Eighty-five percent of all people will experience back pain at some point in their lifetime. Most of the pain will resolve without any treatment.

However, for some of the patients, back pain becomes very painful or long-lasting. In a typical neurology office setting, patients will get orders for physical therapy, muscle relaxers, and gabapentin. In a large number of those patients, pain will indeed resolve within 6 weeks.

Eventually, it will come back, or become chronic and long lasting. The patients will get more physical therapy, will receive epidural injections, and if all else fails, will be sent to a spine surgeon. Commonly, spine surgeons will not find anything that they can operate on and will send them back for more epidural injections and physical therapy. I recently saw a patient who had over two dozen epidural injections with little relief.

Some patients will go to a massage and/or a chiropractor to get relief. And again, some patients will get relief (at least temporary) and some patients will not.

This was my story too. I developed back pain causing severe spasms of the gluteal muscles and tingling in my leg and foot. As a neurologist, I knew exactly what it was – L5 radiculopathy. I knew that I was interested in a more holistic approach and started with stretches and a chiropractic routine. I tried several chiropractors with some improvement. Then, I was told that I have an SI joint dysfunction and was prescribed to wear a brace, which indeed helped, but did not resolve my pain completely. I also tried different types of massages with little results.

At this point, I asked myself, why those therapies were not effective. I addressed “all the bases” without any relief, short of chemical disruption of pain impulses from my irritated nerves.

Well, let's think about it. The job of our body is to provide the most optimal function. It adapts constantly to challenges that we are experiencing. Sometimes this adaptation is not enough, and symptoms occur. The same thing can happen with the spine.

We use our spine constantly, but we always think about spine pathology as a bone or disk disease. Well, according to the literature, 85% of patients with spondylitic changes on an MRI did not have any pain, suggesting that we may be missing other components of this process.

Bones are connected by connective tissue and the muscles. If one of the muscles is under-performing, then other muscles need to take over and work harder. The longer this process continues, the more pronounced the changes are. At some point, the body begins to adapt, starts thickening the ligaments, and forms spurs in order to stabilize that spinal segment. Most of our therapies are designed to address this late consequence and not muscle disbalances.

There are therapies that address muscle disbalances, but those practitioners are not widely available.

There are several reasons for back pain:

  1. Related to nerve compression
  2. Related to muscle disbalance
  3. Related to psychological disbalance.

Nerve compression occurs when the process is far gone, and the nerve is compressed by a herniated disk or a large spur. Chiropractic manipulations are commonly helpful for acute pain. Postural therapy is also very effective.

Muscle disbalances are the predominant reason for the back pain. I have seen numerous patients with back pain and only minimal spondylitic changes on an MRI. Chiropractors state that multiple repeat adjustments will allow the muscles to stay in place and not cause further pain. Well, why did the muscles get out of balance to begin with? This is not being addressed by a vast majority of chiropractors.

Massage will relax the muscle temporarily, but again, would not address disbalances.

Muscle activation technique will address disbalances, but may not address other changes and again, would not address the cause of those disbalances.

Postural therapy may address some of the reasons for disbalances.

All of the above techniques are very effective, but sometimes, back pain requires a comprehensive multidisciplinary approach. Each technique will add to the common goal of resolving back pain.

Then there are psychological causes of back pain. We store our emotions in the lumbar region and there is at least one practitioner who has popularized the idea that ALL back pain is related to hidden emotions (John Sarno:”Healing Back Pain: The Mind-Body Connection”). While I agree that this component is highly plausible, it would not explain ALL back pain and would not resolve everything.

So, what helps me? After doing all the above therapies and still not getting satisfactory results, I realized that I was not using the mechanics of my body correctly.

We walk 5000-10000 steps a day and if we walk incorrectly, then it means that we use and overuse certain muscles in the back 10000 times a day. No wonder our muscles are sore.

Proper gait techniques have several components. Be careful with You Tube videos, some of them have incorrect and sometimes harmful information.

  1. Foot position / movement
  2. Gluteal muscle work
  3. Torso rotation
  4. Hand swing/ position.

The foot should be flexing 45 degrees when we walk. If it doesn’t, then there is weakness of the anterior tibial muscle and increased tension in the posterior calf muscles.

Short steps do not allow gluteal muscles to work properly. This leads to atrophy of the gluteal muscles and overcompensation from the lumbar muscles. Those muscles are not designed to propel our walking and get tired and sore.

Rotation of the torso works the oblique abdominal muscles. If these are weak, then stronger muscles such as the quadratus lumborum will take over and cause bending of the spine, instead of rotation, again leading to back pain.

Arm swing is very important for propelling us forward. It uses large back muscles (latissimus dorsi) and weakness in those muscles again will lead to back pain due to overcompensation by smaller lumbar muscles.

As you can see, back pain is much more complex than simple spurring of the spine and requires a comprehensive approach. Each therapeutic modality has its value and limitation and it is important to choose the correct sequence of therapies in order to achieve long-term resolution of the pain.