Low Back Pain – Part 1
The research on low back pain is so voluminous and overwhelming it is very difficult for the average practitioner to keep up with it all. I’m going to make a humble attempt to go over what I found to be quite striking, profoundly, and fundamentally different from what we used to think we knew.
It’s important to keep in mind that almost all the research that I’m going to refer to with intense brevity was performed by Ph.D. scientists and M.D.’s. Almost no chiropractic studies will be evaluated. This means that the scientists who did perform cervical adjustments did so with a device that did not require chiropractic skills. The art of chiropractic was not factored into their research. Yet, even with the least powerful form of chiropractic, you’ll see they achieved some amazing results.
Low back pain is now considered a recurrent intermittent syndrome that erupts periodically over the course of a lifetime. That means you are not getting over it with one visit. Until 10 years ago, low back pain was considered purely bio-mechanical and it involved finding the anatomic damage then choosing from a host of practitioners; a way to fix it. That seems to be failing miserably and the new paradigm is that it is a multi-factorial bio-psychosocial pain syndrome. They now feel that back pain is composed of 10 factors and only 3 are things that back doctor’s address; the remaining 7 are psycho-social factors.
So in spite of what insurance companies tell you, you are not going to get over a bad back by just keeping a stiff upper lip. It is not a short term situation. The assumption underlying current guidelines that spontaneous recovery occurs in a large majority of patients is not justified. I’m harping on this now, but you will not see why until later.
MRI’s and all other high tech tests cannot find the cause of most acute low back pain. It is now considered to be poor control of low back muscles that allows tissues such as ligaments and tendons to become damaged. But how do you control muscles that you have no control over? The deep core muscles that stabilize our spines are not volitional type muscles like you have in your fingers. They are anti-gravity muscles controlled largely by your subconscious. One thing that may appear evident at this point is that we want more function, not pain relief.
Only a small percentage of patients seek care for low back pain since most episodes are rarely disabling. Most new episodes recover in a few weeks. Of the patients who do seek care, 62% will continue to have pain a year later. 16% who were off work will still be off work 6 months later. One predictor of who will be out of work forever is if the patient hired an attorney. 80% of people who sought primary medical care for their back ache would still have it over a year later. About 6% of people with low back pain, who seek treatment, wind up going to a chiropractor, which these days, means they have to pay for it. That can be interpreted as; chiropractors get the worst of the worst cases.
It doesn’t fare any better for neck pain. 50% to 85% of people with neck pain will have it 1 to 5 years later. So this means that short term care does not change the natural long term history of spinal pain.
Dr. Greg Malakoff D.C.
B.S.: State University of N.Y.
Doctorate: New York Chiropractic College
Diplomate of American Chiropractic Neurological Board (DACNB)
Workers Compensation Qualified Medical Examiner (QME)
Gentle Veterinary Orthopedic Manipulation (VOM)
Certified Veterinary Chiropractitioner (CVCP)
Years in practice, 1983-Present
Practiced internationally, 1987-1991
Part of a medical team for Pain Management at an Israeli Hospital in Haifa
Sports Injury Physician for the Bat Dor Israeli Ballet