“Today is a bad day for backs.”

2 Comments July 19, 2016 drworobec

“Just so you know, today is a bad day for backs.”

That was the text that one of our reception team sent to me last Friday morning. Three new patients had called in that morning, a much higher number than most Fridays through the Summer months, and all three had a primary complaint of back pain.

That part is not atypical; back pain is far and above the most common condition that I treat in my practice, despite us being a full-body, sports-based clinic. The stats don’t lie, and in fact, up to 85% of working people can expect to experience lower back pain in their lifetime. Couple that with the word “spine” in our clinic name, and it makes sense that a lot of low back pain walks into our office.

And guess what? We are really good at treating low back pain. Really good. We can make a big difference in a short period of time, and while I don’t have a randomized controlled trial on my patient’s improvement levels to present to you, I can say that our success rate is very high. We are good at what we do, and a large part of what we do is treat low back pain.

I will go a step further and tell you that what patients do outside of my office (things like following rehabilitation exercises and modifying activities appropriately) are far more important than what they do inside my office, on my treatment table. The hands-on, manual therapy part is a small piece of the puzzle in a lower back complaint. My most effective roles become those of educator (why does my back hurt?), ergonomist (what positions should I modify/avoid?), and personal trainer (what movements should I do to feel better?). My ultimate goal with a lower back pain patient is to avoid a reoccurrent episode down the road; the cycle of lower back pain is all too common. Again, education, ergonomics, and personal training come into play.

The point? Lower back pain is very common, NOT normal, and very treatable.

Happy Tuesday all.

Sit, Stand, Bend, Lift, or Twist

Leave a comment April 12, 2016 drworobec

I’ve come across a concerning trend in my practice lately…. that is, patients assuming that all low-back pain is the same, and therefore all low-back pain solutions are the same.

Low back pain (LBP) is most definitely the number one condition that walks into my office, even though we offer a full-body approach; from necks to toes and everything in between. But here’s my concern: please don’t assume that your low back pain is the same as your friend’s low back pain. Just as you wouldn’t take a friend’s prescribed medication, be wary of taking a friend’s prescribed rehabilitation exercises. I hear this all the time: “My friend told me to do ____ for their back pain.” “I saw this stretch on Google.” “My sister had back pain and she still did 100 sit-ups a day.”

Please, no. (And also, please, please, please, NO sit-ups. Ever. We can talk about this later. Email me.)

Don’t assume that your back pain is the “same” as your friend’s/neighbour’s/Uncle’s/dog’s. There are many causes of low back pain, and it’s my job to figure out what is causing yours specifically, and give you the appropriate rehab to support that. In certain cases, forward fold stretches can be helpful. In certain cases, they can be harmful. The same can be said for extension exercises, and mobility drills, and activity limitations. Each has their time and their place, and one size does not fit all.

Low back pain is a widespread condition; in fact, up to 85% of working Canadians can expect to experience LBP in their lifetime. And if we all work together, from practitioners to researchers to personal trainers to patients, I think we can dramatically lower that statistic.

There is one hard and fast rule that everyone can safely adhere to: a neutral spine is always the most preferred, protective posture for your spine. Keep that in mind the next time you sit, stand, bend, lift, or twist.

Happy Tuesday.

Straw. Camel’s back.

Leave a comment December 22, 2015 drworobec

In my practice, I often ask the question, “Was there an incident that started your pain? Or did it just creep up on you?” The answer is very often, “Well, it could be (insert activity here), but I’ve been doing that for years, so I don’t think that’s it.” But, perhaps, that’s exactly it.

Tissues have a certain amount of force they can withstand before they become injured/dysfunctional/irritated. This is called tissue tolerance. The end result of too much force is usually pain. You see, pain is often the last symptom to appear, not the first. So, prior to your experience of pain, damage has been done behind-the-scenes for awhile. If you are body-aware, you may have already noticed this in yourself; perhaps your first perception of a symptom was tightness or decreased strength or lack of range of motion. But the pain didn’t follow until later.

This process gives us some valuable insights into treatment. At least, that’s how I see it, and that’s how I treat it.

First, pre-pain symptoms (the above-mentioned tightness, strength, and range of motion) should be watched for and can be used as warning signs to prevent further injury. Maybe these pre-injury symptoms can be used as healthy reminders to improve your mobility, add in some recovery time, or focus on your nutrition. Maybe they cause you to re-check your workplace ergonomics or your sleeping positions or your form in the gym. Maybe they are a signal that your body needs some hands-on treatment. Listen to those signals, and heed their warnings.

It is much easier to prevent an injury than it is to fix an injury.

Second, just because the pain has disappeared, doesn’t mean that the affected tissues are back to their normal pre-injury state. This helps to guide my decisions for a patient’s return to activity and give appropriate movement guidelines. So when I tell you to stop box jumps for the time being, or to raise your computer screen, there’s a method to my madness and science in my reasoning.

The bottom line is this: if you’ve been dead-lifting with a rounded spine for months, or you’ve been sitting at a desk job for years, or you’ve been hunched on your couch with your iPad and “it’s never bothered you before,” doesn’t mean that it won’t bother you now.

Straw. Camel’s back. Remember?