Shopping for back pain treatment is like going to the supermarket
Have you ever found yourself in the grocery store behind someone who obviously didn’t prepare a list and are wandering aimlessly around the store, walking slowly, looking like they’re lost, picking random items off the shelf as they meander along? Side note, this happens to me all the time and it turns me into a rage shopper. The market of treatments for low back pain has been compared to a grocery store – so many options and very little guidance to the customer as far as where to start and what works best. If you find yourself looking for back pain treatments, would you rather be the one wandering aimlessly around the store, or would you rather be the one with the list who knows exactly which aisles to go to and can get in and out in much less time?
This is what the CRISP protocols are all about. At Catalyst Chiropractic and Rehab we follow the CRISP protocols put forward by Dr. Donald R. Murphy, DC. Through his 30 years of clinical practice, work on developing spine care guidelines, teaching at the university level, and authoring many articles and textbooks, Dr. Murphy has distilled the most solid examination and treatment techniques into what is known as the CRISP protocols (Clinical Reasoning In Spine Pain). This is a systematic approach to evaluation, diagnosis and treatment of back pain in a way that pairs the most effective treatment with your condition.
You might be saying “duh,” as if this is so obvious an approach that everyone would do it. I’m going to let you in on a little secret – the problem of lower back pain has not been solved yet, despite the enormous expense that is spent on it every year by patients, employers, researchers, and healthcare systems. One of the main reasons is that low back pain, and pain in general, is so multifactorial it’s hard to pin down a simple cause and a simple solution. So if you ever seek treatment for low back pain be very skeptical of people selling you sure-fire solutions. One size does not fit all and what worked great for your neighbor may be of no benefit to you. In other words, your neighbor’s shopping list looks different than yours. If you want a quick trip to the back pain supermarket and get only what’s needed and what works specifically for you, then you need to start out with a “Thorough and Efficient History” as stated in Dr. Murphy’s book.
3 Questions we want to answer before treating your low back pain
You might not believe this, but chiropractors are considered Doctors. Our degree is a Doctor of Chiropractic (DC) degree. This is because legally we are a “portal of entry provider” – we do not need a referral from a physician to see our patients. Thus, chiropractic school prepares us to be non-surgical spine pain experts through a rigorous post-graduate program that teaches us not just how to “crack your back,” but how to diagnose the conditions that present to our offices. Without a diagnosis we cannot legally apply any type of treatment to you. This is because back pain doesn’t always come from your spine, and it isn’t always safe for us to treat it. Thus the first question we need to ask is this:
- Are your symptoms coming from something other than your spine or could your pain be caused by a serious, potentially life-threatening disease? Fortunately, the vast majority of back pain is not caused by a serious disease and can be treated successfully by a chiropractor. In my own experience, though, I’ve had patients come to me with low back pain who, upon further evaluation, turned out to have other conditions such as an infected gall bladder, pancreatitis, and multiple myeloma. If your back specialist takes a thorough history, they will be able to know within reason if it’s safe to treat you or if you should see another specialist and get further testing. Once past that point, then it’s on to question #2.
- Where is the pain coming from? You might be saying “duh” again here. Of course the pain is coming from your spine, but there are 4 different tissues in and around the spine that can contribute to your pain. Knowing which of these tissues are injured and/or bothering you will help determine the correct treatment to apply. The 4 main pain generators in the spine are: Discs, joints, nerves and muscles. This is where your examination enters the equation. Your chiropractor or other spine specialist will perform a thorough examination to find out which of these 4 tissues are factoring into your pain experience. An exam involves testing your range of motion, checking how your nerves and muscles are functioning, feeling how the vertebrae in your spine move and are aligned, and stretching you in different directions to see what causes your pain. From the exam and history we can now come up with a diagnosis, but there’s one more question that will help zero in on the best possible treatment plan for you.
- What else is going on/has gone on in your life to contribute to this pain? This question becomes very important in the case of chronic low back pain or in patients we first see for acute pain but they don’t get better as soon as we would expect. Some answers to this question include physical factors like instability of the joints of the spine and hypersensitivity of the nerves in the area. It can also include psychological factors such as anxiety and depression.
Matching the correct treatment to your type of pain
Once we’ve answered these three questions we have a pretty good idea of where to start with your treatment. Assuming the answer to question #1 is that your pain is not caused by something serious, then we look at the answer(s) to question #2 to decide which part of your spine is injured and what treatment to apply to it. Often times we find that more than one tissue is causing you pain so we might layer several treatment techniques into your care plan. Our go-to techniques for each tissue are as follows:
Spinal joint pain
The joints referred to here are called “facet joints,” the part of the vertebra that articulates with the vertebra above and below it. This is a joint like most of the other joints in your body, with cartilage covering the joint surface and fluid between the two joint surfaces to lubricate so they glide smoothly. These joints can wear out, get sprained, bruised, inflamed, dislocated, etc. What chiropractors are known for and what we do most of all is “pop” the facet joints. This is called a chiropractic adjustment or spinal manipulation and we do it to improve the quality of movement in these joints, reduce pressure on the joint surfaces, and/or realign them. If you’ve never had this done, you haven’t lived! It’s our bread and butter treatment and what keeps our patients coming back because it’s effective, feels good, and is very safe. Here is one of our colleagues on the East Coast demonstrating several adjustments along the entire neck and back:
Now, if you watched the video and thought, “all that cracking looks scary!”, then you are not alone and that does NOT mean that chiropractic isn’t for you. There is more than one way to treat spinal joint pain, and the “popping” adjustments are only one of the ways this can be treated. We have a variety of more gentle and less startling treatments to offer for back pain, so send us a message or call us if you would like to learn more about our more gentle techniques.
