Ask the Doc: Got Back Pain?

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Ask the Doc: Got Back Pain?

First and most importantly, you are not alone: prevalence of back pain is estimated to be 80% in the United States. Most acute episodes of back pain resolve with time — lasting a few days to a couple of months — and very few require imaging such as x-ray or MRI, much less surgical intervention, injection, or narcotic pain medication.

Back pain that has not resolved within 3 months is considered chronic.

However, just because an episode becomes chronic does not necessarily mean that invasive treatments are appropriate. Often with chronic pain the issue is no longer in the back but rather in the brain.
Even after tissues have healed, the brain may still be on high alert and continue to send overactive pain signals. Here is a link to some videos that explain the neuroscience of pain and how to deal with it.

Imaging is typically not warranted for back pain unless a significant traumatic event has happened that would suggest the possibility of fracture and/or a patient is demonstrating signs/symptoms of neurological deficits or has a medical history that is associated with increased risk for serious underlying medical conditions such as cancer. Examples of neurological deficits that should be evaluated by a medical provider include but are not limited to:

  • numbness or altered sensation in the groin or lower extremities
  • decreased function/balance in the lower extremities
  • changes in bowel/bladder function
  • pain that does not change with movement/positioning

See the American College of Physicians Back Pain Imaging Guidelines for more detail on when an x-ray and/or MRI should and should be considered.

There is no magic bullet for back pain

I can think of about 10 terms/diagnoses that…can contribute to unnecessary fear…
Back pain can be severe and therefore scary, especially during your first episode. Unfortunately there is no magic bullet for back pain, so beware of those trying to sell you a product or service claiming to provide an immediate cure. Being patient, modifying your activities to avoid re-aggravation, and continuing to perform progressive tolerable movements are the best conservative self-care method while recovering from an episode. Prevention of future episodes should be a priority by learning from any potential mistakes that lead to the first episode. Remember that a step back can often turn into a step up!

qualified rehab professional will conduct a thorough history and evaluation and is competent to determine if any imaging or further evaluation by a specialty physician is necessary. These professionals should provide hands on treatments such as dry needling, joint mobilization, therapeutic taping and soft tissue mobilization in addition to therapeutic exercise to restore movement. Once pain is resolved, it is a good idea to have a functional movement screen performed to make sure no dysfunctional patterns are present that could increase your risk for future injury.

Many of you (like many of my patients) may be thinking,  “Yeah, but I had an x-ray/MRI and I have _________”.

I can think of about 10 terms/diagnoses that could go in the blank that can contribute to unnecessary fear and lead to the frustration and despair of thinking back pain will never get better and nothing can be done about it.

For the second half of this article I will discuss some of these diagnoses, but I must emphasize that most of the time they do not change the treatment approach discussed above. Often, the diagnosis based on x-ray or MRI may not even have anything to do with current symptoms of back pain.

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