Serious medical conditions such as infections, internal disease, tumors, fractures, and metabolic disease should always be considered in anyone suffering from low back pain. In these situations, a “definitive” diagnosis is often straight-forward and determined by paying attention to key “red flags” and performing the appropriate tests. You can CLICK HERE for an overview of such RED FLAGS.
Once these above situations have been excluded, there are really only 6 areas of reasonable certainty regarding low back pain diagnosis and treatment. These 6 items are:
1. Everyone has a low back.
2. Most will experience low back pain at some times in their lives.
3. Methods used to diagnose low back pain are unreliable.
4. Most EVERY type of treatment will work for SOMEONE.
5. NOTHING works for EVERYONE.
6. It is IMPOSSIBLE to predict with certainty what will work for ANYONE.
I know the above seems unscientific. But, this is really the state of our present certainty regarding low back disorders and may partly explain why confusion and differing opinions arise as you seek help.
There is also a 7th category, but this is more about “knowing what we DON’T know, so I will handle it separately.
I call it; “things we know, but confuse us even more.” Here are some of the things in this seventh category:
• Many people have normal imaging (MRI, x-ray, etc) but still have significant low back pain.
• Many people have horrible looking imaging showing arthritis, disc bulges, scoliosis, spondylolisthesis, etc. but have never had a day of limiting back pain in their lives.
• Most every structure in the low back is capable of producing pain when irritated.
• The type and pattern of pain from any of these structures is the same, regardless of the structure that is involved. This means that..you cannot really tell what structure (where the pain is coming from) by the type of pain you experience!
• There is no single examination procedure, test, or imaging finding that can reliably distinguish one structural source of pain from another.
Complicating things further is recognizing that, as INDIVIDUALS, we are all DIFFERENT. These differences can play a large role in not only how we experience pain, but the response we may obtain from various forms of treatment.
We are different in:
• Our genetic susceptibility to pain and response to many medications.
• The resources available to care for our needs. (time, money, sick leave, family support, etc.)
• Personal lifestyles and habits.
• The demands of our jobs.
Although many more items could be added to the above list, I think the point has been made. Considering this, it is easy to see how a “one size fits all” model of care falls short for many people. This can also explain why your response to a type of treatment may be completely different than someone you know who has had similar treatment, or seems to be experiencing a similar problem.
So, recognizing some of the challenges described above, what should you do?
• First, take responsibility for your own health habits. These play a role in your response to care and recovery. Know what you can do to help yourself. There’s much you can do.
• Be informed when looking for a doctor or treatment. Avoid situations where “hype” or bias supersedes facts.
• Work with a clinical professional who is thorough enough to insure that the serious disorders, if present, are detected.
• Work with a clinician who is open-minded and academically honest about what is certain versus what is reasonable or possible. It is also likely that this type of clinician would be open-minded and willing to recommend alternatives if their method of care falls short of meeting your goals.
Beating Low Back Pain Shouldn’t Be Complicated. CLICK to Learn About SpineCamp Workshops