The Cure for Low Back Pain

Low back pain stands as a pervasive affliction, touching the lives of countless individuals worldwide. It is estimated that up to 80% of the population will experience low back pain at some point in their lifetime, underscoring its prevalence as a leading cause of disability and discomfort. Despite its commonality, the conventional treatment for low back pain often falls short of addressing the root cause of the issue. Instead, many therapeutic approaches focus on alleviating symptoms without tackling the underlying factors contributing to the pain. This gap in effective treatment highlights a significant challenge in the healthcare field, prompting a need for more comprehensive strategies that not only mitigate discomfort but also target the cause, fostering long-term relief and improved quality of life. Here are three root causes that must be assessed for a holistic evaluation and treatment of low back pain.

Muscle Weakness and Spinal Instability

The first root cause of low back pain is muscle weakness, leading to instability in the lower spine. In our increasingly sedentary culture, where hours are spent sitting each day, the muscles that support the spine can become weak and underutilized. This lack of strength contributes to an inability of the spine to maintain proper alignment and support, resulting in increased strain on the lower back. Over time, this strain can lead to discomfort and pain, as the body struggles to compensate for the instability. Strengthening these core muscles is essential for providing the spine with the support it needs to function optimally and prevent pain.

Joint Immobility

The second root cause is joint immobility, which can stem from a variety of factors, including lack of physical activity, aging, or specific conditions, such as arthritis. When the joints in the spine and surrounding areas become stiff or immobile, it restricts the spine’s natural range of motion. This limitation not only contributes to discomfort but can also lead to an increased risk of injury and pain as the body compensates for these restrictions. Addressing joint immobility through targeted exercises, stretching, and sometimes professional intervention, can help restore flexibility and reduce the incidence of low back pain.

Emotional Stress and Neurogenic Pain

The third root cause of low back pain is often overlooked but significantly impactful: emotional stress, which contributes to neuroplastic or neurogenic pain. Emotional stress can lead to chronic tension in the muscles of the lower back, as the body physically manifests psychological distress. Over time, this sustained muscle tension can alter the way the nervous system processes pain signals, a phenomenon known as neuroplasticity. This means that the back may become more sensitive to pain signals, even in the absence of a specific physical injury. Addressing the emotional and psychological aspects of pain is crucial for a holistic approach to treatment, emphasizing the interconnectedness of mind and body in the experience of low back pain.

Diagnosing Low Back Pain

The diagnosis of low back pain is a process with multiple facets that requires a comprehensive approach to accurately identify the root causes and develop an effective treatment plan. A thorough physical assessment is paramount, incorporating a series of orthopedic tests designed to evaluate muscle strength and joint mobility. These tests can help pinpoint areas of weakness, instability, and immobility that may be contributing to pain. Such an evaluation is critical for determining the physical contributors to low back pain and for guiding the subsequent steps in management and rehabilitation.

In addition to a physical assessment, consulting with a mind-body specialist for a lifestyle assessment is invaluable for diagnosing neuroplastic pain. This approach recognizes the significant role emotional stress and psychological factors play in chronic pain conditions. A mind-body specialist can help identify stress-related contributors to pain and recommend strategies for managing stress, thus addressing the neurogenic aspects of low back pain. This holistic assessment ensures that both the physical and emotional dimensions of pain are thoroughly explored, facilitating a more comprehensive understanding and treatment approach.

While imaging studies, such as MRI scans, are commonly used in the diagnosis of back pain, their effectiveness is limited in certain contexts. Specifically, MRI scans may not accurately reflect the state of the lower spine under load or during movement, potentially leading to false negative results. This limitation highlights the challenges of relying solely on static imaging to diagnose structural causes of low back pain.¹ 

Furthermore, the interpretation of lesions on an fMRI study may not always correlate with the clinical presentation of symptoms.² Such discrepancies can result in false positives, where imaging findings suggest pathology that does not align with the patient’s experience of pain. This underscores the importance of a comprehensive diagnostic approach that goes beyond imaging to include detailed physical and psychological assessments for a more accurate and holistic understanding of low back pain.

