By Dr. Rick Morris
As Printed In Investor's Business Daily
Most of us incur the wrath of low back pain sometime in our lives. In fact, next to colds and flu, it’s the leading cause of time loss from work. Symptoms ranges from a temporary annoyance to chronic, debilitating pain.
There is no “one size fits all” approach to treatment. While a few stretches or a board under the mattress may do the trick for some, others believe that the pain originated in their heads. These modifications or changing our perceptions sometimes work, but not often enough? The Agency for Healthcare Research and Quality, a branch of the U.S. Department of Health and Human Services, developed the following guidelines:
- ½ of 1% of low back pain cases fit into the category of a serious medical condition that is best treated by an orthopedic surgeon or neurologist. The red flags include: a. Difficulty controlling the bowel or bladder b. Numbness in the groin or rectum c. Extreme leg weakness
- The other 99% respond best to altering our activities (posture, ergonomics…), spinal manipulation and exercise.
- Surgery is helpful in 1% of the cases but can cause greater problems. Rarely is it an emergency, so other approaches and opinions should be sought first.
So lets look at the various approaches and evaluate their strengths and weaknesses:
Self Treatment - Most instances of lower back pain will be resolved by altering the sources that initiated it such as a faulty mattress, a poor car seat, or a change in activity
General Practitioners or Internists - The most frequently consulted initial provider and are somewhat qualified to spot serious conditions, yet limited in ability to treat the usual causes.
Orthopedic Surgeons - Highly trained at diagnosing the “disease” causes of back pain (e.g. cancer and infection) and the only ones (with the exception of neurosurgeons) to offer surgery. They are usually poorly skilled at conservative treatments. They are often biased against Chiropractic and therefore rarely refer to them offering more invasive and dangerous protocols (e.g. surgery, medication and injections) in its place.
Physical Therapists - Well trained at rehabilitation and exercise. They use physical therapy modalities (e.g. ultrasound and electric stimulation) and often look at life style changes but have limited or no training in spinal manipulation.
Chiropractors - Contrary to traditional views, most scientific studies favor these providers. They are the most skilled at spinal manipulation and perform physical therapy, but their abilities at diagnosis and rehabilitation vary greatly between practitioners. Their treatments, again contrary to popular belief, are the safest and are reflected by a malpractice rate which is 1/10 to 1/30 that of their medical counterpart.
Acupuncturists - Have helped when other approaches haven’t, although large studies have not shown them to be consistently effective. They have limited training at determining mechanical and organic causes.
Osteopaths - Highly trained at the diagnosis of back disorders although treatment varies considerably since most practice as family practitioners.
Since few practitioners have a comprehensive view, back pain sufferers often must seek treatment from more than one doctor. Further compounding the problem, traditional doctors are frequently averse to referring outside their own field. This demands considerable management skills upon the sufferer who is already in pain and distress. So be aware that regardless of the provider, improvement should be notable within one month. At that time, if the doctor does not change protocols—change doctors. Start with the least invasive approaches (life style, exercise, manipulation and acupuncture) then, if necessary, progress to the more invasive (medication, injections and surgery). As in all matters of your health, take charge of your treatment—hire those who have something to offer and fire those who don’t.
Note to our patients…The doctors in our office are among the most skilled in the diagnosis and treatment of low back pain in the country. We teach classes and seminars to the medical, chiropractic and acupuncture professions on this subject and have for the last 40 years. We are published in peer reviewed medical journals.
You have choices. Discuss any and all options related to your back care with us.