The best things to do for a bad back pain episode has challenged people and medical doctors for generations. In the 1980’s bed rest and even a hospital stay was the best option in the USA. In England traction was thought to be the answer to a tight contracted back, that was to gradually stretch it out. Some people had two weeks of traction as the best medical care. Today in England the main medical approach is to provide anti inflammatories and mild over the counter pain killers, with a physiotherapy referral (within a few months). The physiotherapy approach to back pain is to provide reassurance at first. Typically an episode is bad for 3-5 days and can be felt to some degree for 4-6 weeks. People’s episodes are normally over by the time a hands on approach from the NHS is provided. The way the first back pain episode is cared for can have a knock on effect to future pain episodes. If you don’t get fixed at first it just keeps on coming back until you either get fixed or get used to having back pain episodes. 1-3% of back pains will have a sinister aspect eg a red flag such as a collapse fracture
It has been known for 15 years that anti inflammatories are enzyme inhibitors that alter the natural balance between cyclooxygenase (COX) and lipooxygenase (LOX) enzymes. Altering any natural balance creates a drive to re-balance leading to more COX enzyme increasing inflammation after 2 hours. Yes there is a decrease in inflammation in the first 30-60 minutes, then a rebound increase in inflammation begins to develop surpassing previous inflammation levels at about 2 hours after taking the NSAID (Ibuprofen). The marketing of anti inflammatories is highly suggestive having a strong impact on a lot of people.
Recommendations are now recognising that for acute low back pain the best approach is to rest for the first day, then allow yourself to move around as normally as possible, light duties and slow. Consider Chiropractic Care to help (not only this episode but also future episodes – having chiropractic care for your first episode can actually prevent the next episode form occurring).
Two recent studies seem to have conjoined in my mind; one is from Zurich University Chiropractic department showing brain activity relative to lumbar spine pressure such as might happen in low back pain syndromes. The other is about training mice to ‘fear’ a smell across their generations controlling for nurture. Answering the long debate of nature versus nurture. Researchers showed that without nurture the cue for a fear response can still be passed on.
The first study carried out in Zurich; showed that back pain is linked to a part (nucleus) of the brain involved in social pain. What if we as humans could pass on in our genes information that affects the life experience of the next generation? You may find yourself as an individual with a back symptom from ‘nowhere’ due to an ancestral social cue. In generations passed going out of favour with the group could have had deadly consequences.
The second study was published in Nature Neuroscience (2014; 17, 89-96) demonstrating a transference of a fear response genetically; without nurture. The mice were shown to pass on a (protective) smell memory to their children and their grandchildren (F2).
If we as a species can have an ancestral cue for a social stress causing back pain passed on from family member to family member and social stress is not considered in your care plan. You could be forgiven for thinking that you have to ‘live’ with pain. Identifying potential cues from your environment ‘stressors’ to your behaviours, thoughts and/or feelings can be methodologically worked through. Whilst you figure out the cues to your stresses consider having body work to help you with accumulation. Accumulation in my opinion can make your condition worse.
I think when human body tissues are abnormally loaded the tissues do not undergo a training effect and instead are strained. Having a genetic fear response in social conditions where I reflexively squeeze my back muscles from an unidentified cue, providing pressure on my vertebrae, would be an abnormal load; like a repetitive strain scenario on the low back tissues of the body. Choose fascia first chiropractic it is more than a ‘quick click’.
At first learning about the human body can be confusing at best, for the human body is a complex thing to attempt to understand.
In 2007 prominent physiotherapists published a paper on regional interdependence. This is a type of pain that occurs at a distant site to the root cause of pain (nociceptive). E.G that the thoracic spine can be the cause of neck pain, and a not so obvious one that the foot can stop head rotation short. Essentially almost any part of the body can affect any other part as we are well interconnected (hopefully!). The body in fact is bidirectional within itself (Tech bit: in a lower motor neurone way). The knee could cause the painful low back experience of an individual but does not give any pain at the knee. Regional Interdependent pain is different to referred pain as referred pain had been mapped and is known. In a case of interdependent pain the body worker assessing you would have to understand the link in order to help you with your problem. If the site of pain is treated then the problem can be made worse in the case of interdependent pain. Body workers such as chiropractors have ways of identifying areas to treat that are not pain based. Which is why some people have regular care; gaining benefit without the pain involved in a flare up.
