Question
Dr G,

I'm a 32 year old male that's suffered from lower back pain for a little over 4 years. Left lower back, radiating pain. I had injured my lower back 4 years ago (lifting), experienced nasty spasms and after tests and x-rays were administered, I was told that I have bone spurs on the spine. I worked in heavy construction for a numbers of years, and right around the time of my injury, I became an office worker(sitting).

Since that time, pain fluctuates at times from dull, to heavy, particularly after lifting. Have not had any spasms thankfully. About a year ago, I started running on the treadmill again, but my back flared up again and I've been unable to run. Somewhat scared to.. My legs are tight, and I do feel tension in my back. My range of motion when lifting my legs while layig on the ground is minimal.

I've had A LOT of conflicting treatment recommendations. Everything from "no, see an orthopedic specialist, not a chiropractor," to surgery. I realize that exercise is imperative. I've been told that pilates helps, core strengthening, yoga, acupuncture, to loosening up with leg/hip/back stretches. The question is, with so many treatment options available, what might you recommend for just a daily strengthening/loosening exercise routine? I'd like to target the issue and would love to be back in running condition to run a marathon in late Spring. Thanks in advance for your help!

Answer
Hi Joseph,

Bone spurs do not correlate with back pain. Many folks with osteoarthritic spur formation have no pain.   Likely you injured the intervertbral disc and it continues to give you trouble.  You also must have someone to a "prone instability test" on you (google it).  Sitting is not good.   You're better off lifting (but with good mechanics).  There's more back pain in a sitting population than in a heavy labor population.  

There are three 揗odels of Care?that are currently used to approach disabling lower back pain:    

The first model is the 揚atho-anatomic?model.   This is the main model of care for most bodily conditions, and the model that has remained primary when going to a doctor for almost anything.    It is based on the cause of pain being from a body part,  a boo-boo of some sort, like a joint sprain,  disc herniation, inflamed joint, or tumor.    In this model, physical examination as well as imaging procedures is mainly used to home in on the anatomic bulls-eye.     The flaw in this model is that often there is no observable boo-boo.   MRI could be negative, showing all normal bones, discs, and soft tissues, and the physical examination turns up as normal such that the doctor cannot determine where the problem lies.    This is where the doctor might assume that the pain is psychological, further adding to the flaw, when often it is the doctor that fails to do the correct examination procedure, missing the problem.  Regardless, the patient often ends up bouncing between different providers looking for a solution, costing time and healthcare dollars.   

Another model is the 揃io-Psychosocial?model.   It is often overlooked and underappreciated for lower back pain treatment.      Psychological and social issues are part of our human experience.     Depression, family stress, addiction, behavioral issues and unemployment all are proven to be associated with back pain.   Social stressors like family strife or divorce can also contribute to one抯 perception and level of pain.   People suffering in a vortex of psychological and social disorder need help.   This model should never be taken lightly.    Finding a reputable psychologist, social worker, or licensed mental health counselor is the only way to get help ?and help resolve the back pain, too.

The last model is the 揊unctional-Kinetic?model.  In this model what is important is how the body works, or 揻unctions.?   It has nothing to do with social stress, or anatomic boo-boos.    This model is about how well the patient is physically able to bend, move, or function their body.   It is about how physically fit one is, or if there is a lacking of strength or endurance.   Exercise is the best medicine for back pain, and there are correlations between back pain and back weakness or instability.   Assessment by providers such as chiropractors, physical therapists and athletic trainers might include the ability to squat, balance, or to breath with the diaphragm instead of their shoulders.   Other tests might include one抯 ability to perform a prone plank or side plank position exercise, or balance on one leg with eyes closed, or cycle for twenty minutes at a target heart rate.  

Consider these three models of care when obtaining treatment.    They are based on current evidence, and could make the difference between getting better or not.  

Self-care or home-care strategies include watching your posture and being careful how you bend and move. We teach our patients to use a 揼olfer抯 lift?to pick things up off the floor, and not to bend at the waist. Think about how golfers pick up a golf ball: they hold their club against the ground and swing one leg in the air while pivoting on the opposite hip. This keeps the spine straight.

Exercises should be tailored to the individual. For some, any exercise movement that reduces the back pain is encouraged, and those that provoke the pain should not be done. Sit-ups or abdominal crunches are detrimental and should be avoided, since they flex the spine, causing overload to the lumbar spine discs.  When golfers pick up golf balls, they are not flexing their spines.  They hold their club like a crutch and swing a leg in the air as they bend using their hip and not their back.  It's called a "golfer's lift."  Do 搒pine-neutral?exercises like prone planks or side planks. Beginners can try a bent-knee side plank. Also, exercises that engage the back muscles safely are helpful, including the all-4抯-opposite-arm-and-leg, or 揵ird-dog,?exercise. These all can be seen on my exercise page at www.drgillman.com.   

Ergonomics is factor, and those who spend a lot of time sitting at a desk or in a vehicle must find ways to routinely get up and move. Alternating to a standing work station or taking frequent breaks to climb stairs or walk around all help prevent back problems.  

Also, unless you need surgery, the chiropractor is your best bet.   As licensed doctors, chiropractors, or doctors of chiropractic (DC) have the duty to examine and diagnose your condition. DC抯 are also skilled hands-on providers trained to treat MSK conditions. They clearly are the most trained in providing joint manipulation. Specifically, high-velocity-low- amplitude (HVLA) joint manipulation is what chiropractors do best. While anyone can learn to do HVLA manipulation, to do it really well and perform it effectively and safely takes years of training and practice.
HVLA joint manipulation can be powerful medicine in many cases, but not for everyone, and not all the time. Alone it has its limitations, and believing it cures all ills is a fairy tale. Thus, modern chiropractic care combines manipulation with hands-on soft tissue procedures, exercise training, nutrition and ergonomic advice, as well as other modalities such as therapeutic ultrasound, low level laser therapy, foot orthotics and sport taping, for example. This creates a package of care for all MSK conditions, from headaches to foot pain.
Finding a DC with this broader set of skills requires a little research. Check web sites and ask around. While there remains a percentage of DC抯 who refuse to enter this broader clinical realm, most DC抯 blend joint manipulation with other modalities, including some form of soft tissue therapy, at best. Some obtain post- graduate certifications as well as specialist 揹iplomate?degrees in areas such as nutrition, neurology, and sports medicine.

Most importantly, a DC with good clinical skills has the capacity to provide a thorough physical examination and astute diagnosis. Also, they can help direct your care with other providers. This can reduce the odds of getting duplicate care or unnecessary care.

I hope this was not too much to digest.  Feel free to ask me any other question you might have.  

Dr. G'