Back Pain- the scourge of humanity.
National Geographic published an article several years ago about the origins of back pain in humans. It is the price for evolving into an upright posture. Such a posture required the evolution of anatomical changes in the pelvis and spine that put unusual biomechanical demands upon these structures. And our intermittent or chronic episodes of pain are testament to these demands.
I treat back pain all day long and have done so for 29 years now. Treatment for back problems is not perfect. Medicine does not have a solution for everyone’s back pain. There are millions of people in America with chronic pain, mostly in the back or spine.
In my effort to find more effective treatments for patients, I have worked in orthopedics, physical medicine, physical therapy, chiropractic and neurosurgery. I have seen and used and tried many different treatments over these years. I have seen, and continue to see, many fads in treatment come and go. And I see some still which I think will fall out of favor in the coming years.
I have a very unusual position and experience among spine specialists. You see, most doctors or therapists know their specialty, but they don’t know the other specialties. So they don’t really know, firsthand, the relative merits of all the various treatments for back pain. Because I have extended myself to work in all these different specialty environments, I have learned how to assess and treat over 40,000 patients’ clinical presentations.
As an example, if a doctor does not read x-rays or MRI scans, he/she will not SEE the common problems in the spine, which give rise to pain. And he won’t clinically correlate symptoms to visible spinal lesions. This is, for example, a big problem for physical therapists, who are not trained in reading diagnostic imaging. Because of this, they have a hole in their understanding of spinal problems. Sometimes this doesn’t compromise treatment, but sometimes it does. For the record, I have great respect for physical therapists. They are very competent, caring and hard working clinicians.
Other specialists, despite their competence, also have holes in their clinical experience. That includes chiropractors, orthopedists, pain specialists and neurosurgeons. And, despite my point in this post, I have great respect for all of these clinicians.
Now, I’ll get to the main point of this post. Diagnostic imaging, e.g. x-rays and MRI scans are ordered by many doctors. We see all kinds of lesions, and we are looking for all kinds of common problems. These include, herniated discs, degenerated discs, protruding and extruded discs, spinal stenosis, ligamentum flavum hypertrophy, disc collapse, modic changes, lateral recess stenosis, nerve compression, nerve encroachment, spondylolisthesis, etc.
ALL OF THESE LESIONS RESULT IN COMPRESSION OF THE SPINE, which can be painful and disabling. COMPRESSION of the spine is the essential cause of 98+% of spinal pain.
Treating compression is what 98+% of surgery does. That’s how it helps people- by decompressing the spine.
The crazy thing about non-surgical treatment is that almost no doctor actually treats this cause of pain. That’s why so many people don’t improve, get injections, get surgery or live in chronic pain.
And because I actually DO DECOMPRESS patients’ spines, I get people better when others have not.