If you look up “Back Pain Cure” on Google, you get 3 BILLION results. That leads me to believe all the answers are somewhere in that snake’s nest of information.

Yet, I still have patients who struggle with pain, don’t know how to get out of pain, or are overwhelmed by all the different answers they have been given.

The goal of this blog is to show you how just having the information doesn’t always do us a lot of good. Making decisions that are relevant and effective for the individual is where the real magic happens.

Doctor-focused medicine can be pretty cool.

Traditionally, western medicine has been quite doctor-focused. The doctor was an authority on all things health, and would prescribe medications or advice based on the patient’s condition. The actual person’s emotions, environment, ideas, and goals were not always considered in the treatment.

Honestly, it’s not a bad approach for a lot of things. When I got Shingles during exams in chiro school, I went to the doctor, they did a swab, then gave me an anti-viral and I was right as rain (sort of, it still kinda sucked for a month).

Doctor’s analyzing, prescribing, and sending patients off into the wild can be effective for many conditions where we understand the mechanism and understand specifically how to address it with a prescription or medication.

Back pain is a messy monster.

The doctor-focused model falls apart pretty quickly for certain things. When a patient shows up with an achy back that fluctuates between 2-4/10 pain and is triggered randomly it’s hard to prescribe a medication to make it go away. There aren’t any magic tricks that can fix this problem.

This type of problem requires a person-focused approach. The back pain is a symptom, but how it affects the person matters most. We could know everything there is to know about back pain, but if we know nothing about the patient we’re going to have a hard time treating effectively.

In my 5 years of practice I’ve seen patients ranging from teenage competitive gymnasts, to active duty police officers, to pregnant moms, to one guy who was literally 99-years old and still walking around on his own. The main thing that connects all these patients is suffering from back pain.

Clearly, there is no one-size-fits-all approach to back pain.

Most low back pain is “non-specific” and that introduces uncertainty.

For many diseases, we perform test after test until we get a very confident, precise diagnosis, then we apply a specific treatment for that condition. “Non-specific” pain throws a huge wrench in that plan.

According to much of the newer research, “non-specific” low back pain is probably the most common type of low back pain that we experience. In the context of back pain, “non-specific” means we can’t be certain what muscle, joint, or nerve is causing the pain, or it may be a combination of structures that are causing pain. Often there are clues such as leg pain, or certain painful movements that give us ideas about what structure is injured or irritated, but that doesn’t tell us the whole story.

Patients may be referred for X-rays or MRIs and they may find disc bulges, arthritis, or disc disease that will then be blamed as the cause of pain. The problem is that when we take X-rays or MRIs, around half the people WHO DON’T HAVE SYMPTOMS are also showing disc bulges, arthritis and disc disease. Sometimes patients have even gotten surgery for findings on MRIs without it solving their pain, because it wasn’t the real cause. Like I said above, back pain is a messy monster.

****Sometimes arthritis, disc bulges/herniations, and disc disease absolutely CAN contribute to low back pain - we should never ignore them. As well, surgery can be an extremely effective tool for some patients.

The point of “non-specific” low back pain is that it’s hard to be certain, and treating the person is still more important than treating the condition.

More invasive treatment options and additional testing are all still useful tools, but we want to use these tools sparingly and only when appropriate.****

The “person-centered” approach to back pain can solve some of the issues with uncertainty.

At Highlands Wellness, I want to provide lasting results for patients and I know that might require a different approach than some people have seen in the past. Because back pain is so messy, I decided to follow the “person-centered” approach that combines good guiding principles of care with the experience, capability, preference, and history of the patient in front of me.

It’s important to understand how back pain affects your mental health, your work, your sport, your family, and as many aspects as your life as possible. The better we understand what this pain means to you, the better guidance we can provide. This is the “person-centered” approach. Through this better understanding, we can use the mountains of information and make it applicable to the individual.

Once we’ve assessed to ensure their are no medical emergencies and found a few areas and activities we can work on, we usually get started right away.

The principles are simple. We want to find treatment options that will calm down symptoms, and over time we want to build patients back up. We rely on effective guidance, hands-on care, education, and things they can do on their own to feel better and become more resilient.

• We want to find pain-reducing movements and therapies.

  • Hands-on care is very effective for managing pain and acute symptoms. Care may include exercise, manipulation, soft tissue therapy, acupuncture, or any combination of these.

• We want to modify important activities as necessary.

  • We will work together to brainstorm helpful modifications to work duties, getting baby from the crib, finding ways to play with kids, or changing exercises in the gym.

• We want to build up strength, mobility, and any other physical attribute necessary to return to living a full life.

  • We offer rehab and training at the Highlands Wellness gym and can provide a program of things for patients to do on their own at home or in their own gym.

• We want to build confidence and problem-solving skills in case of a setback or a new challenge.

  • We rely on education and identifying potential barriers to recovery and having a plan for how we can overcome them. By discussing what might go wrong, we can be better prepared to manage it if it does - this makes back pain much less scary.

The key here is that nothing is prescribed until we’ve discussed with the patient and learned how their condition is affecting them. We are treating the patient, not the low back pain. There is no magic number of adjustments that will realign someone, there is no pill that works for all back pain, and there are no tricks to getting strong and resilient.

The Highlands Wellness approach and my approach is figuring out where a patient is starting from, collaborating with them to create a plan to get them to where they want to go, and then consistently executing that plan to the best of our ability.

When there are setbacks or barriers, we want to prepare for them and modify the plan as needed, but continue progressing towards a full life performing the activities we love without suffering in pain.

If this sounds like something you, or someone you know could benefit from, please contact us. We offer in-person care in Kanata, and virtual care throughout Ontario. We are happy to discuss if our clinic will be a good fit!