Doctors are MIS-Treating the BACK PAIN....

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)

Contact Details:
998302757
kvashist.physio@gmail.com

NO !! Your leg pain is not just SLIP DISC...

It won't be wrong if I quote that BACK PAIN is second most common condition after common cold which makes people suffer affecting their daily life. Every third person has faced atleast one episode of back pain in their life. Our SPINE encloses and protects spinal cord which carry information from brain to the body via nerves. Without such information the body cannot control, move or feel anything effectively making you senseless and motionless.

"Are you suffering from back pain? 

Or

Do you get a pain travelling down your one or both legs? 

Or

Is it difficult to walk few minutes or few steps without a back or leg pain? 

Or 

Do you know someone who is facing such a complaint?"

Read the article carefully to understand what is going wrong inside your body. Read it as you will get to know things beyond your doctor might have missed to share with you.

You may have a leg pain travelling down along with back pain or sometimes without any back pain. The reason for leg pain can be nerves compressed from the spine or even at your hip. Sometimes muscular pain mimics like a nerve pain in the leg which makes you and your doctor confused. The difference between leg pain due to nerve or muscles is that former causes sharp shooting or electric current like leg radiation whereas the latter creates a continuous dull achiness in the affected leg along with pain in the muscle involved.

If you have seen a human spine, it looks like a curvy snake formed by multiple bones called vertebrae arranged in a manner to give it "S SHAPE " when looked from side view. But from front or back view it looks like a straight vertical spine. Any deviation in these curves can put the spine structures under stress causing lot of muscle imbalances or vice a versa.

When your muscles doesn't support the spine symmetrically it can cause excessive stress between couple of vertebrae causing reduced space for the nerves exiting from the spine. Hence, leading to compressed nerves causing painful radiation in the leg. These imbalances can even create severe muscular spasm putting heavy pressure on your affected nerve and the result is your painful suffering again.

Interestingly, the above mentioned reasons can put the disc under pressure and making it appear like a bulge or on MRI Scan. This should be called as false or pseudo disc prolapse causing nerve irritation and leg pain. This type of bulging can disappear or improve once the pressure between vertebrae goes away.

   

I have come across patients who comes with a dull pain in the hip which also radiates down the leg but does not behave like sharp shooting pain. And the reason is not your spinal disc or nerve but a muscle around the hip known as GLUTES MEDIUS (the HIP Abductor) which may have a TRIGGER POINT - muscle knot causing nerve like pain which people often confuse with sciatica due to nerve compression. 

 A deep muscle of the hip known as PIRIFORMIS (the HIP Rotator) is placed right on top of your sciatic nerve and in some cases this nerve pierces from within the piriformis muscle. If this muscle becomes tight it can cause a similar nerve pain but thankfully then the reason is not your spine. This is more common in people who keep purse in their back pocket and also when people sit with scissored legs (Cross Leg Sitting).

A disc is a doughnut like structure with hard outer shell filled with jelly like material inside. Disc is found between the vertebrae of the spine adding shock absorbing effect. In case there is a sudden trauma or repetitive wrong movement pattern in daily life, the disc wall gets weakened and starts bulging mostly backwards and outwards. If the nerve gets compressed by this bulging disc as it is lying very close to it, you can get a sharp shooting pain radiating down the leg. This condition is popularly known as SLIP DISC OR SCIATICA. The people describe this feeling as painful electric spark travelling down the leg. Your bulging disc or slip disc cannot cause leg pain if it is not pressing on to a nerve.

Bulging discs are very common and not everyone who has a bulging disc go through pain. Infact, after 30 yrs of age, every 10 years increases the chance of finding one or more bulging discs with or without leg pain. So when disc bulge is so common then what is causing your leg pain. Careful examination can reveal whether your nerves are compressed due to muscular imbalance, a mis-alignment in the spine or a disc compression on your nerve.

This information is totally in contrast with MRI reports showing disc prolapse as the possible cause of your pain. Trusting the MRI reports without careful examination can misguide you towards unnecessary treatments not required for your stage of the disease.  If you are better informed then you can reduce your suffering by heading towards the effective treatment for your condition.

The information on this blog is helpful in creating awareness related to different problems which produces similar symptoms and often confuse against reaching better treatment approach. 

Please do not consider this blog as a medical advice and do visit your doctor or physiotherapist whenever you experience such symptoms.

Feel free to explore more information by commenting here anytime.

Regards,

Dr. Kunal Vashist,PT

MPT(Ortho), Manual Therapy

DryNeedling Practitioner

Email ID - kvashist.physio@gmail.com

Contact No. 9968302757

More Than Physio... Clinics                       

REMEDY FOR UNRESOLVED PAIN

Any pain lasting for more than 12 weeks is generally considered as Chronic Pain. This means whether the injury is traumatic or non traumatic, it should or must heal within 6-12 weeks at maximum. If you do not help yourself to get better within this time frame, you are basically channeling your nervous system to adapt to the painful sensation given by the local tissue damage.

Poor Diet, Lack of Sleep, Emotional or physical stress, lack of physical activity, your boss and colleagues, family and friends. all of this can affect your pain to become good or bad. Many things are not in our hands but anything from the list above which you can change to help your self should be tried. Hence, your lifestyle modification is a big term where you have to consider anything which influences your pain. Just remember self help is the better help. The change starts from YOU and the rest will follow. A doctor or Physiotherapist can give you the path to recovery but you need to proactively participate and reach to the goal of pain-free life.

Long standing pain generates a threat to your normal body movement and you start avoiding them which in turn makes the joints and muscles unhealthy. There is a sub-conscious fear in moving all the time and the brain and body kind of pre-decide that this particular movement will cause pain. Inability to move freely along with fear of pain increases the neural and chemical response in the brain to make you feel sick all the time. In such conditions, medicines usually don't work or mask your pain very temporarily.

What you need to do at this stage is to come out of threatening painful memory  through controlled pain-free movements (Pain free activities). Resting at this time is not a correct choice but being careful to not create too much pain is. I believe any activity or exercise causing pain more than 20 % is a good sign to step back or stop that activity. Doing ice compression as a therapy can work very well if and when pain increases. At times you need pain modulation procedures like Manual therapy, Massage, Dry Needling / Acupuncture or even taping to facilitate pain free movements. Once you get better with pain, simultaneously start loading your damaged tissues via exercises which mainly includes strengthening against gravity or resistance. 

In the beginning, you may find some discomfort in doing strengthening exercises but that is a normal response to tissue loading rather than any damage which you might think is happening. But tissue loading capacity will increase you will start feeling stronger and active with your earlier painful movements. In my opinion, it will take from 6 weeks to 6 months, where decent muscle strength will build up and you will reach to your pre-injury level of fitness.

Since, chronic pain involves memory of local tissue damage, nerves which conducts painful sensation to spinal chord and the brain at the center, there are social and psychological factors which can variate your pain on daily basis. I always tell my patients that the part of brain which responds to chronic pain is also responsible for your emotions. So, it is very natural for emotions to make you feel pain and vice a versa. You definitely feel emotionally stressed on the days when it is painful or when you are emotionally stressed your pain increases. Anything which disturbs the chemistry of your brain will disturb the pain also.