The Reality of Low Back Pain; you're not Misaligned, just Misinformed.

By Dr Marcus Chidiac, D.C.

Low back pain (LBP) is currently considered to be the leading cause of disability. 1 in 3 people in the world are currently estimated to be suffering from it as you read this. Its likely to affect you at some point, likely multiple times over, during the course of your life.

It goes without saying that there is not one cause, nor is there one treatment. 

An image (be it an MRI or X-ray) that shows structural “abnormality” will not always correlate well with your low back pain. Pain does not always correlate well with structural abnormality or tissue damage, either.

Then we get to structure. Can structure contribute to symptoms then? Of course. The problem lies in when we say it CAUSES pain. This is simply not the case It may correlate to pain, but pain is complex and multidimensional. You are not ‘out of place’. Your body is more complex than that.

As such, there is not one move, one technique, or one ‘alignment’ that can allow me, or any Chiropractor for that matter, to correct your LBP. I also stress the importance of my patients relying on adjustments for their condition. The spine will not become misaligned without adjustments, nor will an adjustment put something ‘back into place’ so as to address your pain. If a Chiropractor is feeding this narrative to you, I’d caution you to question their knowledge and intentions.

It is easier to look for the quick fix, one that is labelled and neatly packaged into a black and white diagnosis, opposed to considering a multifactorial, useful approach. 

THIS is what Chiropractic is about: considering and engaging in multifaceted assessment and intervention to best address the myriad of factors feeding into someone’s pain or dysfunction.

Pain is affected by our expectations, mood (stress, anxiety, depression), beliefs (fear avoidance), and a host of other factors. 

Indeed, your LBP a protective mechanism produced by a wide array of systems. 

Why do we try to simplify LBP then? “My core isn’t switched on” “my gluteus aren’t firing”.

Perhaps it is because its complexity can be unsettling for both patients and practitioners alike.

A common area of focus for Chiropractors and physical therapists alike is the emphasis of core strength in preventing and treating low back pain. It is important, no doubt, however it is not the only factor, nor do we know why it is one.  

In as much as the research, Core stability, or lack thereof, does not yet appear to be a causative factor in Low back pain. Yes, these exercises can help, but for reasons we don’t yet fully understand. It’s likely as a function of these exercises improving motion in areas that were otherwise stuck. Think lumbar spine joints and deep core muscles that are attached to these joints.

Contrary to what we’re told, activities such as walking, standing, lifting, and even bending often require very little activation of trunk musculature. And yet, individuals experiencing LBP sometimes have an INCREASE in core activation. 

Could the exercises above be decreasing fear? Improving self-efficacy? Reducing stress? Perhaps it is these factors that are implicated in exercise and it’s ability to decrease the pain response. 

Suffice to say, the body needs movement. It needs recovery. It needs good habits. The body plays nicely when you treat it nicely.

Does all of this mean getting an outcome has to be complicated? Not necessarily. It means that there needs to be an honest and open conversation between client and practitioner about the reality of LBP and the reality of what in fact will actually help. 

Moving with exercise will help. Moving the spinal articulations with manipulation will help. Mobilising the joints will help. Releasing hyperactive musculature will help and addressing the emotional and stress related component of your condition will help.

That’s the reality of it.

References:

Darlow, B. (2016). Beliefs about back pain: The confluence of client, clinician and community. International Journal of Osteopathic Medicene, 20, 53-61

Ledreman, E. (2010). The myth of core stability. Journal of Bodywork and Movement Therapies, 14(1), 84-98.

Louw, A., Zimney, K., O'Hotto, C. & Hilton, S. (2016). The clinical application of teaching people about pain. Physiotherapy Theory and Practice, 32(5), 385-395. 

Mosekey, G. L. (2007). Reconceptualising pain according to modern pain science. Physical Therapy Reviews, 12(3), 169-178.

O'sullivan, P., Caneiro, J. P., O'keefe, M., & O'Sullivan, K. (2016). Unraveling the Complexity of Low Back Pain. Journal of Orthopaedic & Sports Physical Therapy, 46(11), 932-937.

Simpkin, A. L. & Schwartzstein, R. M. (2016). Tolerating Uncertainty - The Next Medical Revolution? New England Journal of Medicene, 375(18), 1713-1715.