Updated: Feb 1
By Ana Soulia, PT, DPT | Inertia Physiotherapy Missoula, MT
Why is Lower Back Pain so Hard to Treat?
Lower back pain is a complex problem that plagues 50-80 % of adults in their lifetime. In fact, it is a leading cause of disability in the US. As a country we spend upwards of $100 billion dollars a year treating lower back pain. There are around 12 million spine injections and 1.62 million spine surgeries performed each year and while some of these are helpful, many are not successful and result in further disability, reliance on pain medication and serial surgeries. So, what's leading to all these lower back surgeries and is there something we can do to reduce the incidence, suffering and overall cost? Keep reading for more on why and what we can do about it.
The medical community is gaining a deeper understanding of the origin of pain of how and why we experience it and physical therapists are leading the charge. Pain at the base level is a sensation that our brain sends us when it wants something to change. We have learned a lot in the area of pain science and one of the most important things we've recognized in lower back pain is that there is a poor correlation between static images like MRIs and X-rays and the source of lower back pain. For every person we find that has significant degenerative changes in their spine with back pain, there's another with the same or worse findings and they have no pain what so ever. In contrast, there are plenty of people suffering with back pain that have no obvious signs on their imaging at all. This doesn't mean that one person is faking it and the other needs surgery. It means that pain is complex and is the outcome of multiple inputs from multiple systems. It means that we have to dig deeper than a static image to really figure out why each individual is suffering from lower back pain. The truth, all of our systems are connected, none of them work alone and any one of them has the possibility of causing lower back pain. It be overwhelming to figure out what's causing your lower back pain. That's why it's extremely important to find a practitioner who understands this and can effectively identify the root cause of your pain.
A Whole Body Approach to Low Back Pain
At Inertia Physiotherapy, we believe that process must start with the patient's story. Your life experiences, previous injuries, surgeries, work demands, hobbies, sports, diet, exercise program, sleep habits, relationships, home support and more all play a role in how you feel today. They are the starting block to help us get to know you being to understand what is leading to your lower back pain. It's often during this history that we can uncover details of your past that you would never have linked to your low back pain. Common findings include history of:
Head trauma and concussion
Frequent use of antibiotics
Knee or hip pain
Sustained awkward postures
At Inertia Physiotherapy in Missoula Montana, once we have the identified key elements of your history, we let your body tell the story through posture, movement and function. If 10 people walk into my clinic with lower back pain, they may all have different tasks or functions that are limited by their pain. One may have difficulty sleeping, another can't sit and yet another can't walk or run. It seems obvious that the evaluation that effectively finds the source of low back pain for each of these patients shouldn't be the same, but in most clinics that's precisely what you get.
At Inertia Physiotherapy we tailor your evaluation to reflect the positions, functions and movements that cause you the most problem. We call this problem your meaningful task. This laser focused evaluation doesn't waste time considering postures, positions and functions that aren't an issue and lets us find the primary driver of your low back pain. The primary driver is the body region that is causing the most dysfunction for you in your meaningful task. Once we know the primary driver, we have a variety of tools to help address your problem and restore balance and function in your body. In many cases, restoring function and balance results in reduction and elimination of low back pain where standard treatments for lower back pain have failed. Put another way, if you fix the source of the problem, you turn the volume down on the stereo. The real issue with the majority of back pain treatments is that they don't take into account all the special details outlined above. They focus in on the spine treating instability where the may not be any, inflammation that is there for a reason that may be far away from the site of pain and they fail to reflect the true nature of how and why we experience pain.
If you have tried and failed to improve with standard courses of treatment for your lower back, even surgery, Inertia Physiotherapy has a different way. You are invited to schedule a FREE Discovery Session today at https://InertiaPhysioMT.janeapp.com.
Self Care to Help Resolve Low Back Pain
We have discussed why many standard medical interventions and even physical therapy treatments have failed to reliably produce relief to lower back pain. Is there anything you can do at home to find relief from lower back pain? The answer is yes, but for optimal results you need a comprehensive evaluation so that you can target the exact areas that will help you most. I always feel ambivalent about providing general advice for lower back pain treatment because the causes and solutions are so diverse. The more patients I see, the more I believe that lifestyle has more to do with your persistent pain than any one exercise you're not doing. That is why I feel confident in offering the following advice to get you started.
If you aren't sleeping well, work on your sleep hygiene. We all handle stress and discomfort more poorly when we are tired. Avoid caffeine after noon, get off your devices at least 1 hour before bed, try blue light blocking glasses, set a regular bed time and develop a wind down routine to help you get quality rest.
If you aren't drinking enough water make this a goal. Drink 1/2 to 1 ounce of water per pound of body weight. Our body is 60% water and our fascia is up to 70% water. We need proper hydration for our tissues to be flexible, adaptive and reactive.
Try adding in a few extra servings of fruits and vegetables per day and reduce the amount of processed food you consume.
Sitting is the new smoking. If you sit for a living, make it a habit to get up more often and consider a sit to stand desk that easily transitions between the two positions.
Movement has a cumulative effect. Take movement breaks throughout the day. Even 5 min here and there can break up your habitual postures and offload the tissue that might be irritated as a result.
Start a mindfulness practice to help manage stress and identify where you might be holding tension. You can use breath to identify and release this tension. There are many apps on the market. One that is free to download and has loads of amazing free content is Insight Timer.
A note of caution, don't try all of these at the same time. These are common lifestyle factors that play into overall health and lower back pain. Change is hard and developing new good habits is even harder. Pick one and stick with it for a month, then add another. Track your symptoms to identify positive change. Start with the one that seems the most relevant to your life or even pick the easiest one. Celebrate your small wins. Treating low back pain is a process and it is multifactorial but with the right expertise and dedication, it is possible. You can reduce or eliminate pain, restore your function and live the active, healthy Montana lifestyle you deserve!
If you are in the Missoula area and have any questions or would like to discuss your case further don't hesitate to call or text for more information at 406-880-7945 or schedule your FREE Discovery Session by visiting our website www.InertiaPhysioMT.com/discovery-sessions-missoula-mt.
1001 S 4th St W Suite 4
Missoula, MT 59801