“My back hurts, but I don’t need to get help. It will go away if I just take it easy for a few days.”
This is a familiar response by someone dealing with low back pain, but as chiropractors we know that pain is a warning sign for something bigger going on behind the scenes in the body. Yet, there is a common conclusion that keeps popping up in medical research: some treatment protocols are no better than no treatment, based on the fact that symptoms gradually improve on their own. This conclusion can be disturbing to the practitioner because of the influence it has on the culture of health care and – by its very nature – is intellectually dishonest if used in the wrong context.
Some Treatment Better Than No Treatment?
A recent research paper investigated the efficacy of a particular treatment regimen for patients with low back pain. The conclusion stated that the treatment had positive results because pain was diminished and function was restored in a relatively short period of time and that there was minimal need for expensive pharmaceuticals or surgery. This shouldn’t be a shock to you or anyone else in our profession. Chiropractors have had over a century of practical clinical experiences like this, in addition to tremendous patient satisfaction.
The interesting part of the study was the peer reviews of this article. Many respondents felt the research was not sufficient because it did not prove the treatment was more beneficial than the placebo or no treatment at all. The rationale for this argument was that low back pain is self resolving with no treatment, given an adequate amount of time. Remember that this is research and should not be confused with what is medically necessary or clinically appropriate. Research is used to determine appropriate outcomes for treatment protocols based on necessity.
If we allowed this logic to be taken to the extreme, it would essentially preclude the need for health care intervention for anything that presents as pain. It would pretty much be game over for chiropractic, end of our profession. For example, for a large percentage of patients that experience heart-related chest pain, the symptoms are self resolving. According to the self-resolving symptom model, this would constitute a successful outcome even if the mechanism of symptom suppression was a fatal heart attack. That is an extreme interpretation of the model, but it illustrates the point: we need to be interested in more than the symptoms to understand the whole picture of health.
Investigate to Find the Cause
Pain is not a disease. It is a symptom, an indication of imbalance, trauma or inflammation. It is the neurological result of chemical mediators that initiate an impulse that we interpret in our sensory cortex. Our search is for the cause.
The human body is filled with righting mechanisms that are programmed in our DNA:
* If the blood sugar drops a sufficient amount, receptors in the brain trigger the mechanism to urge us to eat.
* Thirst mechanisms work to keep us from becoming dangerously dehydrated.
* Inflammation is a mechanism of homeostasis as is perspiration or shivering.
The body’s production of endorphins as a result of pain or stress is part of the balancing act. Fluctuations in blood pressure and respiration are adaptive as well. Balance is the adaptation to proprioceptive input that keeps our eyes level with the horizon and allows bipedal ambulation against the constant pull of gravity. As long as the human body is upright, and ambulatory, there is some degree of balance at work.
The list of righting mechanisms is extensive. It validates the fact that our genetic programming dictates movement towards homeostasis, as if there were an internal gyroscope keeping us on course.
When you graduate and start practicing chiropractic, you’ll see patients come to your office in pain and the only thing they’ll want is to get out of pain. No one is better at assisting the body to accomplish that than you – a chiropractor. Our challenge and duty is to educate the patient about proper function whether there are symptoms or not.
You have to talk to your patients about the many degenerative processes that take place – in the absence of pain – over long periods of time. Chronic postural distortions are one of the most common causes of degeneration of spinal and extremity joints, especially the lumbar spine, knees and hips. These distortions often begin with subtle imbalances in the feet and translate rotational distortions up the kinetic chain through the knees, hips, pelvis and spine. A simple way to catch these distortions before they become major problems is with an evaluation of the feet.
Evaluating the feet as part of every new patient examination can reveal the cause of many preventable conditions and the symptoms they create. Stabilizing the feet with custom-made, flexible orthotics is the beginning of creating a stable pelvis and spine which will enhance the care you provide by reducing the incidence of degeneration and the symptoms that diminish the quality of your patients’ lives.
Pain, Pain Go Away
“My pain will just go away on its own if I take it easy for a while.”
This may be true short-term, but we recognize the fallacy in this statement for overall, long-term health. Our goals should be to teach that pain is a symptom of a bigger issue and to use chiropractic to help those in pain feel better both now and for years to come.
About the Author
As the Associate Director of Education at Foot Levelers, Dr. Brian Jensen shares more than 20 years of practice experience in chiropractic colleges and seminars around the world. He teaches a common sense approach to gait, posture and biomechanics and how these ideas can be implemented in a wellness based practice. A graduate of Palmer College of Chiropractic, Dr. Jensen speaks internationally on a wide variety of topics, including orthotic therapy, structural preservation, breaking free of the medical model of health care, and innovations in nutrition.