Redefining Low Back Pain:
Dispelling Misconceptions and Finding Solutions
Did you know that low back pain is the main reason people will go to the doctor?
Did you know that at any given moment 25% of the population will be experiencing low back pain?
Did you know that 10% of the population has chronic low back pain?
Chronic pain is anyone who has pain longer than 3 months. So as a healthcare system- what are we doing with this information?
In our opinion- not much. We are putting too much emphasis in all the wrong areas.
We are slapping a diagnosis on the patient and hoping that does the trick. With that diagnosis usually follows cookie cutter treatment such as waiting weeks for imaging to get approved or to get in for an appointment to see a specialist, prescribing painkillers, referring them to a pain clinic instead of physical therapy, cortisone injections, or even sometimes performing a surgery!
Yes, we know- some cases will respond well to painkillers, cortisone injections, and even surgery; However, most cases will not. This is the unfortunate truth. Of those few cases that do have a positive outcome- it typically only helps in the short term.
What happens when the pain comes back? Then what? More painkillers? Another round of cortisone injections? Another invasive surgery?
Before I go any further. I want to apologize. As a healthcare community we have failed you when it comes to treating pain. We are putting too much emphasis into “what’s going on within the tissues” and not enough emphasis on “what’s going on with the patient.”
the biomedical model used when it comes to treating pain is outdated in our opinion.
The biopsychosocial model, developed in 1977 by George Engel is what we should be going by more often than not. Dr. George Engel was a psychiatrist who wanted to utilize a model that takes into account the psyche and soma (brian and body). However, his colleagues didn’t approve because they weren’t able to retract enough data using this model.
So, what is the biopsychosocial model and what makes it different from the biomedical model?
The biopsychosocial model considers biological, psychological (thoughts, emotions, and behaviors) and social (socioeconomical, socioenvironmental, and cultural) factors which play a significant role in health and disease. The biomedical model suggests every disease process can be solely explained in terms of deviation from normal function such as physiological processes, infections, genes, developmental abnormalities, or injuries.
It is important for us to remember pain is a normal human experience. It is how we survive, know we are alive, and adapt. Living in pain is what is not normal.
When a person has back pain we immediately jump to three different things
- It is something wrong in the muscles
- It is something wrong in the nerves
- There is something wrong with the structure.
Then we order imaging. We don’t consider any other factors. Specifically psychological or social factors. See image below for further information.
Regardless if it is a muscle, ligament, tendon, disc, nerve, bone involved- they all heal, just at different rates. The healing timeline can also change depending on age, gender, and any comorbidities. Typical healing timelines are as follows:
Muscle- ~ 4 weeks
Tendon- ~ 6 weeks
Bone- ~ 8 weeks
Ligaments- ~12 weeks
Cartilage- ~ 12 weeks
Nerve- ~ 3-4mm/day
Discs- 9 months
It would make the most sense for those who experience pain, especially low back pain, to see a healthcare professional who specializes in pain. Oh, like a physical therapist!
We can look at gait, posture, range of motion, strength, and lifestyle factors. We are able to approach a person’s pain using this biopsychosocial model to give our clients long term solutions. We must remember- there is no “one size fits all” approach to pain.
We actually inquire during sessions about sleep, stress, grief, coping skills, support you have at home, and so on and so forth. These are important when it comes to managing pain for the long haul. We have to figure out why your body is sounding this alarm.
If we just treat pain as if it is only an issue in the tissues- the person is going to plateau and they will become very unhappy. If the person is unhappy, that will not help their pain.
Why isn’t imaging the necessary first step when someone is in pain?
It is important to remember that ordering imaging to treat a person’s pain is just solving the smallest piece of the largest puzzle. It is just words on a paper. It is normal as we get older to have tissue changes. These tissue changes aren’t 100% indicative of a person’s pain. If it were 100% of people with knee arthritis would have the same level and type of pain.
Some additional facts to consider
- Of people with arthritic changes in their neck scans- 10% have pain
- People post surgery to repair tissues, which was “successful”, ie. no pain & regained all motion- 20% still have a muscle tear when imaging is repeated
- People ages 30+ who have a shoulder muscle tear- ⅓ have pain or limited activity
- People who have NO pain, 75% have scans that show tissue issues
- Tissue Injury does NOT always equal pain and vice versa
- People with arthritis in their knee- 50% have no pain
- Among people with no back pain, more than 40% have a building disc on their scan
- There is even new research emerging showing that people have the same outcomes conservative treatment vs surgical repair after tearing their ACL
Pain is a very complex and personal experience for each person. We all deserve to receive care from an attentive person who is an expert in this realm. Delaying care can lead to worsening of pain due to frustration, increased fear of movement, increased stress, and feeling disempowered.
“But physical therapy can be expensive and I need to know what’s going on!”
- 10 PT Sessions on average- $1,000
- 1 MRI- $2,611
- People who seek an MRI first vs PT first spend a total of $4,793 more on their total care
- Remember MRI or X-Ray is just information. It is not a death sentence and not the main reason for pain
- A Series of Injections- $3,857
- Injections done repeatedly actually make the ligaments and tendons in the joint more susceptible to becoming injured
- A Year’s Supply of Opioids- $6,754
- When people seek PT first they are 35% less likely to be prescribed opioids even when they aren’t completely compliant with a plan of care
- Opioids are more harmful to the brain and can make our nervous system more sensitive to any external stimuli; therefore, setting off the pain alarm.
- A Back Surgery-$31,549
- Low Back Pain Patients who seek PT immediately after pain starts and adhere to their PT program will spend on average $3,000 vs those who delay care and/or receive multiple types of testing/treatments will spend on average $6,000
- Surgery is no guarantee
- 10 PT Sessions on average is $1000
- Clash’s average plan of care is 8-10 sessions.
- It is a non invasive, holistic approach where we get you out of pain and educate you on how to continue to stay pain free.
So, that 10 sessions of PT price isn’t looking too bad. It all depends on who you see for a physical therapist though. You are not out of line to ask if they are familiar with the biopsychosocial model. You can even ask what their speciality is.
Here at Clash PT we specialize in treating chronic pain and utilize the biopsychosocial model. We take a very holistic approach with all of our clients no matter the ailment. We understand how the body and brain work. We understand how pain works. We continue to take courses to stay up to date and expand our knowledge.
Want to learn more?
Email us @ clash@clashpths.com and put in the subject line “low back pain” and let us know how we can help you. Or you can text “low back pain” to 774-314-2487. Make sure to include a name, so we know who we are speaking too.