Hello everyone, I’m Dr. Tom Johnson, your chiropractor for low back pain in Oxnard, CA. Today we’re continuing our discussion on low back pain and how it is the number one cause of worldwide disability.
Yes, I said it, I’m gonna say it again. Low back pain is the number one cause of disability pain and suffering in the entire world. Today we’re gonna to take a look at frequently asked questions.
Over the past 20 years of clinical practice these are the top 10 most common frequently asked questions. We got a lot to unpack today, so let’s dig out the science and get right into it:
You know first, patients ask “My primary care doctor said that low back pain is self limiting and then it’ll simply go away by itself, don’t worry about it, is this true Dr. Tom?” False! While it is true any pain has the potential to simply go away and get better on its own, the cause of that pain is still there.
And that is very typical and common with spinal disorders and low back pain. The body has got a great way of decreasing the pain signals to brain. We call that descending pain inhibition. An example is you cut your finger, it hurts really bad for a few minutes, but then the pain gets better and better, less and less and less, but my finger’s still cut and bleeding.
And so, yes, while your back pain might improve in terms of the intensity of the pain or the frequency of the pain, the cause of that back pain is still there. I wanna point out that this thinking in primary care medicine that low back pain is self limiting is the number one cause and reason why it is now the number one disability in the entire world.
Because we neglect detecting, properly diagnosing and properly treating low back pain and spinal disorders, ’cause we’re telling patients it’s gonna go away by itself. We gotta stop this nonsense. This is a real problem, we need real solutions and real answers. So no it is not self limiting.
Two, what causes low back pain? “My physical therapist and primary care doctor said it’s just simply a muscle spasm, is this true Dr. Tom?” False! While it is true muscle spasm is one of the many causes of low back pain, it is usually never the primary cause.
It is a simple reflex muscle spasm or muscle guarding. The muscles spasm to guard the spine to prevent you from continuing to move the spine in unhealthy ways or manners. Whether it’s in sport, work, at home.
So no, back pain is not simply caused by muscle spasm. If you only treat the muscle spasm, which is typical in primary care medicine and physical therapy, the pain will continuously come back and become chronic. That again is the number one reason why we see today, low back pain is the number one cause of disability in the entire world.
We are not diagnosing it properly in primary care medicine. We’re not treating it properly in physical therapy and primary care medicine. We’re gonna come back to how an integrated model is far superior, than the very traditional isolated system we have in healthcare. So we’ll come back.
Three, “Should I be worried about low back pain Dr. Tom, when is it really serious?” That’s a great question. There’s two main facts here. One, something we call red flags. Red flags are emergency, loss of bowel and bladder function, intractable pain, that’s not going away with rest or over the counter prescription medication.
Chronicity, the back pain is chronic now and getting worse. My pain levels are, eight, nine out 10 or 10 outta 10 and it’s constant. It’s waking me up at night, I can’t sleep. I’m having foot drop. I’m having weakness. I’m having an altered gait or walking. It hurts a lot when I sit or stand, I can never get comfortable.
I’ve tried conservative treatments and they’re not working over period of weeks and months. And so all these are are red flags. These are emergency red flags that needs further attention.
Further diagnostic assessment, possible surgical. For sure we need to get some help. Also if there’s signs of infection, we’re running a fever. Signs of infection are leading cause of red flags as well.
And so we need to differentiate is this a mechanical low back pain? Is this more organic? Is there a kidney stone or kidney infection? Is there something going on that’s very atypical? So those would be the red flags.
Now the other part is yellow flags. Yellow flags are your key warning that the problem’s not going away and needs further attention. Yellow flags are not emergency but they are that the pain’s chronic, it’s not getting better. It hurts when I sit for a long time. It hurts when I stand for a long time.
Hurts of movement. It generally is relieved by rest and laying down however, and in typically yellow flags, I don’t have pain, I’m not getting woken up in the middle of the night, two in the morning. So yellow flags tell you that we need attention, we need help, although it’s not an emergency, I don’t need to go to the ER.
Four, “What is sciatica Dr. Tom?” Great question. Sciatica is a very non-descriptive
term for low back pain. It includes pain that is local low back pain, that’s radiating into the glutes or down the back of the leg, typically above the knee.
Sciatica is a condition where now we know we’ve got not only problems in the muscle, the tendon, the ligament, the bone and joint, but now we have neurological structures, nerves being compressed or irritated. Whether it’s the spine, from the nerve roots of L4 to S2 and 3 or maybe it’s in the sciatic nerve as it forces its way through the gluteal region and piriformis or deep gluteal muscles.
So sciatica is a very serious condition and needs immediate attention and they tend to get worse and they can become surgical if not treated and diagnosed properly.
Number five, “What is piriformis syndrome Dr. Tom?” Piriformis syndrome mimics sciatica. Piriformis syndrome is a condition where we have a peripheral nerve entrapment. The primary nerve entrapment and pain or the main diagnosis is not so much of a spinal origin, it’s in the periphery, into the gluteal regions.
