Individual Approach To Back Pain Treatment
Back pain is very common. In fact, it has been estimated that up to 80% of people will suffer from back pain in their lifetime. It is easy to search for that stat on the web but finding a solution for back pain has proven much more difficult.
For a long time, rest was the “treatment” of choice. In many cases, bed rest. In recent years, experts have prescribed a more active approach. Physical therapy and specific therapeutic exercises came to the forefront of many back pain treatments. Now, results from new research are hinting at a different approach, an approach where both (rest and exercise) are right… and wrong.
Here’s what this is all about: A study published February 29, 2012 in BMC Medicine compared rest vs. active treatment with low back patients with modic changes (MC). Modic changes have been described as early disk degenerative changes only seen on an MRI.
Results: In total, 100 patients were included in the study. Data was available on 87 patients at 10 weeks and 96 patients at one-year follow-up and used in the intention-to-treat analysis.
Conclusions: No statistically significant differences were found between the two treatment approaches (rest vs. active treatment) in patients with persistent LBP and modic changes.
What does all this mean? According to the study’s lead author, Rikke K. Jensen, MSc, “The results do not suggest that patients with MCs should not exercise… But I think clinicians should be careful; when patients come back and say this treatment didn’t work, it’s not because they did it the wrong way or they didn’t do it enough. It’s very possible that this treatment is just not very effective for this group of patients.”
In other words – THERE IS NO ONE APPROACH THAT WORKS BEST FOR ALL PATIENTS WITH LOW BACK PAIN.
It is estimated that 40% of low back pain sufferers have modic changes. This means exercise may not be the best treatment protocol for 4 out of 10 sufferers. The cause of modic changes is unknown. Jensen said, “We know that they are part of the degeneration process but we still don’t know what causes them.”
It is theorized they may be caused by mechanical stress. Mechanical stress can cause excessive loading, micro fractures and inflammation of the vertebral endplate and bone marrow.
“When you’re jumping up and down on micro fractures, they tend not to get better,” said Jensen. “It was important for us to test the hypothesis that people don’t improve with exercise if they have these MCs, and there are other treatment options that could prove to be more effective.”
Here’s something interesting: One Chiropractic theory is that malfunctioning spinal joints cause abnormal mechanical stress. Over time, this can cause degenerative changes. So, is it possible that exercising on a spine with malfunctioning joints is doing more harm than good?
Some Chiropractors have theorized that these spinal malfunctions should be corrected BEFORE an exercise program is started. More research needs to be done but it seems like there is no one answer when it comes to helping back pain sufferers. Every case is individual and no one way is the ultimate solution.
