10 Dec 2011

Living in Fear of Flaring Up Your Low Back Pain

Low back pain is highly prevalent in society today. Most studies suggest that about 80% of the population will experience low back pain at some time in their lives. For some, it is a few days of being careful how we move. For far too large a percentage of others, this pain passes into chronicity. So what creates the different outcomes?
This question is not a very easy one to answer, but research does provide some insights into how to keep acute situations from progressing to chronic problems. Two situations, in particular, show up again and again.

The first has to do with how long a patient takes to get care after an injury. It is very clear that the longer one takes to seek out care the more likely an injury is to become chronic. In my experience, it seems clear that, when a patient comes in mere hours after an injury, or at least within a few days, the condition can be cleared in a matter of a visit or two.... In general, this makes sense.

The fascial system that surrounds our joints and muscles like a sheath has a degree of fluidity to it. Initial injuries that involve the fascia can begin to increase the viscosity of this fascial tissue as a result of inflammation. This may serve as an action to restrict or splint the motion of a joint after the injury. But, within a short period of time, this increased thickness or viscosity of the fascia begins to become more permanant. This changes the movement of the muscle that is sheathed in this injured fascia. This, in turn, affects the motion of the joint that these muscles are connected to.

Treatment at this point is much more problematic. Recovery is very possible, but it's going to take a longer period of time to overcome the increased density in the fascia. For this reason, getting treatment directed at the fascia quickly after an injury or after the onset of symptoms is always the best option.

The second situation has to do with our beliefs surrounding low back pain. It has been well established that a fear-avoidance belief system as it relates to low back pain is a major predictor for the progression to chronic low back pain. What does this mean?
If someone has a fear avoidance belief system what they will or won't do centers around their low back pain. This person is afraid of doing things that will injury their low back and so they avoid them. There is always a deep down fear that their condition is very serious or that surgery is inevitable. Xrays or MRIs, in the absence of certain red flags, taken early in the course of low back pain actualy promote this fear avoidance behavior ( http://onlinelibrary.wiley.com/doi/10.1111/j.1525-1497.2005.0230.x/abstract;jsessionid=43896910F847C675FC3D841AE1E502C4.d01t01 ).

This particular article ( http://www.sciencedirect.com/science/article/pii/S1529943011005274 ) reinforces the position that fear avoidance beliefs promote chronicity and produce worse outcomes. In chiropractic, half of the job is to reassure the patient that their condition is not serious (unless, of course, it is...) and promote physical activity as soon as possible. It is very rare that a patient's activity should be restricted for more than a few days. In almost all cases, getting up and moving around is going to help a condition respond quicker than sitting on the couch eating bon-bons.

There have been times in practice that I have had to "un-brainwash" a patient who has been told by another provider or by a surgeon (if they had surgery) that their activity is going to be forever limited. Most often, once these patients are reassured that their particular condition will actually do better with movement and they begin to increase their physical activity, the condition inevitably improves.

Dr. Bogash has a passion for understanding physiology, the medical research and how the combination of these two can lower the risk of disease or manage current chronic diseases such as diabetes, cancer, hypertension, obesity, osteoporosis or heart disease. Visit http://lifecarechiropractic.com/blog/?p=blogroll to sign up for Dr. Bogash's Rantings, a biweekly email that summarizes the daily blog posts related to improving society's health.

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