Now, we know better.

This is a tale of my mom, and of advances in research and medical treatment.

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Maya Angelou famously said, “Do the best you can until you know better.  Then when you know better, do better.”  This statement can be readily applied to scientific advances in patient care, and in the case of my mother, low back pain.

In the 1980s, when my brother and I were very young, my mom suffered from chronic low back pain.  There was no incident that started her pain, per se, but it was a dull ache that developed into chronic pain over the years.  She was diagnosed with “degenerative disc disease,” and in 1988 had aggressive back surgery, whereby the surgeon fused four of her five lumbar vertebrae together via screws and an eight-inch metal rod.  I have vague memories of visiting her in recovery in an Edmonton hospital, a few hour’s drive from our tiny prairie town of Hughenden, Alberta.  My nine-year-old brain didn’t hold on to many of the details, just that she was in a hospital bed, and I’d never seen my invincible mother, well, not invincible.

She recovered well, and her low back pain was a thing of the past through my ego-centric teenage and young adult years.  And while her history of back pain and surgery didn’t play a conscious role in my decision to become a chiropractor, the irony is not lost on me that I treat patients like her pre-surgical self every day.  I could have helped her, and let me boldly state that she might have avoided back surgery.  You see, she had no radiculopathy (pain down the leg due to pressure on a lumbar spinal nerve), no indicators of disc bulges or herniations, and she was only 38 years old, coincidentally the exact same age that I am now.

However, her back pain is back with a vengeance now, thirty years later.  It’s worsened over the last several years, and she now has trouble being on her feet or sitting for prolonged periods of time, and struggles to lift much more than her youngest 21-lb granddaughter. It’s affecting her quality of life, despite regular rehab exercises guided by yours truly, ergonomic modifications, and other conservative treatment measures.  The thing is, for the last thirty years, her body has compensated for the lack of movement through her lumbar spine, and the segments above and below her fusion now show advanced degeneration.  Her movement patterns have changed, her core muscles have changed, her biomechanics have changed.  Her spine does not move well, and as a cumulative result, she is in pain much of the time.

She’ll tell you she feels lucky.  Lucky that her pain was mostly gone for the last thirty years.  Lucky that the post-surgical ramifications haven’t affected her much until now.  But I’ll tell you that I wish she didn’t have chronic low back pain in the 1980s, because the conservative management today would be far different.

Why do I tell you this?  Because now, we know better.  Now, we do better.  And we are really good at treating low back pain.

lumbar fusion

This is similar to my mom’s spinal surgery in 1988, although four of her five lumbar vertebrae are involved.

*** As an aside, I never use the term “Degenerative Disc Disease” as a diagnosis because I think the term creates fear-mongering and patient helplessness.  Words spoken by a medical professional carry power, a power that I do not take lightly.  Improved semantics = improved patient outcomes.  And might I remind you that there is not always a correlation between clinic imaging results and a patient’s symptomatology…..


I Hurt My Back

I hurt my back last Thursday.

I have never had a back injury.  Like, never.  I’ve hurt my neck, broken my thumb, sprained my ankles, and torn my ACL, but my back has never given me problems.  As a chiropractor, perhaps this is to be expected, but in fact, the opposite is true.  Many of my colleagues decided to join this profession after having great success with chiropractic for their own back injuries, and many others now suffer with lower back pain as a result of the physical nature of what we do.  But for me, despite two babies, 225lb deadlifts, and a clumsy fall-down-often nature, my lower back had been spared.  Until Thursday.

Thursdays are my GSD day (Get Sh** Done).  I don’t have clinic hours that day, so my day often begins at the gym and ends at the grocery store, doing computer work, or cleaning my house.  This past Thursday, I was with my 9am crew working on back squats.  It was a 12-minute working segment; one back squat per minute for 12 minutes, with progressively increasing weight.  On minute six, I lost my focus.  I didn’t concentrate on my core, or my breath, and I heard a “click” from my back on the way down to the bottom of my squat.  I didn’t have pain immediately, but it’s not my first rodeo, and I knew exactly what I’d done.  I let my competitive ego take over, finished the workout, and then called the clinic.

I was in a treatment room less than two hours after that dreaded “click” and by then, I couldn’t even stand up straight.  But Dr. Dave worked his magic, and when I left thirty minutes later I was feeling almost 100%.  Through the weekend, my back pain came and went, but with some heat, core stability exercises, hot yoga, and a great Sunday long run, I am back to full function and pain free today.  Five days from start to finish; from hunched and bent forward in pain to a full deadlift workout at 6am this morning.  Chiropractic works.  That treatment set me up on a path of quick healing.

I’ve written about low back pain before, but this is the first time I had been on the other side of the coin.  This experience has grown my empathy and expanded my amazement with the wonders of my “job.”  It comes down to mechanics, and if we can fix your mechanics, we can get you out of pain and functioning optimally.  Quickly.

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Straw. Camel’s back.

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?

straw-camel