Almost all of us will at some point in our lives experience lower back pain. Chronic lower back pain is a condition that drives people straight to the nearest clinic to find out what can be done. Often the doctor will prescribe physical therapy. If this doesn’t do the trick, cortisone injections, or ultimately surgery is suggested.
Injections or surgery “may” reduce the pain but will not address what is causing the pain. We must begin to recognize that in most cases chronic back pain is a symptom of musculoskeletal dysfunction. We can attempt to fix the “symptom” by getting an injection, removing a disc, or fusing vertebrae, but this will not deal with the underlying cause. This is why many people experience pain relief only to have the symptom reoccur. I’m not anti-surgery or injections in all cases, although I do advocate trying other solutions first, but I believe it’s imperative to address alignment instead of just treating the symptom. There is a reason the disc bulged and the dysfunction is still present even after an injection or surgery. Ultimately, we must remove the cause to assure pain symptoms won’t reoccur.
When you address WHY your back hurts only then can you alleviate pain long term. Basically the back is a series of curves. You have a lumbar and cervical curve, which should be in mild extension, and a thoracic curve, which should be in mild flexion. The muscles surrounding the spine should support these curves for a healthy spine.
Muscles only follow orders, and if they are not being told to move, they learn to stay where they are. In our society we spend a great deal of time sitting at a desk at school or work, on a computer, in a car, or in front of a TV. Due to this more sedentary lifestyle, the spine loses its structural curves and flexibility becoming more rigid. Sometimes we have the weekend warrior who after sitting most of the week decides to play a game of golf or tennis. The body is unable to handle the excessive strength and rotation these sports require on a rigid and often flexed lumbar spine and this can lead to disc issues and back pain.
There are many terms that are thrown around in the medical world describing this condition: Ruptured disc, torn disc, slipped disc, collapsed disc, disc protrusion, bulging disc or herniated disc. Don’t let all these terms scare you, these are just terms diagnosing a symptom. This condition CAN be alleviated, the body just needs the right stimulus to correct whatever is causing the disc to bulge and push on the nerve. It’s not the disc that’s actually causing the pain, but the nerve that’s being pinched. This radicular pain that comes from the nerve root can be referred to other parts of the body. If the nerve being pinched from the disc bulge is the sciatic nerve then one may experience pain running down the leg. For example, if someone has an elevated left hip, the sciatic pain from the herniation may be on the right leg because the disc is being shifted and compressed to the right. Surgery can remove the piece pressing on the nerve, but it will not address the elevated hip and potentially rounded lumbar spine that is causing the herniation, so you can see how symptoms are likely to reoccur.
The disc is the tough pad that acts as a cushion between the vertebrae. With a disc herniation it is being squeezed by the bones until it ruptures or comes in contact with a nerve. As I mentioned earlier, the doctors want to remove the piece pressing on the nerve. Here’s the issue – I believe the back is designed to use all of that disc! Sure it’s currently pressing on a nerve and that is causing severe pain, but the important question to ask is how did it get there? The only thing that shifts bones is muscles, so if muscles moved the spine into its dysfunctional state, they should be able to shift it back to its functional alignment.
The majority of disc herniations will occur in the lumbar spine at L4-L5 or L5-S1. In most cases if the pain caused by the herniation persists for over 6 weeks, doctors may recommend surgery. A microdiscectomy is designed to take the pressure off the nerve
root. In this surgery, a small portion of the disc that’s pushing on the nerve is removed. Although the surgeon will tell you the success rate of this surgery is about 95%, what they are not telling you is that a smaller percentage of people will experience another disc herniation within a few months! And a larger percentage will experience symptoms again within a year. Why is this? Once “again,” the symptom has been dealt with, (being the disc pushing on the nerve), but the cause (being incorrect curvature of the spine and possible rotation and pelvic misalignment) remains the same. In many cases if these disc herniations occur multiple times a lumbar fusion surgery will be recommended.
Some people say you may not completely heal the ruptured disc; however, it has been proven that the discs can shift back into place if provided with the right stimulus and by restoring proper structural alignment and there are MRI’s to prove it. When restoring
alignment it is possible to prevent the disc from leaking onto the nerve root and this may resolve the pain symptoms, which is typically the main concern. Therefore, it makes sense to attempt to restore the body’s alignment before rushing into surgery. As previously stated, even if you do opt for surgery, the problem is likely to occur in the future with another disc if the musculoskeletal problems that caused the herniation have not been addressed.
Although the symptom is not our main concern, it is important to understand what is causing the pain. The treatment for back pain due to a disc herniation for example can be quite different than that for other symptoms of back pain such as stenosis, spondylosis, spondylolisthesis, spinal arthritis, or disc degeneration. Therefore, what exercises you may prescribe to alleviate one form of back pain may exacerbate another. This is why customized exercise menus that address each individual’s specific alignment issues are very important when dealing with lower back pain.
So in summary, remember that the spine with its correct curves intact is a natural shock absorber. Therefore, to alleviate pain symptoms, we must first restore the proper spinal curves and joint alignment. This allows us to strengthen on a more stable frame, and ultimately regain functional mobility, stability and biomechanics. In order to achieve this, we must regain awareness and control of our body. Pain symptoms will come and go, but it’s important to remember that by continuing to focus on correcting dynamic alignment and posture, these symptoms will become less prevalent and can ultimately be resolved.
Lisa Decker M.S.
PAS, CES, PES, CPT, CAMQ