidence and encourages the patient to try harder, that they can feel better and live a life they enjoy.

Next week, in part 5 of our Fix Your Low Back Series, we are going to discuss red flags, when you need imagining, and why you shouldn’t always rest your diagnosis and pain on those images.


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.



Runner's Knee Part 4: Treatment, Rehabilitation, & Return To Running

After three exhilarating weeks of discussing Runner’s Knee, we have covered the anatomy, mechanism of injury, hip and ankle mobility, training modifications when injured, and self-care options. This week, we culminate with what happens when self-care is not enough, when you need to seek help, and what that looks like.

SEEKING HELP

When to seek care while dealing with patellofemoral pain is a common question we encounter.  In all honesty, as a runner, our natural tendency is to ‘wait & see’ and try to run the problem away. Furthermore, some will try and rest a week or two, putting training on hold, only to start running again and find the knee pain is still present.  

Not to be all high and mighty, but in my professional opinion, the earlier you seek care, the less likely you are to lose precious training time, and the quicker we can get you over Runner’s Knee.  To help simplify this, here are three rules to adhere to when debating care for your knee pain.

Knee pain is worsening with each run, earlier in the run, and lasting longer after each run causing your training to suffering.
Knee pain is not responding with consistent self-care and proper warm-up and cool-down routines.
Knee pain starts to be present during regular daily activities such as walking, taking the stairs, and rising from a chair. 

WHAT DOES TREATMENT LOOK LIKE

So, you have decided to seek help with Runner’s Knee.  

Step one: find a doctor that runs!

Now that step one is out of the way, let's talk about the basics of what actually happens and what you can expect from care in a sports medicine/chiropractic office.  

To get us started, let's look at the hardest question first...How long will it take?  That is a hard question to answer because every case is different. Each person presents with a different level of pain, unique exacerbations, varying training volume, intensity, and running age as well as racing expectations and outlook on their condition.  From all of that, nailing down an exact timeframe to peak performance is elusive. However, typical treatment plans range from 2 weeks to 2 months, again depending on goals and time the condition has been present.

Once this is understood, next is to understand that this is a team effort.  For the majority of clinics, you will only be actively receiving care for 1-2 hours per week.  What happens the other 166 hours of the week is up to you, and we discussed that in our last article regarding self-care.

When an athlete presents to a clinic like ours, treatment should be a 3-tiered approach.  

Soft Tissue:  As we have reviewed the anatomy, we know that there is significant muscle ‘issues’ involved in runner’s knee.  For this reason, this is where we start. How to decrease the tension and abnormal pull from muscles so that the patella tracks correctly and decreases joint wear is one part of the puzzle.  There are numerous ways to achieve this and in our clinic, we find Dry Needling, Active Release, IASTM - instrument-assisted soft tissue mobilization, and cupping therapies to provide the best, and quickest, results.  
Joint Mobility & Stability: After the soft tissue is addressed, we look at the structure.  As discussed in our second article, the mobility of the hip and ankle are vital to correcting and relieving runner’s knee pain.  Manipulation is designed to restore normal motion to a joint that is currently not moving properly. Over time, restored joint motion can improve running mechanics and decrease strain and stress placed on the surrounding muscles.  
Rehabilitation Exercise:  Lastly, once we have the muscles and joints under control, a building back up must occur in two ways.  One, we must create stability and control of the joint through muscle strength. Two, training volume must begin to ramp up, slowly and controlled, which we discussed in the third article of this series.  To further address part one, rehabilitation exercises need to be explained and directed.

Below is a basic 3 phase rehabilitation program aimed toward relieving patellofemoral pain, while helping to build back up and prevent future occurrences.

Phase 1:   During the first phase of care, our exercise prescription is aimed at pain relief and mobility improvement.  These exercises should be performed 3-5 times per week, preferably as part of your running warm up if we are able to continue training through care.  We start with 1 set of 10 reps for each exercise and 30 seconds for the wall sit, working up to 2 sets over the course of this phase of care which is typically 2-4 weeks.

 
 

Phase 2: The second phase of care focuses on returning to your full running volume while building strength and stability.  We expect to perform these exercises 3-5 times per week again, preferably before running but we will start with 1 set of 15 for each exercise and a 45-second hold for the wall sit.  Over the 2-4 weeks of this phase, we will work up to 2 sets of each exercise.

 
 

Phase 3: The third phase is aimed at strength and injury prevention.  At this time, we move to self-care as the patient is released from active care.  Our goal is to perform 2-3 sets of 10-15 reps for each exercise as a warm up before each and every run.  

 
 

RETURN TO RUNNING

Once we work thorough care and training is gradually ramping back up, or you have been consistent with home care, how do you know you are ready to return to full, unrestricted running?  To help determine if you can get back out there and get after it, we utilize our return to running assessment.  Our goal here is to complete each of the five exercises without pain.  In this assessment, each exercise must be completed for 60 seconds, with as many repititions as possible.  

 
 

Finally, we have covered more information than you could ever want to know about patellofemoral pain syndrome.  Hopefully this has been enough information to keep you out of our office, but...runner's have many other issues and injuries to face and Runner's Knee is but one of them.  Until next time...

Train Smart, Recover Well, Race Great!

-Dr. Reheisse


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.