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Our Back Clinic Calgary: 9 Myths Of Lower Back Pain Treatment

back-clinic-calgaryOur location: 2004 14 St NW, Calgary, AB T2M 3N3

Low back pain is a very common condition affecting  80% of the adult population at some point in their life, and is something that our Back Clinic in Calgary often treats. It results in significant disability and lost time from work as well as compromised quality of life. Dr Scott Haldeman an expert trained as both a chiropractor and medical doctor has suggested there is a supermarket of choices with 200 treatment options available to low back pain patients. There are many different health care professionals and lay people suggesting treatment options. It is important for you to understand some of the common misconceptions associated with the cause, nature of the injury and treatment  associated with low back pain.

1.Your response to treatment is determined by the severity of the back problem!

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It is well known that people who feel overwhelmed by the stressors of life don't respond as well to treatment of low back pain as those patients who are happier with their life situation. These things in our personal life that modify our response to treatment researchers have labeled as Yellow flags. These are the psychosocial problems seen with stress or depression.

2. An MRI can determine the problem causing your low back pain!

This type of imaging is a terrific tool for visualizing the structures of the body particularly discs and nerves that are not seen on plain x-ray films. Unfortunately, it is not an omnipotent process able to say which of the damaged tissue is clinically relevant. One study that reviewed MRI's of people without back pain found that 4/10 of them had bulging discs. They are overly diagnostic with many false positives. Nothing is more important than a good exam.

Imaging for Low Back Pain: the use of lumbar MRI increased 307% in a recent 12 year period (American Medicare data). Surgery rates are highest geographically where imaging rates are highest – patients who receive early imaging (CT/MRI) have higher rates of surgery than those who receive only plain film x-rays, yet the clinical outcomes are no better.

 When judged against clinical guidelines (that all recommend AGAINST routine use of imaging for LBP), an estimated 33-66% of spinal CT and MRI studies may be inappropriate

3. Plain film x-rays will determine the cause of your back pain!

It is well known now that imaging findings correlate poorly with clinical symptoms. At our clinic we regularly take digital x-rays to visualize the spine we are treating and not to diagnose the pain of the patient. Taking an x-ray to determine the function of the spine is a lot like taking a photograph of a car to see how it is running.

4. Bed rest is important!

Brief periods of resting flat on your back on a firm surface when it is initially injured can help but most health professionals today understand that movement is important to heal a back. When I was first in practice 30 years ago many of my patients had been told to rest flat on their back for a week to heal their low back pain. A week of bed rest will not fix a back problem it will wreck a good back.

 5. Avoid movement!

Fear avoidance beliefs (FABs) have been described as the avoidance of movement and/or activities due to fear of pain. This fear may be based on emotion or reason, or both. Much like bed rest a sedentary approach to back pain will create more problems in the long term. At times patients come to the clinic in very severe pain. We still encourage them to limit sitting and be as active as possible. They may begin by walking or doing movement in a pool.  In keeping with this early return to work is associated with less long term disability.

6. The exact tissue causing the pain is easily identified!

As much as patients and the doctor wish to isolate  a specific injury research suggests that the exact tissue causing the problem is only correctly identified 10% of the time.

7. There is one best treatment!

I would like to say yes, and it is chiropractic. The correct answer though is that the response to treatment is very individual.  95% of low back pain is mechanical in origin and research has shown chiropractic adjustments to be one of the most effective choices for treatment. Also there is a high level of satisfaction with chiropractic treatment reported by chiropractic patients.

Be careful of the care you choose as many treatments are not supported by evidence and worse options are not only ineffective but carry significant risk.

8. There is no role for medications!

Medications are overused and often used to the exclusion of good conservative treatment options. There are many risks associated with their use: The active ingredient in the pain medication Tylenol,vAcetaminophen is associated with liver damage, Non steroidal anti-inflammatory drugs such as Naprosyn cause gastrointestinal bleeding and narcotics are addictive with many side effects.

There is good evidence however that medications can be used initially to help patients deal with the symptoms that limit their ability to be active or get chiropractic adjustments or physical therapy.

9. Surgery is a solution for degenerative low back!

Surgery has a well-established role in treating fractures and deformity, but limited evidence for treating degenerative discs with back pain alone. From 1994 to 2007 MRIs have increased 307%, spinal fusion surgery has increased 204%, spinal injections have increased 629%, opiate use has increased 423%. During this time clinical outcomes did not improved. There is a patient cohort who will benefit from surgery but most others would be better in the long term to have conservative care.

Click on the link for more information about Dr. Davidson, and his experience in over 30 years as a Calgary Chiropractor T2M

Please click on the link if you would like to learn more about spinal manipulation.

Our location: 2004 14 St NW, Calgary, AB T2M 3N3

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Research Studies References

Study Title: Fear-avoidance beliefs & pain avoidance in low back pain – translating research into clinical practice Authors: Rainville J, Smeets RJEM, Bendix T et al. The Spine Journal 2011; 11: 895-903

Study Title: Overtreating chronic back pain: Time to back off? Authors: Deyo RA et al  Journal of the American Board of Family Medicine 2009; 22: 62-68.

A hospital-based standardized spine care pathway: Report of a multidisciplinary, evidence-based process Paskowski I, Schneider M, Stevans J et al., Journal of Manipulative & Physiological Therapeutics 2011; 34(2): 98-106.