Why is Low back pain so hard to diagnose?
Let's start this discussion by touching on why the source of low back pain can be so difficult to diagnose and successfully treat. Low back pain is the leading cause of disability worldwide and also ranks high in level of daily burden. While it is common for your first experience of low back pain to self resolve, it is also common that back pain becomes episodic, and that over time those episodes become more frequent, more intense and harder to resolve.
When you go to your physician's office with a compliant of lower back pain, they often take an x-ray or MRI of your spine. In some cases these images show significant findings such as disc bulges, degenerative joint disease and spinal stenosis. Your doctor may even say something like, "you have the spine of a 90 year old." This is not only offensive to 90 year olds, it isn't a very good predictor of pain. The problem with static images
diagnosing your lower back pain is that there is a poor correlation between medical imaging and pain. For every person who is having back problems and a remarkable x-ray finding, there is another who is suffering and gets a "normal" imaging report. Even more confusing are the people who have major findings on imaging and have no pain what so ever. This can be very frustrating for both patient and provider. It would be so much easier if the picture told us what was wrong and then exactly what to do about it. Unfortunately, this is not the case. The causes of lower back pain are multifactorial and as unique as the individual seeking answers. That means that the treatment plan that helped your friend, isn't necessarily going to help you. This is where a proper evaluation of your whole body is essential to getting you the right treatment for your back pain.
A Different Approach to Evaluating Lower Back Pain
The Integrative Physical Therapy approach at Inertia Physiotherapy in Missoula, Montana is a truly whole body approach that takes into consideration all your systems. Pain is an output. It's a real experience, but it's a decision that your brain made based on the information it has on hand. That means there's something sending the signal or causing it to persist. That signal may be coming from any structure in your body and especially in cases where a traditional musculoskeletal approach hasn't proven effective, it's often not where you think it is.
In Physical Therapy School we are taught to understand the hardware of the body: the bones, muscles, tendons, ligaments and nerves. We learn to strengthen what is weak and stretch what is tight. We learn biomechanics and look at the body as if it is as machine. It turns out we are so much more complex and elegant than that. No system works alone and influence on any one system will have a ripple effect on the rest of the body. We can use this fact to our advantage if we can evaluate the body in such a way that identifies the primary area of dysfunction, or the "Primary Driver". The Primary Driver is the zone of the body that is causing most of the problems, or the Villain in your plot. The Victim is the tissue that hurts. In this scenario the Victim is your lower back. Quite often, treatment has failed to yield lasting results because it has been directed to the Victim. Sometimes you can soothe the Victim for awhile, but the Villain will usually prevail. With subsequent episodes the Victim screams louder and thus the cycle repeats more intensely with more disability than before.
With the Integrated Systems Model, we gain a deeper appreciation for the interconnectedness of the body and we understand how to identify the system at fault. This results in treatment targeted to the right tissue with the right tool. An under appreciated, but very logical system to find dysfunction in is the visceral system. Let's take closer look at why this is true.
Internal Organs As a Source of Pain
The abdominal organs (viscera) are fascially and neurologically connected to your spine and spinal cord. They all have an intrinsic movement that is essential to health of the organ and organism (you). If the fascia surrounding the organ becomes inflamed as a result of infection, trauma, environmental toxins, emotional stress, poor diet, or repetitious movement or posture, the function of the organ can become impaired. This results in reduced communication with the brain and further dysfunction in the organ. Since your organs can't directly communicate with your consciousness that they are in distress, they may instead send a signal to your musculoskeletal system in the form of pain in the spinal segment that innervates that organ or the surrounding muscles.
A common association with low back pain is "weak core muscles." While core strength is important, if your gut isn't happy (inflamed, bloated or restricted), your abdominal tone will be neurologically reduced and your lower back and pelvis are more vulnerable to injury or strain. Often our clients have been prescribed "core" exercises, but they haven't provided relief or even made them worse because the underlying dysfunction hasn't been treated. Once the underlying problem is addressed, the abdominal muscles come back online, your core exercises are more effective and your back feels much better.
Benefits of Visceral Manipulation for Low Back Pain
Visceral Manipulation is a gentle manual therapy that targets specific restrictions in the fascia (connective tissue) that surrounds and suspends the organs in your body. It helps to restore mobility and motility of the tissue to promote optimal function. Through this process we help your body regain the natural rhythms that create communication between your organs and your brain. This in turn helps the nervous systems relax and stops the signals to the brain that mean "pain." When your gut is happier, your brain is happier. When you resolve the restriction and inflammation of the gut your nervous system allows your abdominal muscles work better and respond to exercise. The result is a more supported and stable spine that allows you more freedom to lift, twist, bend and do the things you need and want to do without pain.
The Moral of this story is...
If you are stuck in a cycle of back pain episode that are getting more intense and harder to resolve. If you aren't responding to your current treatment plan or despite time and effort you don't feel your core getting stronger, visceral manipulation may be the answer you're looking for to jumpstart your healing.
If you are interested finding out if visceral manipulation would be beneficial for you, we invite you to contact us and discuss your case further to find out if we have the solution you've been looking for. You can call 406-880-7945, email ana@inertiaphysiomt.com or visit our site to request a phone consultation here.
About the Author- Ana Soulia is a Dr. of Physical Therapy and founder of Inertia Physiotherapy in Missoula Montana. She specializes in treating complex problems and persistent pain issues. She is passionate about helping her clients move well and enjoy an active Montana Lifestyle.
Her Integrative Approach to PT emphasizes the need to evaluate the whole person in order to understand how all the systems contribute to pain and nagging injuries. If you are in the Missoula area and you'd like to know more about Ana and how her practice is different please visit www.InertiaPhysioMT.com
1001 S 4th St W Suite 4
Missoula, MT 59801
406-880-7945