Have a nagging deep pain in your lower back?
Move the wrong way and throw your back out? Lower back pain is one of the most common musculosketal conditions and can prevent you from doing many of the things you enjoy.
Why Does My Back Hurt?
Humans have evolved to stand erect, on two feet, as opposed to quadrupeds that can distribute their weigh over four feet (or paws). This sets up apart in the animal kingdom and provides humans with a unique set of problems.
Our lower back is made up of very large bones, discs, joints and thick muscles that help to stabilize us. It must support our upper body, as well as transfer forces from our legs as we go about our day. The structures in our lower back are constantly working, being twisted and compressed as we walk, stand or sit. Gravity, poor body mechanics / posture and aging takes its toll on our lower backs. Discs begin to dry out (desiccate), they may bulge (herniate) which can choke the spinal nerves or spinal cord. The vertebrae may slip forward or back on each other. Ligaments and joints will thicken as a result of stress and also choke out the spinal cord or nerves.
What Is Going On?
Lower back pain can be classified into two major groups: Acute pain and chronic pain. Acute pain is usually due to a traumatic event such as a slip & fall or car accident. It can also be caused by an accumulation of lot of smaller traumatic events such as repetitive motions, poor posture and poor body mechanics.
Chronic pain is due to several factors. Aging (degenerative processes), arthritis/ arthrosis, spinal stenosis, disc bulges /herniation, misalignment of the spine and muscle imbalances. Chronic pain does not happen overnight and it is possible to have an acute condition of chronic pain.
How Dr. Fuhrmann can Help?
A proper history and physical exam will determine what is injuried and once we diagnose your problem (s), a specific treatment plan will be designed to get you pain free as fast as possible. Dr. Fuhrmann has several treatment options available to reduce and eliminate your pain:
- Spinal Decompression / Flexion & Distraction
- Spinal Manipulation
- Soft Tissue Therapy /Trigger point Therapy
- Instrument Assisted Soft Tissue Mobilization
- Cold Laser / Low Level Laser
- Rehabilitative Exercises
- Patient Education
There is moderate evidence to support that spinal manipulative therapy is effective for acute low back pain in adults. There is strong evidence to support that spinal manipulative therapy is effective for chronic low back pain in adults.
Bronfort G, Haas M, Evans R, et al. Effectiveness of manual therapies: the UK evidence report. Chiropractic & Osteopathy. 2010;18(3):1–33. http://www.ncbi.nlm.nih.gov/pubmed/20184717 . Chou R, Huffman LH, American Pain Society, American College of P. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. Oct 2 2007;147(7):492-504. http://www.ncbi.nlm.nih.gov/pubmed/17909210
A joint clinical practice guideline from the American College of Physicians and the American Pain Society suggests that “For patients who do not improve with self-care options, clinicians should consider the addition of non-pharmacologic therapy with proven benefits-for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation.”
Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. Oct 2 2007;147(7):478-491. http://www.ncbi.nlm.nih.gov/pubmed/17909209. A 2011 Cochrane review reported that there are no clinically meaningful differences between spinal manipulative therapy and other interventions for pain reduction and functional improvement for chronic low back pain. Rubinstein SM, van Middelkoop M, Assendelft WJ, et al. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews. 2011;(2):CD008112. http://www.ncbi.nlm.nih.gov/pubmed/21328304
Results of a 2013 randomized controlled trials suggest that 12 sessions of spinal manipulative therapy for chronic low back pain offer the best “dose.” Haas M, Vavrek D, Peterson D, et al. Dose-response and efficacy of spinal manipulation for care of chronic low back pain: a randomized controlled trial. Spine Journal. October 16, 2013.Epub ahead of print. http://www.ncbi.nlm.nih.gov/pubmed/24139233.
There is strong evidence that spinal manipulative therapy is as effective as a combination of medicalcare and exercise instruction. There is moderate evidence that spinal manipulative therapy works as well as prescription nonsteroidal anti-inflammatory drugs combined with exercises. And, there is limited- evidence that spinal manipulative therapy works better than physical therapy and home exercise.
Bronfort G, Haas M, Evans R, et al. Evidence-informed management of chronic low back pain with spinal manipulation and mobilization. Spine Journal. 2008;8(1):213–225. http://www.ncbi.nlm.nih.gov/pubmed/18164469