The Most Common Cause of Lower Back Pain
Figure 1 - Most lower back pain treatments are nothing more than bandages attempting to "stop the bleeding".
Allow me to set the stage. You've just returned home from the hospital after welcoming your new baby into the world. You feel like you’re starting to get the hang of this parenting thing and are even starting to notice a difference between their cry sounds. Why does that matter? Of course, because you want to know WHY your bundle of joy is crying so you can help.
Are they hungry? Do they have a fever? Do they need a diaper change? We instinctively go searching for the root of the problem so we can put our new loved one at ease.
If you just wanted to stop the crying, all you'd have to do is muzzle the baby to turn down the volume. Just the thought of this probably makes you cringe but this is exactly what millions of people do every day when they use medications, receive injections, or undergo unnecessary surgery targeting the "crying" tissue and not the root cause. (Word of caution, even if you're a big fan of using pain meds, don't muzzle your baby…bad idea).
The pain (crying) and difficulty that we experience in our bodies is no different than the crying baby and deserves the same level of focus and problem-solving. Whether it's lower back pain, sciatica, neck pain, knee pain, shoulder pain, arthritis, headaches, plantar fasciitis, heel pain, or carpal tunnel syndrome, they all have one thing in common. That is, the inefficient and undesirable movement patterns that developed from your years of human existence.
Despite the significant progress and awareness about the positive benefits of movement and exercise in our society, most information is still focused on producing superficial outcomes like getting ready for swimsuit season, getting shredded, or developing 6 pack abs.
Figure 2 - Most exercise is focused on outcomes related to appearance rather than quality of life and movement.
We see a similar problem in healthcare when it comes to pain. Look around one day and you will see a barrage of messaging for products and services to "fix" your pain. Closer inspection will reveal that very few (if any) of these products or services are doing more than masking symptoms.
To illustrate this problem further, allow me to use an auto analogy. You’ve noticed that your car is making a rattling sound once the vehicle's speed rises above 55 mph. You take it to the mechanic and they walk outside, look at your car and without even turning it on, tell you the tire is worn and needs replaced. I'm quite certain you're going to hop back in your car and find another mechanic! Guess what? This is exactly how most lower back pain and other musculoskeletal conditions are handled in our country!
Let's say my knee hurts both when I run and climb stairs. I visit the physician, they do or don't take an x-ray (which is just like looking extra close at the tire in our analogy), have me move my knee back and forth (if I'm lucky), prescribe medication and maybe refer me to Physical Therapy. All without ever watching me run or climb stairs!
Figure 3- The medical system is simply not set up to properly evaluate problems that are movement related.
Despite efforts from the American Physical Therapy Association, Physical Therapists have not moved into a primary provider role for musculoskeletal conditions. Primary care physicians (PCPs) remain the first point of contact. This is not a criticism of the providers but rather the system. With increasing medical complexity of the primary care patient coupled with changing delivery and payment models, PCPs, Nurse Practitioners (CRNP), and Physician Assistants (PA-C) are facing greater pressure to deliver care that achieves improved population health. Primary physician offices are also faced with significant challenges when you consider that the average time spent with a patient is about 10 minutes! Compare that to the 45-60 minutes that a Physical Therapist will spend with a client on their first session alone.
At $190 billion per year, musculoskeletal health accounts for 10% of the total healthcare spend in the US. This is more than the combined cost to treat all cancers and lower back pain is a big portion of it. In most cases, these rising costs are being shifted directly to the consumer. Despite these costs, funding for research continues to decrease.
Figure 4 - Despite costing more to treat than cancer, musculoskeletal research receives less than 20% of the funding.
Whether you're seeing a Physical Therapist, Physician, Nurse Practitioner, Physician Assistant, or Chiropractor for your pain, they must be a movement specialist, using that specialty to uncover the true driving force behind your problem. That being said, Physical Therapists are uniquely trained and positioned as experts on human movement. They know above all, how negative changes to the movement system can create dysfunction and how treating those dysfunctions will fix the problem.
Remember, next time you have a muscle spasm or feel stiffness in your lower back, it's likely related to how you control your movement. If you're not back to feeling your best, it's a must that you find a movement specialist to help get you back on track.
If you want to feel, perform, and live your best, you've got to MOVE your best.Until next time…Keep it movin'!
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Freburger, J.K., Khoja, S. & Carey, T.S. Primary Care Physician Referral to Physical Therapy for Musculoskeletal Conditions, 2003–2014. J GEN INTERN MED 33, 801–803 (2018) doi:10.1007/s11606-018-4426-6