Low Back Pain Series: Volume 4

My name is Dr. Robert Cutting and I am the sole Chiropractor working alongside the team at Mackie Physiotherapy. When it comes to treating patients, I believe in taking an evidence-informed approach to care. Evidence-informed care takes into account the best available evidence, a patient’s preferences and my own clinical knowledge and experience. There certainly is no “one size fits all” when it comes to treating an individual’s musculoskeletal complaints. It’s important to approach each case on an individual basis, and treat based on the individual’s needs and with their specific goals in mind. 

This is installment 4 of a 6 part series focusing specifically on low back pain. By educating patients about their low back pain we can provide the tools to help them understand it and feel empowered to take an active role in their care plan. This lays the foundation for them to regain a locus of control and develop the confidence to return to doing the things they love.

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So what does mechanical back pain mean & how do I as a Chiropractor at Mackie Physiotherapy address it?

First and foremost we need to understand that greater than 95% of low back pain cases that walk into a Chiropractor or Physiotherapist’s office are NOT considered a serious condition. Now, do I mean we shouldn’t take it seriously…? Well of course not, everyone’s pain experience is individualized and serious to them; it influences your day-to-day routine and may even impact you from being able to do the things you love.

What I do mean is that your “source of pain” is rarely due to a sinister reason such as an infection, fracture, or malignancy (tumor) that would warrant immediately referral to your family doctor or even the emergency room. Back pain from sinister sources is very rare.

However, chiropractors are extensively trained to recognize the signs and symptoms of serious causes of low back pain. Once these serious causes or “red flags” have been ruled out and it’s determined that no specialist referral or advanced imaging is necessary to confirm a diagnosis, we can confidently consider the patient’s low back pain to be from mechanical sources. Now, I use the word mechanical but by no means do I want you to consider your body the same as a machine or car - just because you have pain and a potentially sensitized structure contributing to that pain, doesn’t mean you can just swap it out for a new younger model with leather heated seats, more horse power, and slick rims. It also doesn’t mean experiencing low back pain now means you “have a bad back” or that you’ll have to live with this pain forever. I like to explain to my patients that even though you’re in pain, you back is normal, just currently sore.

So what do I mean by “mechanical?” It means that there may be a nociceptive driver (i.e. receptors within a structure are causing pain signals to be interpreted by your brain) somewhere within the neuromusculoskeletal system. Neuromusculoskeletal… say that 10 times fast. What could have happened is some initial insult to the system (ex. lifted a weight you may not have been ready for, twisted the wrong way and felt a catch, sat at your desk for 8 hour and when you got up you felt sore, etc.) may have irritated a structure in your body such as a joint, muscle, tendon, ligament, bone, bursa or nerve.

We know that any pain experience can be viewed as serious to the individual experiencing it, and we know more than just mechanical culprits play into it as well. Ask yourself this, have you ever gotten a poor nights sleep that made even the simplest things seem unbearable or made you irritable towards people or tasks that any other day seem simple? Perhaps you have a stressful deadline to achieve at work that put additional strain in your life that made you want to shut everyone out. These sorts of things can add pieces to the puzzle that is your current episode of low back pain. We also know low back pain, like a headache, is an episodic condition that can come and go.

As pain persists it becomes less about tissue damage and more about the stressors in your life or something in particular about you that can make you more sensitive to your pain. Remember, pain is normal but what happens when it persists is that we get better at it. In a sense, we have an over-reactive system. Its easier for the pain to be “triggered’ and multiple things in our lives can contribute to this. It’s not just about muscles, tendons and joints (although they are sometimes important). It’s everything in our lives. For example, athletes are more likely to get injured when they have a lot of physical / mechanical stress. That is what most people would expect. But they are also more likely to get injured when they have a lot of academic and/or psychological stress as well.  

Look at pain as the overflowing of a cup. Many things contribute to what is in that cup. You can have a lot of physical, mechanical, emotional and social stressors and have no pain. But at some point a sudden increase in one of those stressors, or a new stressor, puts you just over the edge and the water flows out and now you have pain. Often people will have more pain when there are changes in the stressors in their life. It is the inability to adapt to the new stressor that contributes to pain and not necessarily the amount of the stressor in your life. Pain occurs when we fail to tolerate and adapt to all the stressors in our life. In general we say that the cup is filled by the BIO-PSYCHO-SOCIAL factors in our life. In other words, all areas of our life make up the cup. We need to keep that cup from overflowing to stay out of pain!

It's Not All In Your Head

As soon as people start talking about emotions, psychological factors or the brain the assumption often slips in that we are saying your pain is now just in your head. Just because psychological factors or the brain is involved does not mean the body is not important or the pain is imagined. In fact, the brain and psychological factors can amplify your physical factors. This is a very important concept that people need to understand! For example, you might be forced to sit at a desk all day for your job and typically experience a little bit of “back-soreness” here and there, nothing unbearable, you manage it well and it tends to go away just as quickly as it showed up. However, if you are stressed and sitting somewhere where you are worried you will often “feel” your back-soreness more and may not be able to manage it as efficiently. This is not just in your head. If you are in a situation where you must lift a fallen tree off your loved one you
 will be able to lift way more weight then you could if you were just in the gym. This is not psychological and is not in your head. You really would be stronger and that strength is not imagined. The same with pain- it is real and not imagined.

What is great about the cup analogy is it means we have a lot of options to help with your pain and your sensitivity. And rarely is there just that one thing that must be “fixed”. A lot of things can help you get better and we can adapt to a lot of things.

My hope is that this information may challenge some of the current misconceptions surrounding low back pain. My goal with this series is to educate, empower and create a more positive and resilient outlook towards low back pain!

If you’re ready to start doing something about your low back pain give our Evergreen (306-952-6277) or Arlington (306-955-7888) locations a call and ask for Dr. Cutting or book an appointment with one of our front desk staff. I will thoroughly assess your individual case and create a targeted treatment plan based on sound clinical reasoning and research to help you manage your low back pain.

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Dr. Rob Cutting can be seen at both Mackie Physiotherapy Clinics!

Monday / Wednesday / Friday at Evergreen Mackie Physiotherapy
Tuesday / Thursday at Arlington Mackie Physiotherapy

You will not be disappointed with the quality of skill and patient care.

Call and book today!

Arlington: (306) 955-7888                   Evergreen: (306) 952-6277