Disc injuries sound scary, but the fact is that somewhere around 40% of back pain comes from the discs between the vertebrae. These are made of softer tissue similar to ligaments and are wedged between each vertebra to distribute weight evenly. Like other ligaments in the body this tissue can be sprained. In mild cases, this causes just back pain and often gets worse with bending forward, putting on shoes and pants, sitting, driving, lifting, etc. In worse cases the disc may bulge or even herniate and pinch a nerve.
One of our go-to treatments for disc injuries is what called the McKenzie Method, or Mechanical Diagnosis and Therapy. It is a method of using specific stretches to help reduce stress on the portion of the disc or joint that is injured, reduce nerve pain, and restore range of motion. If you don’t like the idea of getting your back “popped,” then this treatment is for you. It is very helpful and you are able to do most of it on your own without the help of a chiropractor or other practitioner after the initial visit.
One of the most common McKenzie stretches that we find helps with disc pain is the press up, shown here by our friends at Chiro UP. We use their service to send our patients videos of their home exercise plans so you have a reference to help you remember how to do them at home:
One of the other tools we use at Catalyst Chiropractic and Rehabilitation is called flexion distraction. This is done on a special table in our office that stretches your body lengthwise (traction) and then flexes repeatedly in the middle to decompress the discs in the lumbar spine and reduce pain and stiffness. Here is a video of one of my colleagues demonstrating the technique in his office with the same table we use at Catalyst Chiropractic.
The third type of pain we might find on your exam at Catalyst Chiropractic is nerve pain. One of the most common ways we’ll see this is in sciatica, or shooting pain down the back of your leg. One of the causes of sciatica is a bulging, or herniated, disc in your lower back. When the discs bulge they can put pressure on the nerves that branch off of your spinal cord and run down your leg. Thus, many of the treatments we do for discs, such as the two shown above, can also help with sciatica and other types of nerve pain, such as pinched nerves in your neck causing radiating pain down your arm.
Pinched nerves don’t always just cause pain. A number of problems can be caused by pinched or irritated nerves in your neck and back, such as numbness, tingling, burning, and weakness in the muscles that the nerves innervate, or connect to. In addition to the McKenzie Method and flexion distraction, nerve flossing can be an effective way of relieving symptoms caused by a pinched nerve. Nerve flossing is a way to stretch so that you are sliding the nerve back and forth to free it up from whatever is pinching or binding to it, such as a disc or a muscle. Watch Bob and Brad, the most famous physical therapists on the internet ;), demonstrate how to floss the sciatic nerve here:
During your exam, we will often find spasms, “knots” or trigger points in muscles around your area of complaint. I admittedly have a biased opinion, but it is my impression that muscles are often blamed for back pain but not often the primary cause. I’ve had many patients come to me after being seen by their general practitioner, who diagnosed them with “back spasms.” To me, diagnosing somebody with back spasms is like diagnosing someone with COVID19 with loss of taste and smell – it’s a symptom of the primary cause, not the primary cause itself. The exception would be a muscle strain, where the primary injury is to the muscle itself, like a pulled hamstring. Muscles do what they are told. If there is a joint that is irritated, injured, stuck, inflamed, etc., then your brain will tell the muscles around that area to tighten up and protect that joint. All that to say that muscle pain is often found along with the other three causes of back pain, so we are often doing soft tissue treatments in addition to the treatments shown above.
In a typical visit I like to start with 5-10 minutes of soft tissue work to calm the muscles down and increase circulation prior to doing any adjustments or rehab exercises. We also have two AMAZING massage therapists, Christie and Jennie, to provide 30 and 60 minute dedicated soft tissue treatments ranging from relaxing spa-type massages to deep tissue therapeutic massage for specific health conditions and injuries. Here is Christie showing how she approaches massage therapy for headaches:
Addressing the other factors contributing to your back pain
In question 3 above, I mentioned that pain is not always just caused by joints, muscles, discs, or nerves. There are other factors in our life that can amplify our pain or prolong our recovery. A comprehensive approach to treating back pain will include changes to your daily routine to address some of these other factors. One thing we commonly address in our office is ergonomics. If we help fix your back pain, then you go back to work in bad posture for 10 hours a day in a chair that doesn’t fit you right, then we are going to see you back in the office soon for the same issue. To this end, we offer an online tool to help you assess your workstation ergonomics to see what is ideal and where you can improve. Click here to take our online ergonomics assessment and let us know if you have any questions about your results. Dr. Thompson is a Certified Ergonomics Assessment Specialist and is well equipped to help you optimize your workspace environment.
Another common contributor to pain is our diet. The common American diet is heavy on refined carbohydrates, sugars, fats and oils. These substances can contribute to excess inflammation in our bodies and amplify our pain in addition to causing other common illnesses. For more on nutrition and inflammation, visit https://deflame.com
The causes of back pain can be many, and the solutions offered on the marketplace are seemingly infinite. It is difficult to know where to start, which type of provider you should see, and what kind of treatment is going to be most helpful. What you need is a practitioner who acts as your primary spine care practitioner. Someone who is well-versed in what the research tells us about the best treatments for low back pain and who can act as your guide in the “supermarket” of low back pain treatment options. That is what you will get with Dr. Thompson and Catalyst Chiropractic and Rehabilitation. If you are in pain and want answers to your questions and effective, cost-efficient and time-efficient solutions to your problems, schedule online or give us a call at 503-526-8782 today.