Self-Assessment and Treatment of Low Back Pain

Moving to diagnosis and treatment are approaches that can be self-assessed using the resources mentioned, offering a starting point for individuals to understand and address their pain. However, for a more thorough evaluation and customized treatment plan, consulting with a healthcare provider knowledgeable in these specific modalities. 

Muscle Weakness and Spinal Instability

The treatment of muscle weakness and spinal instability is addressed through the innovative approach of Foundation Training, developed by Eric Goodman, DC. Foundation Training focuses on a series of exercises specifically designed to strengthen the core, improve postural awareness, and enhance the body’s natural movement patterns, thereby directly tackling the issues of muscle weakness and spinal instability. Goodman’s method is built on the principle that a strong, well-aligned spine supported by a robust core is fundamental to alleviating and preventing low back pain. By teaching individuals how to effectively activate and utilize the muscles of the posterior chain, Foundation Training empowers people to correct dysfunctional movement patterns that contribute to pain and instability.

Joint Immobility

In addressing the challenge of joint immobility as a root cause of low back pain, the work of Stuart McGill, PhD, becomes indispensable. Renowned for his contributions to spinal health, McGill outlines a comprehensive approach to treatment in his seminal book, “Back Mechanic.” This resource is pivotal for both practitioners and patients, offering deep insights into the mechanics of the spine and practical strategies for overcoming immobility. McGill emphasizes the importance of targeted exercises designed to enhance mobility, stability, and strength in the lumbar region, advocating for a patient-centered approach to rehabilitation.

Emotional Stress and Neurogenic Pain

The treatment of emotional stress and neurogenic pain is compellingly addressed in “The Way Out: A Revolutionary, Scientifically Proven Approach to Healing Chronic Pain” by Alan Gordon, LCSW. Drawing from his extensive experience in psychotherapy and pain management, Gordon elucidates how chronic pain can be exacerbated or even initiated by psychological factors, and offers a path to recovery that involves retraining the brain’s response to pain signals. His approach centers on techniques that promote pain desensitization through cognitive and behavioral interventions, aiming to break the feedback loop where emotional stress amplifies physical pain. By fostering a deeper understanding of the mind-body connection in chronic pain, Gordon’s work provides invaluable insights and practical strategies for individuals seeking to reclaim their lives from the grips of pain driven by emotional and neurogenic origins.

Conclusion

Muscle weakness and spinal instability comprise the yin and yang in the functional understanding of low back pain, acting as two sides of the same coin. Coupled with the significant role of neuroplastic contributions to chronic pain, these elements paint a comprehensive picture of three primary root causes, each calling for a distinct yet synergistic treatment approach.

As a licensed acupuncturist, you might be curious why, at the conclusion of this blog post, I haven’t yet extolled the virtues of acupuncture—or chiropractic care, for that matter—as effective treatments for low back pain. Indeed, both modalities offer valuable strategies for managing this condition and undoubtedly merit inclusion in a holistic care plan for the spine. However, their efficacy can be hampered when confronting the trio of muscle weakness, joint immobility, and emotional stress. The best among us know this, and educate our patients accordingly. The optimal intersection of lifestyle and intervention medicine is the partnership of a compassionate & knowledgeable provider and an informed & empowered patient.

References

1. Kobesova, A., Kolář, P., Andel, R., Kyncl, M., Štulík, J., Davidek, P., & Lardner, R. (2020). Dynamic Magnetic Resonance Imaging Assisted Diagnosis of Occult Spinal Instability – A New Useful Approach. J. Medical Imaging Health Informatics, 10, 2649-2653. https://doi.org/10.1166/jmihi.2020.3219.

2. Ashar, Y. K., Gordon, A., Schubiner, H., Uipi, C., Knight, K., Anderson, Z., … & Wager, T. D. (2022). Effect of pain reprocessing therapy vs placebo and usual care for patients with chronic back pain: a randomized clinical trial. JAMA psychiatry, 79(1), 13-23. https://doi.org/10.1001/jamapsychiatry.2021.2669