Chiropractors are educated intellectually and trained in manual procedures differently to specialist manual physiotherapists, hence why in the case of a person with regional interdependent pain, we find that tacitly the concept is already part of chiropractic care plans to help musculoskeletal pain experiences. In other words: My pain does not always signify the body part that requires treatment. There will be an order of care in your chiropractic care plan that involves you finishing the course of treatment. Chiropractic is more than a quick click.
Chiropractic’s famous first adjustment story is recognized each year by the Chiropractic profession when we are reminded about our roots. There is much hyperbole about the story as one can imagine that occurs when embellishment meets embellishment and enthusiastic well meaning generations alter the story slightly to fit with their momentary feelings whilst retelling the story. This process repeated many times over gives a sense of mystery. The stuff every good story is made up of. For example this year the ICA have released their version of the story as:
‘On this day, 118 years ago, Dr. Daniel David Palmer administered the first specific chiropractic adjustment on his patient, Harvey Lillard in Davenport, Iowa. Dr. D.D. Palmer delivered this historic first chiropractic adjustment with the specific intent of realigning a malpositioned vertebra on the patient, restoring its normal position, and Harvey Lillard, who had lost most of his hearing 17 years earlier, noted his hearing swiftly returned under Dr. Palmer’s care.’
I personally have had two people have vast improvements in their hearing and know of 5 other chiropractic patients that have had vast improvements even two brothers under consultant supervision within the NHS who had years of tests and investigations as to their hearing deficits. The real life examples are there but few and far between to really ‘hang one’s hat on’.
Not only was the story of DD Palmer rare but a stroke of luck as described by Life University in their reconstruction of the story told by DD Palmer himself(!) http://www.youtube.com/watch?v=kSfQQGAkb7k In this telling the story is different to the intended and ‘specific’ nature of the first adjustment by DD Palmer. Here the story is that DD Palmer was saying goodbye to Harvey Lillard and on the staircase gave him a truculent slap on the back with a large book. A few days later Harvey returned to DD unannounced and said his hearing was significantly improved. Chiropractic had a chance beginning.
DD seemed to have gotten lucky and then set to work to explain what he observed. There is not mention of how many other people he tried to slap on the back with a book who had hearing problems or of his attempt to replay the context within which the slap was given. DD immediately set to work on the spine and tried to be more specific in his net application of force to Harvey. Further ‘ adjustment’ restored the rest of Harvey’s hearing (or now that Harvey was primed his expectation was to create the same state and rapport and he’d naturally get better). This is a great story and one that has set the tone of the profession from bone setting (DD had training in) into the muti technique conglomerate of done by hand that is helping millions of people get well today.
I have a particular view based upon how our practise is set up today that the first adjustment was as much about the context, meaning, intent, environment, priming and belief as much as it was the spine to ‘align’… Ever since Chiropractors have been stuck on just the spine. By using nothing more than interaction, simple props and rapport humans can help other humans over come just about anything as long as their culture and/or they think it is possible to get well (hope).
In my mind there are a myriad of explanations for why Harvey Lillard had an improvement in his hearing. DD Palmer explored many and found that adjusting the spine had a miraculous effect. Just as alcohol could fuel the first riders in the Tour De France times change, perceptions, knowledge and culture changes. Thus today the founding principles of Chiropractic cannot be held onto. They can however be kept as a comforting story about the beginnings of the largest non drug health care profession in the world. From such chance beginnings people have a way of being healthy that does not have to involve drugs. Education, knowledge and standards are changing and those for Chiropractors have changed too.
