Back and Neck Pain

Posted by on Wednesday, April 4, 2012 · Leave a Comment 

Back pain affects 90% of Americans at some point of their life and is the leading cause of visits to the doctor. Low back pain is the most prevalent cause of disability in people under age 45; $100 billion is spent annually on treatment of low back pain, with more then half of that spent on surgical treatment. Low Back Pain (LBP) has long reached epidemic proportions in the Western world. Acute LBP is one of the leading symptoms that force an individual to seek medical attention. At the same time the chronic back pain is responsible for enormous cost to health care and society.

It has been traditionally, although incorrectly, believed that acute LBP episodes resolve themselves within a relatively short period of time. This mistaken belief has led to the symptomatic management, consisting mostly of the bed rest and pain medication, which is proven to promote chronicity. A scientific consensus gradually emerged over the past ten years that deemphasized the role of the structural findings by MRI and/or X-RAY as being decisive in LBP diagnostics and treatment strategies. By far the most common painful locomotor system conditions are in fact the ones called idiopathic(without an apparent cause) because no structural pathologies can be found.

An alternative had been suggested advising encouraging LBP patients with reassurance that there is no serious life-threatening disease involved and that the only sure road to the complete recovery goes through the measured resumption of normal activities and restoring function. Implementation of this approach resulted in significant decrease in LBP chronicity and consequent disability in part by eliminating the psychological impact of pain on the nervous system.

Restoring function has only recently become the standard in physiotherapy and chiropractic. However the restoration of function is mostly attempted by the practitioners through the purely mechanical means. They commonly fail to acknowledge that functional pathology is not just altered biomechanics, but rather a response of the Central Nervous System to pain and dysfunction by altering motor control residing in the brain. Therefore, it is motor control of the Central Nervous System and not the biomechanics that should be addressed when formulating the treatment of LBP.

It must be also realized that by no means can people complaining of pain with non-identifiable origin be labeled malingerers, nor should their condition be identified as psychogenic. The somatic origin of their symptoms can be easily established. Clinical examination usually reveals the multitude of signs and symptoms of physical origin of pain. And here lies another problem. Because functional aberration can be objectified through the physical examination, it is routinely treated as a mechanical disorder, the approach which, as we stated above, is inadequate and leads to poor treatment outcomes.

When treating the function it is important to realize that the mechanical change is a source of information processed through the Central Nervous System, which in turn makes the locomotor control programs react in a coordinated fashion. Even when mechanical changes are obvious and structural pathology is objectified, it is the disturbed function that should be the primary target of the treatment.

How Functional Treatment Is Conducted

The term Locomotor Dysfunction, as we have stated above, describes an abnormal condition of tissues involved in body mobility, posture and balance, including muscles, joints, discs and, most importantly, neural wiring in the central motor regulation centers of the Central Nervous System. This situation can be reversed by a variety of manual techniques and remedial exercises, which affect the nervous system globally, as a whole. Manual techniques used to treat locomotor function consist of joint and soft tissue manipulation, reflex stimulation, various muscular techniques, which release Trigger points and either inhibit hypertonic muscles or facilitate (strengthen) weak muscles. Exercise program includes stability and postural training, body awareness exercises, sensory inhibition, breathing retraining and therapeutic exercises.

Rooted in Developmental Kinesiology, our therapeutic program is based on evoking the ideal movement patterns through the reflex stimulation of the motor regulation centers, and then conditioning the patients through exercise to be able to activate these patterns automatically without any conscious effort. All of the soft tissue techniques and gentle non-forceful manipulations are conducted in basic primal positions of an infant and follow the rules of Development Kinesiology. Different challenges are applied using thera-bands, gymnic balls and therapist cues.

Our therapeutic program puts a special emphasis on the importance of deep spinal stability. Deep muscles of the spine are the first ones to be affected when motor programs become corrupted. They almost never produce pain, but their inability to properly co-contract (contract together) overloads more superficial muscles. This creates trigger points, fascial restrictions, joint subluxations and other abnormalities that ever so often result in excruciating pain so familiar to the LBP sufferers. Therefore, our primary goal in this respect is to teach our patients to feel and control these muscles. We further aim to train our patients in how to activate these muscles at will evoking appropriate movement patterns and eventually to condition the brain to activate the associated locomotor programs automatically without the patient voluntary control. In our experience this is the best way to release muscular tension, remove sublaxation, establish proper movement patterns, improve posture and dramatically improve and strengthen spinal stability. This approach not only alleviates suffering but also prevents relapses and recurrences which are so common with the back pain. For patients with increased work demands or athletes whether recreational or professional we progress spinal stability training into a functional training. The functional training is goal-oriented and involves various movements like: lunges, squats, pulling and twisting all of which are performed in challenging positions and are enhanced by different labile surfaces.

Even though the optimal goal of our rehabilitation programs is to optimize the function, it does not mean that we reject cooperation with the most accepted and therapeutically proven conventional methods of medical intervention which involve such invasive procedures as epidural injections or surgery.

It is commonly believed, even by most conservative health care practitioners, that a patient should consider surgery only when all other options are exhausted. This belief unfortunately may backfire and harm the patient if the practitioner is biased or if he is not greatly familiar with pain management and surgical guidelines. The blind belief in the holistic approach can bring disability to the patient if the conservative care practitioner rejects the radical treatment and has poor understanding of when and what type of pain management or surgery is best for the patient. We, in our practice, do not overestimate the power of functional approach and never ever deny the qualified patient timely referral to a pain management specialist or a surgeon. The functional approach that we profess is actually the best indicator of when a patient has reached the plateau and the conservative care is no longer going to bring any results.

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