Chiropractors are generally perceived by the public as back pain experts. The fallacy is that although all chiropractors treat back pain not all chiropractors manage specific back pain conditions. In other words, some chiropractors may not treat a disc herniation or spinal stenosis (which involves damage to spinal joints, nerve tissue, disc tissue, reaction of muscle tone, change in posture, loss of strength and conditioning, change in nerve conduction and alteration in brain, psychological and behavioral response) but only manage an aspect of the pain. This is because some chiropractors only focus on removing what is termed spinal “subluxations” which is essentially areas of the spine that are fixed or immobile causing pain and stiffness. In spite of the fact that delivery of a spinal adjustment can help restore spinal joint movement which can reduce some level of pain, this may not be adequate in fully managing your spinal condition or injury. The same is true about a massage therapist delivering massage to a tense muscle tissue or a physiotherapist prescribing only strengthening exercise or only using ultrasound therapy or a family physician only prescribing pain relieving and anti-inflammatory drugs. Rehab clinics that offer multiple therapies under one roof may not mean you will be receiving coordinated and comprehensive spine care that is targeted to your condition.
Treatment of Back Pain and Spine Related Disorders:
A variety of providers have traditionally been involved in the treatment of back pain and spine related disorders. This includes family physicians, chiropractors, physiotherapists, massage therapists, physiatrists, orthopaedic surgeons, neurosurgeons, kinesiologists, acupuncturists and even personal trainers. This has resulted in what some have termed a “supermarket approach” where the patient or “consumer of healthcare” is left to sort out which of these approaches is best for his or her particular spinal or spinal related condition. Unfortunately, a patient’s selection will be based on salesmanship rather than on science, cost effectiveness and clinical benefit.
The Challenge with Back Pain
Back pain is a common problem and affects 80% of the population at least once in a lifetime. There are hundreds of causes of back pain, from simple sprain/strains to spinal disc herniations, arthritis, fractures or even cancer. Diagnosis of your back pain condition requires a comprehensive examination sometimes followed with advanced imaging, like CT scans and MRIs. In some cases back pain is considered benign and self- limiting, meaning it will resolve without therapy over a course of a few days. This is typically seen in most cases of minor spinal sprain/strains caused by postural stresses. Your back or neck may feel stiff and achy from sitting too long at your desk or you may wake up with pain from improper sleeping postures. In these cases, stretching, hot baths and spinal stabilization exercises may be enough to assist with your recovery.
Back pain, however, may also result from more severe injury to joint tissue, disc tissue, muscle, bone or may be a cumulative effect of multiple injuries, dysfunctions and disease. Back pain may also be a consequence of referred pain from an internal organ such as the digestive tract, pancreas or gall bladder or may be a co-morbidity associated with another illness (most commonly depression, anxiety, diabetes, heart disease and obesity). In fact, back pain is now considered by the World Health Organization as a “chronic disease” because of its complex nature and the huge impact it has on our health, productivity, our economy and quality of our life.
Chronic back pain, as most chronic diseases, require a comprehensive treatment strategy and will not resolve with simple physiotherapy. Research supports the importance of planning and coordinating your treatment plan with a team of healthcare providers to achieve better outcomes
Back pain conditions have features that differentiate them from other health conditions. For example, diagnosis is challenging in many causes of back pain particularly when there is no lesion or injury detected by MRI, x-ray imaging or special tests. In many cases a lesion or injury like a disc herniation for example may not even be the cause of back pain. Additionally, most cases of back pain are multi-factorial, meaning back pain may involve many factors including psychological, social and neuropsychological factors. Management of back pain thus requires a high level of expertise that can respond to these multiple challenges. This high level of expertise necessitates an experienced spine care provider who can offer a clear diagnosis for your condition and provide a treatment strategy to directly address your condition. For instance for many back conditions, i.e. disc herniations and spinal stenosis, it is not enough for a health care provider to provide one intervention repeatedly like acupuncture, spinal manipulation or massage therapy. These interventions will only address a small component of the problem and therefore only offer temporary pain relief. Your condition may require a thought out plan that includes sessions of varying interventions or interventions from multiple experts for a particular period of time.
Look for a Spine Care Provider with the Following Necessary Skills:
• skills in diagnosis
• skills in the management of different patient populations
• wide range understanding of complex nature of spinal pain with psychological factors
• ability to detect and manage psychological factors
• appreciation in minimalism of treatment in spine care
• an understanding of the methods, techniques and indications of medical and surgical procedures
• a unique understanding of work related spinal disorders
• a unique understanding of motor vehicle accident related spinal disorders and injuries
• public health perspective and co-morbidity relationship with diabetes, hypertension, obesity, dementia and depression
• the ability to coordinate the efforts of a variety of providers; case management
• the ability to follow patients over the long term to monitor and treat re-occurrence and educate patients in self-management
• the ability to performance manage and assess outcome measures
The research is clear that some cases of back pain tend to reoccur and persist if a comprehensive solution is not delivered by expert in spine care. Due to its complex nature, a comprehensive approach is recommended to effectively manage back pain including emphasis on pain management; patient education, regeneration and repair; lifestyle modification, psychological factors and functional rehabilitation. This approach ensures long lasting restorative effects with fewer treatment visits and less overall costs.