Let´s have a look at the media. What do you find if you type”low back pain” on Google? There are thousands of websites that tell you what it is and how to manage it. I wonder why there are so many “clever guys” who know how to deal with low back pain and there are still many people who struggle to get rid of this pain.
Since I started doing research about different aches and pains, among them low back pain, I realised that there are many, what we call in my country, “smoke sellers” (people who sell information and treatments with no value). What do I mean by that? Basically that there are many people who talk about low back pain solutions like if they were talking about things that are certain. I am a physiotherapist myself with a masters in Osteopathy and I have been taught a thousand different ways to treat low back pain, most of them to deal with the symptom, but not the cause. Different treatments that are supposed to be good are: ultrasound, TENS, heat therapy, osteopathy, chiropractic, acupuncture, dry needling, etc. But, are they actually good?
I am going to try and make you think. I would like you to stop and think with your brain, leave your pain aside. This is not about the things you want to believe, but the things as they are.
Low back pain and misalignment?
“My physiotherapist/osteopath/chiropractor told me that I have a “misalignment” and that´s the reason of my low back pain” For me it is quite difficult to believe that someone can re-align your spine. Yes, I am talking about these guys who tell you that your spine is not straight and they can put it back to normal with different techniques such as manipulations. I don´t say that manipulations don´t work, I just say that I find difficult to believe that someone can “solve” a “misalignment”. Anyway, should we try to “fix” a misalignment? Actually, who decides what a misalignment is? I have heard so many theories about this matter. “Never try to re-align joints, as that misalignment might be an adaptation and you will worsen the situation”, “it is all about posture, once you improve your posture, you will be pain-free” Pufffff. There are millions of people with non-straight spines with no pain at all and millions of people with straight spine and they are in chronic pain. Note that I am not talking about severe scoliosis, but slight deviation of your spine. There are not straight spines, perfection doesn´t exist, basically because no one knows what a perfect spine is.
Another thing I find interesting is the way health professions work sometimes. As I told you before, I studied Osteopathy and I can be a very annoying student, as I ask many questions, basically because I need to understand what I am doing and why. I have never been happy with the “you just do it, it works”. I need a how, why, when, where and so on. Manipulations are complicated if you study them in depth, although very easy if you study them as a technician. I find very difficult to understand why some people manipulate everything, it doesn´t matter how, neither why. Some people are machines of manipulation. Click-clack and all fine. Not sure about that. How can you repair twenty different “misalignments” (or what you think to be a misalignment) with exactly the same techniques. Obviously there are good and but professionals everywhere you go. Do you know what? If it worked for you, great!
Note that I use manipulations myself and they can be of great help sometimes, although I don´t think they are useful for every single low back pain in any direction possible, just the right one in the right moment and direction.
What about having an MRI scan done for my low back?
I am going to explain to you why doctors tell you what they tell you when you visit them and get frustrated because they don´t send you for X-rays or MRI scans. “Why don´t my doctor sent me for a MRI scan? I have heard that they can see my low back muscles and spine pretty well”. You are right, doctors can see many things when they see MRI scans, but my question is “they found something, and what?”.
Different possible scenarios:
1. They don´t find anything, you still feel low back pain. You are frustrated because you feel a bit silly, as everything in your spine is okay or you might feel relief because you don´t have any damage.
2. They find something, you still feel low back pain. You ask your doctor for a solution, as you have a diagnosis now. More and stronger tablets is the answer. Also, you might get worse as a result of you worrying because you have a real damage and you are afraid you might have low back pain for good. You need to add the stress of being off sick, because you can´t manage the pain at work.
MRI scans are expensive, plus rarely what doctor finds is the cause of your low back pain, plus the treatment usually is going to be the same. Of course, when we come across with situations like the described in the post When to worry about low back pain, MRI is more helpful and recommended, basically to make sure that everything is in order and the patient is not in an important risk.
Be careful with those surgeons who want to solve your low back pain with surgery. Most of the times surgery is not recommended or, in other words, it is only recommended for the surgeon´s pocket (oops, did I say that?). Sadly, money can be one of the reasons you are having low back surgery. Make sure that you get a second opinion, mainly if your doctor is a private one ( it is rarer to have surgery through the public health system).
Advice to follow when having low back pain
My advice when you have low back pain is as follow:
- Make sure that you don´t present with red flags. You might need to visit a health professional if you are not sure, to know the procedure to follow. When in doubt, don´t hesitate to contact your doctor.
- Be patient, low back pain usually is not something that should worry you too much, as you usually recover without any problem after some time and the correct exercises recommended by your physiotherapist. Note that by “some time” I don´t mean days, but weeks or even months sometimes.
- Rest in many cases makes things worse. It is an old fashion treatment which is not recommended any more. Of course, there are exceptions like fractures or inflammatory conditions, among others, that cause low back pain.
- Gentle exercises are usually recommended.
This is all for now. I hope you found this article helpful. If you have any questions, you can leave a comment or contact me on The physical Therapy Southampton Physiotherapy clinic.