5 Things I Wish Everyone Knew About Back Pain
“You didn't get this far to only get this far.”
Introduction:
Welcome everyone to the Resilient Body Institute.
My name is Dr Corey Podbielski, and I'm a physical therapist with a board certification in orthopedic physical therapy. I've worked for nearly 10 years and thousands of clients with back pain. I've seen the "YAHOO" success stories, the debilitating injuries that change the course of a life, and everything in between.
My goal here is to inform. I have had an enormous amount of success in my own practice treating patients with back pain. However, this is not always the story I hear when I talk to people in person or on the internet.
The landscape surrounding back pain is mixed. It can look different in every person. Sometimes there seems to be a cause, sometimes there isn't. Some people get better very quickly, while others have pain that persist for months or even years.
I believe that there are things we do really well with back pain, and things we do absolutely terribly.
With that said, let me tell you about 5 topics I hope to shed light on over the course of this blog! 👊
1. We usually don't know why your back hurts
You heard that right. Sure, there are obvious reasons to have back pain that readily come up on an image or scan. Fractures, spinal infections, tumors. Maybe you fell down a flight of stairs, might be reasonable to have back pain. Sometimes it adds up, and it makes sense for you to have back pain.
Sometimes its less clear. Maybe you did a lot of lifting one day and pain started the next day, slowly increasing as the days went on. Maybe you just bent over once and your back started hurting. Maybe you didn't think you did anything wrong and had pain develop. So you seek help.
A lot of doctors will take an image (despite my best efforts to delay this), but these images tell an incomplete story (see below for more info). It likely won't give us any definitive answer of why your back hurts. It's a tough truth, but it's the truth.
This is so tough because this is the #1 thing people want answered, and we as a medical community don't do a good enough job of explaining the nuance. Of course, this explanation should be tailored to the individual person experiencing the pain. This is where I feel like I excel (more info at the end).
2. The "S" Word
Surgery can definitely help some people. I can't deny that.
I think that we, as a medical system, are extraordinarily good at putting things that are broken back together.
However the issue with surgery I don't think is the surgery itself.
It's that we just aren't that good at selecting what people will benefit from surgery and who probably doesn't need it.
Sure there are some reasons to definitely have surgery. Fractures, tumors, etc. There is also some orthopedic/neurological reasons to have surgery. This is where it gets tricky...
Physical therapists and doctors are trained to identify people who have more urgent need for referral. This is not an exhaustive list, but some of the main reasons would be something called "cauda equina syndrome" which is actually an emergency, suspicion of fracture/tumor/infection, or progressively worsening neurological status.
These are not your routine back pain patients, these are outliers.
Currently, the absolute best strategy for what is termed "non-specific low back pain" is to do every conservative management option first. Before any imaging or more invasive procedures.
WHY?
Because a HUGE proportion of people will get better, and not need any additional care. The people who don't get better may have more invasive procedures as options.
This IS the right way to do things, the most efficient, and the least harmful to patients.
3. Imaging doesn't help us that much (in most cases)
So you just started having back pain. Should you get an MRI to figure out why? Except for a couple emergency situations, the answer is usually a resounding know. With "uncomplicated'' back pain, the physical therapy and physician guidelines are pretty clear.
No imaging
No opioids
No referral to a specialist.
Advice to stay active
Unfortunately, this isn't always what happens. Many end up getting early images which ultimately leads down a surgical pathway. Why? Because there will likely be something on your MRI. Don't believe me? Look at this...
Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. doi:10.3174/ajnr.A4173
This table shows how prevalent MRI findings are on ASYMPTOMATIC PEOPLE. Meaning...people without any pain.
This is a pretty nuanced subject that I will no doubt have multiple blog posts about. But the explanation is, a lot of stuff is common in the general population. The lapse in thinking is that when we see these on people with pain, we assume this is the reason for pain. There is just no way for us to say this for sure.
4. Most back injuries have a GOOD prognosis
If you saw earlier, one of the guidelines for back pain is advice to remain active. This is because the research supports the idea that most people can just keep moving, exercise, and stay active and the back pain will go away.
Just because you had a bout of back pain, you are not guaranteed to have years' worth of back pain with multiple episodes and debilitation.
Overall, back pain is very common, and goes away pretty regularly. The presence of pain does not necessarily suggest something is wrong. Sure, you may need to adjust how you do things for a few days, but then you should be able to resume all activities normally.
5. Fitness and Health Over Everything Else
Staying active is for sure the most evidenced-based way to avoid and treat back pain. Our spines are an extremely strong and resilient structure. They can handle amazing amounts of stress and load. Sometimes, they become injured or painful, but that is OK. Like i mentioned, back pain is EXTREMELY common.
Our bodies adapt to the stresses we put on them. If we make our back work hard regularly and progressively, the tolerance to activity and loading improves. IE if you work on bending and lifting in a systematic way with progressive loads and intensities, you will become better at bending or lifting.
Our overall health also ties in closely with our spine health. Things like diet/nutrition, healthy or unhealthy behaviors, exercise habits, sleep, stress, and many others are closely tied with pain. Once again, this is a topic I will talk about frequently in this blog!
I want to give you the chance to start to think about and plan for your life without limitations from back pain. Take a second to think about the checklist below. Think it in your head, write it down, whatever will make it more real for you...
Start your own "better back" checklist:
Here is a quick checklist to get you started with finding out where you are currently. Remember imperfect action beats inaction, get started and keep pushing forward.
As always, I will leave you with this.
If you feel like you might need some help navigating the healthcare system, then I've created some content just for you. These programs are meant to teach you about orthopedic conditions and allow you to implement changes in your own body in as little as 4 weeks!
www.resilientbodyinstitute.com/programlist
If you need any help with any of the information I've given or the questions I've asked, please email me at [email protected]
*This is not intended to be medical advice. If you are experiencing pain, always consult with a physician.
If you believe this to be an emergency, please call 911 and seek medical attention.
