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Exploring the Root Cause of Your Back Pain. Feeling Like You Are Chasing Your Tail?

Exploring the Root Cause of Your Back Pain. Feeling Like You Are Chasing Your Tail?

Dr. Michael Derry, DPT, PT, OCS Jacksonville, Florida
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Are you feeling like you're endlessly chasing your tail, trying to decipher the mysteries behind your persistent back pain? There are many complexities to understanding the root causes of your back pain. I want to explore why imagining isn't reliable, what conservative approach really do, and what really needs to be done to find lower back pain relief. After nearly a decade of treating back pain when people ask me what is the root cause of their pain, this is what I say.

Traditional Medicine May Not Find The Root Cause: Challenges in Pathoanatomical Diagnosis

The traditional medical model, often reliant on pathoanatomical diagnosis through imaging. This faces inherent challenges in effectively addressing the root causes of back pain. As you dive into understanding these challenges, you'll uncover the need for a more nuanced approach to unravel the complexities associated with diagnosing and treating back pain. I see often when people feel that their pain is coming from what they found on their MRI or X-ray.

One significant challenge lies in the overemphasis on anatomical findings from imaging studies, such as x-rays and MRIs for back pain. I often find they do more harm than good.

Let's explore the disconnect between the increased use of imaging technologies and the lack of improved outcomes in managing back pain. While these diagnostic tools can reveal anatomical variations, the leap from identifying these variations to attributing them as the sole cause of back pain is not appropriate.

You may resonate with the common scenario where individuals experiencing lower back pain visit a primary care provider who, in turn, may order an x-ray or MRI. This diagnostic pathway, rooted in the pathoanatomical model, aims to identify specific structural issues that might correlate with the reported discomfort. However, the limitations become apparent when these imaging studies reveal common age-related changes, disc bulges, or degeneration, prevalent in a significant portion of the population, even those without back pain.

A critical issue arises s in the interpretation and communication of these imaging findings.

  • They are not adequately discussed or deciphered with the patients. Consequently, individuals are left with a label, such as disc degeneration or bulging, without a thorough understanding of whether these anatomical variations are genuinely the cause of their pain.

The trend of increased utilization of imaging technologies without a corresponding improvement in patient outcomes. Despite the growing prevalence of x-rays and MRIs in clinical pathways, disability due to back pain continues to rise, challenging the effectiveness of the pathoanatomical model.

The challenges in pathoanatomical diagnosis revolve around the oversimplification of back pain causation, leading to inadequate treatment strategies. To address these challenges, a paradigm shift is necessary—one that acknowledges the individualized nature of back pain and considers a broader spectrum of factors, moving beyond the limitations of anatomical-focused diagnoses.

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Conservative Treatment Approaches: One Step Closer to the Root Causes of Your Back Pain

As you explore conservative treatment approaches for back pain, you'll find yourself navigating a landscape filled with complexities and evolving perspectives. Many providers including myself will often try to say that pain is from changes in the spine such as disc bulges, arthritis, and muscle strains. While they do vary in clinical presentation and how they feel to you, not one person can say with 100% certainty what is causing your back pain. Especially those with chronic back pain.

Initially, you might incline towards the belief that muscle activation delays, like I did, might be the primary cause of your back pain. This belief could lead you to embrace recommendations focused on core activation and muscle bracing, hoping for a tangible solution.

However, you'll soon realize the limitations of this approach, recognizing that enforcing such behavioral changes may not align with your pre-existing patterns and could potentially hinder your overall function.

The shift in your perspective will extend beyond personal experiences to encompass various conservative approaches, including dry needling, massage, acupuncture, chiropractor and soft tissue mobilization.

There is evidence behind each of these so I can't not support the use of them but there is no magic bullet to back pain.

Seeking to understand the root causes of your back pain, you'll confront the challenge of finding a one-size-fits-all solution when you speak with providers. This isn't true and I am often the first one to say that each back pain treatment is unique. And, if these therapies were universally effective, you would expect consistent positive outcomes, yet the reality is far more nuanced.

Treatments like manipulation and soft tissue mobilization, often employed in chiropractic care. You'll grapple with the difficulty of correlating specific structural interventions, such as subluxations, with sustainable relief. Questions about the definitive efficacy of these methods will arise, grounded in the observation that while some individuals may experience short to medium-term relief others may not. Often times, long-term effects can vary significantly.

Moreover, the cloudiness surrounding the interpretation of subluxations or other targeted interventions, especially when attempting to validate them through changes in imaging studies, adds to the complexity.

As someone seeking to uncover the root causes of your back pain, the lack of consistent evidence supporting the direct correlation between structural adjustments and sustained pain relief will underscore the challenges within the conservative treatment paradigm.

As you continue into find the root causes of your back pain, instead of relying solely on specific treatments or rituals, you'll be encouraged to consider a more comprehensive, evidence-based approach. This shift involves viewing back pain not merely as a localized issue but as a representation of your overall health, encompassing mental, physical, and emotional well-being.

A Holistic and Evidence-Based Approach to the Root Cause of Back Pain

"What can you change and what can you not"

In 10 years the approach to back pain that I have found to be most impactful is a more well rounded and holistic approach. We know that everyone's back pain is different and that relaying on imagine and other diagnostic tools not only lacks evidence but effectiveness.

Advocating for a holistic and evidence-based approach to address your back pain, you'll embark on a journey that prioritizes the understanding of your body so that you can find root causes and seeks sustainable relief. This pivotal perspective shift is rooted in the acknowledgment that back pain is not merely a localized issue but a reflection of your overall health.

A 15,000-foot view of your well-being if often warranted. We need consider how you move, think, and feel about your back pain. As you navigate this holistic approach, you'll recognize the individualized nature of the root cause, understanding that your experiences and lifestyle factors play a crucial role. This realization will reshape your perception, urging you to move beyond a one-size-fits-all mindset towards a more personalized understanding of your back pain.

Evidence and experience tells us that an assessment with a conservative provider is not only needed but ideal for an optimal outcome

The assessment must:

  • Go beyond traditional diagnostic pathways. This involves scrutinizing not only the physical aspects of your back but also delving into the mental and emotional facets of your well-being.
  • Take time
  • Understand your challenges
  • Provide hope

In doing so, the goal will be to uncover modifiable factors—those aspects of your life and habits that can be changed—and non-modifiable factors that, while challenging to alter, need acknowledgment in your back pain journey.

This holistic lens will encourage you to view your back pain not as a standalone ailment but as part of a broader narrative encompassing various aspects of your life. Lifestyle factors, work demands, and even your thoughts and feelings about your back discomfort will be considered integral components of the overall picture.

The holistic and evidence-based approach will invite you to actively participate in your back pain journey. It will encourage open communication with healthcare providers, fostering a collaborative relationship where your unique needs and experiences are valued. This shift from a passive recipient of treatments to an engaged partner in your health journey will empower you to make informed decisions about your well-being.

In conclusion, in the journey to unravel the cause of persistent back pain, it becomes evident that relying on imaging and traditional diagnostic models falls short. The challenges in pathoanatomical diagnosis highlight the need for a different approach. Exploring conservative treatments emphasizes the unique nature of each individual's back pain. The holistic and evidence-based journey encourages active participation, open communication with healthcare providers, and a personalized understanding of back pain. Embrace this transformative approach, and empower yourself to make informed decisions on your path to sustainable relief.

Dr. Michael Derry is a Doctor of Physical Therapy and board certified in orthopedics. He is very passionate about treating lower back pain and helping people build their resiliency. He has spent time assisting at universities as well as managing large clinics before starting his own practice in Jacksonville, FL.

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