YES !!! YOU READ IT CORRECTLY.
MIS treating the back pain here means using M- Medicines, I- Injections and S- Surgeries. Studies have shown that back pain is an outcome of poor physical activities, mental stress and sleep disorders. None of it needs medicine if the pain is not acute. Moreover in chronic stage injections and surgeries have almost failed to show promising results so far.
Why medicine and surgery doesn't help in long term back pain? The answer lies in what causes a long term back pain or chronic back pain.
From last one Decade I have been raising my voice against managing LOW BACK PAIN through surgeries and injections. No! This doesn't mean they are not required but definitely not at a scale at which surgeons and hospitals are performing it.
Yes surgeons do not immediately operate on every patient who complains back pain. But what you want them to do when every time you enter their office saying no relief and high suffering. Most people who undergo operations for back pain have not done enough but only tried medication with no exercises or lifestyle change before opting for their surgeon's advice.
"BACKPAIN SURGERY IS NOT A SOLUTION BUT AN OPTION"
Long term back pains are non-specific (80%) in nature which means the pain is caused by tight muscles, stiff joints, lack of physical activities, Stressed life or Sleep difficulties. Some backpains are specific meaning they have a disease involved like Disc bulge, sciatica, spondylosis and spondylo-listhesis etc. There is a very thin line between non-specific and specific back pain because above 40 years of age it is very common to find damage in spine structures even if someone's back is pain free. In fact studies have shown, after 40 years of age chances of having one or more disc bulges increase with every decade of life with or without a back pain.
So for now it is sure that even if your investigations reveal a structural damage to your spine, your suffering may not be caused by it. A thorough clinical checkup designed to investigate your source of pain is necessary to confirm your diagnosis. Also your check up must involve your muscle flexibility testing, spine and peripheral mobility assement, strength and functional testing. A careful history taking to understand your basic life issues related to mental health, sleep troubles and much more is also needed. This definitely needs excellent clinical skills by your doctor rather than a hybrid XRAY / MRI Machine.
Backpains are funny as they scare the hell out of you giving you worse nightmares but still the reason can be very simple when checked thoroughly. Most back pains doesn't respond well or benefits temporarily with medication. The limited use of medication is only to control some inflammation and give you a good start in your recovery process.
The real nature of our spine is to be strong and functional at the same time. Pain restricts our movements and makes the unused muscles weak. Well this can be other way round also. Reduced physical activities and long hours of sitting (leisure or work related) can make spine weak and stiff resulting in pain.
A proper diagnosis not just based on investigation is required to select which patient needs injection or surgery. In my opinion all patients except emergency situations should work hard on regaining the spine mobility and strength. Rehabilitation or physiotherapy should focus on getting their functional recovery and putting them back to physical activites which they like.
Reaching out to a physiotherapist can help as they can do a damage assesment as well as bio-mechanical assessment of your whole body including spine. At times we have issues in spine superimposed with stiffness and weakness around it. Physiotherapist will help you in pain education, exercises and way to increase physical activities which is backed by scientific evidence in today's world in dealing even with complex spine disorders.
What your spine doesn't like:
- Prolonged sitting hours
- Prolonged standing hours
- Less physical activities
- Lack of hydration
- Stiffness and poor mobility
- Wrong sitting or standing habits
- Stress in life
- Lack of sleep
What your spine likes:
- Active movements throughout the day
- Good range of motion
- Less physical and mental stress
- Goodnight sleep
- Strong and flexible muscles
- Cardiovascular health to provide enough oxygen and blood flow
"In BACK PAIN - Our spine is more robust than our mind" - KUNAL VASHIST
In case of any further questions, Feel free to ask for any furhter information but do not use the blog as a medical reference. Your treating doctor knows the best about you compared to a write up which doesnt even know you.
Dr. Kunal Vashist, PT
MPT (Ortho), Manual Therapy
Dry Needling Practitioner
Movement Specialist (usa)