In yester year there may have been a singular adjustment that was considered the reference point that made a difference and lead to the ideas of administering an adjustment. Contemporary Chiropractors realise that the same rules do not apply today as they did one hundred and 18 years ago. The first subject may have been ‘subluxed’ at his T4 segment or his atlas (depending upon which story version you hear!) whereas today a look into the nervous system of a person may look something like:
Symptom: upper cervical pulling sensation that leads to an almost unbearable migraine that is not totally relieved with valium, pain killers and anti-inflammatories. Imaging was unremarkable.
Chiropractor interprets: Occiput dysfunction (CN10 vagus nerve), no sacral dysfunction or lower extremity dysfunction, CN9 motor dysfunction at back of throat, cn12 tongue motor dysfunction, cn11 traps weakness and opp scm (hemisphericity?), along with external ear pinna sensitivity (cn9), shimizu reflex, larger vessels in the eye, eye press dysfunction in changing heart rate; corneal reflex is ok so just cn10 dysfunction etc. Chiropractors continue along a deductive line of thought based upon the idea that somewhere the body is telling the brain the wrong information creating a Chinese whisper (subluxation) that creates an unconscious reflex response from the brain to create the sensation of a symptom. The point is that examination today is in more detail than it was in 1895 by a long way due to the advances in science and the understanding of the brain body and body brain connection.
Some chiropractors can rest on their laurels and only follow lines of possibility that are similar to the founding principle of everything comes from the spine. Even though this line of enquiry into human health was reinforced by Henry Windsor MD in 1921 for just over a decade who demonstrated that natural causes of death correlated exactly to the controlling level of the spine 99% of the time in cats dogs and humans. There have since been advances in knowledge around causes for changes in human health that are not considered a disease process. For example: development (attachment), interaction, genetics, trans-generation habits (copying conscious and unconscious aspects of influential people), environment, activation of HPA axis (trauma), culture, religion, mechanical injury, insidious injury, infectious load, fitness, family commitments, pressure of life, relationship with yourself, diet, hours driving, hours sitting, free time, spiritual development, social group, and knowledge are all factors to take into account when considering the health of a person’s nervous system.
Stories convey meaning and enable us to feel. We can all recognise a pleasant feeling over an unpleasant feeling and thus a good story from a bad. Altrusim / helping the greater good of mankind is a great theme to help Chiropractors be reminded of why they are chiropractors and not a time to return to the (original) adjustment being king and everything is from the spine! May the chiropractic profession expand, spread the modern word and help millions more people.
The classic example of somebody having a restriction in their flexibility and they feel it at the back of the legs is thought to mean tight hamstrings. Yet in a fascial model of the body the TFL muscle is actually under about twice the strain that the hamstring muscles are under during a straight leg raise. The most obvious place to consider changing would be the side of the leg in tight hamstrings and not the back of the leg where it is felt! The fascial connections of the thigh are complex and numerous; for example in clinical practice I have ‘worked’ on the adductor muscle of the lesser affected leg and gained 20-25 degrees of extra flexibility in a straight leg raise of the more affected leg.
Having the view that my problem is where I feel it is a difficult concept for most to let go of. Sometimes where you feel it does not need to be changed. Where you don’t feel it does! Having an in depth knowledge of anatomy and understanding human movement and how tissues interact within the human body is essential to truly get to the root of a musculoskeletal problem.
Training such as in a Chiropractic degree (undergraduate Masters) is ideal to start to see the root causes of a problem within the human body. When the human body is not able to change in a certain place, the body compensates and thus moves the symptom, yet the root cause is still the same; there is just a longer more complex chain of events that exist once a compensation occurs. Addressing the fascia before any adjustments is my strategy in clinical treatment. This way I am able to work through the layers of compensation until I find the root cause. Step one for you with tight hamstrings is to come to terms that the root cause is most likely (if you’ve had the problem for more than 5 days) somewhere else (in my opinion) than the back of your leg. Psychologically speaking if you keep on putting your problem to the back of your legs you will in fact keep a problem at the back of your legs! When seeking help from a Chiropractor it can be useful to look up the conditions that have evidence behind them.