We don’t typically use piriformis syndrome anymore. We used to think the sciatic nerve goes through this piriformis muscle that spasms or compresses that muscle, that nerve, it can cause irritation and radicular symptoms.
We now know that it’s more of a deep gluteal syndrome. It’s not just piriformis, it’s glute medius, it’s glute minimus. There’s a series of deep glute muscles that can all contribute to this piriformis syndrome.
Number six, “What is radicular low back pain Dr. Tom?” Great question. Radicular low back pain means I’ve got a yellow flag emerge into a red flag. We’ve got a serious condition. My pain is not just local in the low back pain. Now it’s radiating all the way down my leg.
We differentiate radicular pain above the knee and below the knee. If your radicular pain crosses the knee and goes into the foot, we’ve got a much more serious condition, that needs further attention. Diagnostic imaging, MRI, nerve commission velocity, EMG testing. Maybe a referral to an ortho or neurologist for further diagnostic testing. Could be a surgical matter. Hopefully we can treat it and correct it by nonsurgical conservative measures.
Okay, number seven. “What is a slipped disc, Dr. Tom?” We used to use that term a long time ago. We don’t use that word anymore. There’s no such thing as a slipped disc, your disc doesn’t just slip out, okay? You can have tears in the disc, in the periphery.
We can have disc herniations, disc prolapses. We can have discs that are pressing on nerves or spinal cords or the covering of the spinal cord the dura amount of the sheath. So disc herniations are real, they’re very painful, they need immediate attention, but the disc does not slip out of place. We have to get away from that terminology. That’s old terminology that’s not used anymore.
Okay, number eight. “How should I sleep with lower back pain, Dr. Tom?” Great question. We need to use pillows and supportive devices to simply get comfortable.
Typically most of us will start on our back, maybe a pillow underneath our knees. We’ll typically turn to our side. I recommend putting a pillow between the knees, to keep the hips nice and balanced and level.
Maybe a pillow underneath the armpit or the shoulder. Making sure your head is nice and supported well with your pillows as well. And just trying to do the best you can to get a good night’s sleep. I would rather you sacrifice a position of sleep being to get that quality of sleep.
So it just a matter all of positional. What can you do to position yourself to get a good night’s sleep? But most of the time we’re gonna be woken up throughout the night, to turn over to get comfortable and that’s totally normal.
Number nine, “My doctor said I need spinal surgery, what should I do Dr. Tom?” Well, let’s investigate that further. Let’s get a second opinion. Let’s understand what they’re recommending.
There’s several countries in the world that don’t even allow spinal surgery unless you fail conservative treatment plan. Which includes chiropractic physical therapy, massage, acupuncture, pain medications, epidural, so forth. And so some countries don’t even allow you to have spinal surgery again until you try conservative treatments first. I highly recommend that.
Now if we have red flags that there’s an emergency, loss of bowel and bladder function, irretractable pain. Yeah we might need surgery. Okay, that’s an emergency.
But most times surgery is not an emergency. It’s just over-utilized, over-recommended. We always want to try something conservative and natural first to prevent surgeries.
Spinal surgeries have very poor outcomes. Too many times I’ve heard of patients having second and third surgeries on their low back. And they swear that they wish they didn’t even have the first one. They could live with the pain they had before even the first surgery.
But the surgeries made their pain worse. Their function worse. And so surgeries should be a last resort, unless there’s red flags.
Let’s see, number 10. “What is better for low back pain, Dr. Tom, chiropractic, medication, physical therapy, massage, acupuncture, exercise?” Yes, all the above. If we’re performing a scientific study on you, yes I will isolate each of those different treatments and providers to see which one’s the best for you.
But you’re not a scientific study. You are a human being that needs immediate help.
That’s why at Kalani Total Health Center, we’re an integrated center, we use all of it. It’s not a matter of chiropractic or physical therapy or medical or exercise, it’s all the above. Our treatment plans are customized for our patients, but we use an integrated model where all those different providers see the patient.
We all work together, we communicate together. Traditional healthcare systems are isolated and separate. Your medical doctor’s not talking to the chiropractor and physical therapist. No one’s talking to the orthopedic neurologist. No one’s sending information. They’re treating different body parts and locations. And so there’s no clear concise uniform treatment plan for the patient, it’s separated.
Here, we’ve changed that. We’ve integrated our treatment plans and programs.
You know, “What’s the difference between acute care, Dr. Tom and corrective care that you do at the clinic there?” Great question. We wanna give patients choices. We wanna meet patients goals and expectations. So if a patient came to me and said, “Dr. Tom, all I wanna do is get out of pain as quickly as possible.”
Great, I have at treatment program just for you, we call it acute care. If a patient’s goals and our clinical findings indicate that they are a great candidate for corrective care. We’ll set them up on a corrective care program that includes acute care, but it goes into different phases of care to actually correct the cause of your pain. So it doesn’t return or get worse.
All right everyone, thanks your time. Appreciate your help and support. We’re here to support and help all of you. Wanna wish you a happy day today.
Mahalo. Aloha. This is Dr. Tom from Kalani Total Health Center, your one stop holistic health care shop. Have a great day.