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Bexley Physical Therapy Center
Bexley Therapy Services

562 North Cassady Avenue
Bexley, OH 43209
614-246-5093

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Chronic Low Back Pain Problem

You are not alone.

Back pain is the most common complaint.

The most common reason for a medical visit is pain. And the most common of pain complaints is back pain. We also know that those who suffer from chronic, impairing low back pain, have had multiple episodes ; each episode worsening in intensity and involvement. Does this outcome have to be your outcome? The answer is no. This guide is written to give you some information that I hope will inspire you to get the help you need and then get on with your life.

Diagnosis

Does my particular diagnosis matter?

Over the past 12-years, use of lumbar magnetic imaging (MRI) has increased by 307%. The problem with diagnosis by MRI is that it often results in alarming findings that are irrelevant. Did you know that herniated disks are commonly found in people with no symptoms? According to the Quebec Task Force study written in the mid 1980?s, 90% of the time a doctor cannot come up with an accurate diagnosis of low back pain. For a doctor to assert that your pain is a result of the bulging or herniated disk on your MRI image is his guess only. And more often than naught the solution offered to you is conservative treatment first, physical therapy, and then ultimately surgery. And your orthopedic surgeon can bet that you will eventually seek the surgery.

Why?

Conservative treatment

When you come to your doctor for relief of low back pain he will first prescribe anti-inflammatories, anti-pain, and/or muscle relaxant medications.

The anti-inflammatories are meant to reduce the inflammatory response and thus swelling and pain. Taking these might make sense upon initial injury to reduce the intensity of your symptoms. But to continue to take anti-inflammatories for a chronic low back without attempting to properly address the source of the inflammation and provide a method to manage or abolish this source of inflammation only leads to monthly medication bills.

The anti-pain or analgesic medication is prescribed out of a motivation on the part of your physician to give you some relief- and that they can. These are powerful opioids. Upon initial injury the pain can be so intense that such a powerful anti-pain medication can be very helpful. With chronic back pain anti-pain medication can also be helpful so long as the pain persists. But, unless the cause for the pain is addressed, anti-pain medication will continue to be taken and can ultimately lead to addiction.

Muscle relaxers are prescribed for the tight muscles or muscular spasm that patients report to occur with their low back pain episodes. There has never been a documented case of low back muscular injury. Muscle spasm or tightness will resolve as the injury resolves.

Physical Therapy

No pain no Gain?

The trend in physical therapy has been to address low-back injuries like no other musculoskeletal injury. Therapeutic exercise has been shown to have uncertain results for low-back pain. Recent theories like the muscles of the low back needing strengthened are theories at best and detrimental at worst. Patients who are sent to physical therapy and then are asked to perform strength training only end up with more pain and more dysfunction in their low back than prior to physical therapy. The failures are alarmingly high and yet physical therapists continue to insist on strengthening ?core? muscular groups. And it is not just physical therapists. Work injury rehabilitation specialists continue to insist on work hardening sessions that only continue to insult and injure already injured people. Such demoralization only leads to increased disability claims.

Spinal Surgery

My doctor says I have to have surgery.

After medication and physical therapy the forgone conclusion is surgery. Spinal fusion surgery for low back pain has increased by 70% in the past 10 years. Are we improving outcomes as a result? Not according to the American Board of Family Medicine who determined that "Even in successful trials of these treatments, most people continue to experience some pain and dysfunction." And few if any return to some form of productive employment.

Alternative Treatment

What about other forms of treatment?

Before we consider some other forms of treatment I would like to address with you the placebo effect. This is the tendency for a form of treatment to provide positive results just based on the beliefs of the individual receiving the treatment. The placebo effect is found to be present approximately 30% of the time.

Chiropractic

"My back goes out on me. My chiropractor puts it back."

There is some evidence that spinal manipulation in the acute stage (first couple of weeks) can be effective in delivering pain relief and increased function. Over time, spinal manipulation looses its ability to resolve low back pain and specifically chronic low back pain.

Injections

Despite the limited benefit of epidural injections and facet joint injections claims for these treatments rose by 271% over the past seven years. According to both European and American guidelines epidural injections may offer temporary relief of sciatica but they do not reduce the rate of subsequent surgery. And facet joint injections appear to be no more effective than salt solution injections.

Traction

The idea that we just need to uncompress a nerve or a disc to get low back pain relief is very attractive. But in spite of the recent claims of 80% success rate with the modern traction devices you read about in your local newspaper there is no supporting evidence for the use of traction. Spinal traction has been used for over 100 years, studies have been conducted to confirm the claimed results and thus far the results are negative.

The Good News.

What has been outlined above is the bad news. From here I want to give you the very best news. By now you should understand that not only is your low back pain problem a most difficult problem to solve but also the most difficult problem to solve in all of medicine. There is however very convincing evidence for how to treat low back pain effectively. What I would like to do now is provide you the basis for considering treating your low-back pain differently and then offer you a very convincing solution.

If you were to injure you ankle, say by a sprain, you would feel pain. Anytime you tried to put weight on that ankle you would experience the pain more intensely. Your doctor, your coach, your athletic trainer, your personal trainer, if they know anything, would not tell you to run on the treadmill to heal your ankle sprain. Instead, you would be told to elevate your ankle. You might be given crutches, or a cane to keep your weight off the ankle and you would be told to do this for 6-8 weeks. During the healing time your ankle pain would continue to decrease in intensity and frequency and you would always be reminded of your injury anytime you put weight back on the ankle and before it was fully healed. And if this guideline is followed strictly, your ankle does indeed heal.

The method to healing an injured ankle is the same method that must be applied to low back pain. Remember, it does not matter that we cannot diagnose just what tissue is injured in your back. What we do know is that the source of your pain is mechanical. Regardless of whether or not the tissue is disc tissue, nerve tissue, or bone tissue. Any tissue in the human body, when given the proper environment, will heal.

Tissue Unloading

"Protect, Protect, Protect!"

Any tissue that sustains a load that is greater than its inherent properties will fail. And any failed tissue will fail again and again when submitted to reloading. Think, again, of an ankle injury. If you can give your low back the consistent environment that protects the tissue from forces that cause pain, the tissue can heal. It is not easy. But it can be done. And with the right guidance your low back injury can be resolved in as little as 2-4 months.

This applies to back pain of all sorts including, pain that radiates all the way down a leg, pain involving other symptoms such as numbness, burning, tingling. Even after failed surgery, it is possible to still heal your injury.

Centralization

In the library are copies of 6 abstracts from the most prestigious of medical journals outlining the consistent and predictable results of a form of treatment that rapidly brings relief, and over time, abolishes all low back pain and other symptoms. I invite you to take a look at these abstracts and consider the possibility that you just may finally have found the way to end your back pain and get on with your life. I can tell you that the process of eliminating your back pain for good can be one of the most satisfying endeavors of your entire life and I would be pleased to assist you in your endeavor.


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