I see this all the time in my practice, and it has happened to me personally. (Like a lot of doctors of chiropractic, I was a chiropractic patient first.) A patient tells me his back was fine until he bent over to tie his shoes or pat the cat or even just brush his teeth, when wham, there was a sudden, intense pain in his back.
Usually the patient asks me, “What did I do wrong? Should I have bent my knees? Why does my back go out without warning?”
The answer lies in the nerve supply to the spine. Our ability to feel pain, as well as everyday sensations such as touch and movement, is different in different parts of our bodies. For example, we are very aware of everything that happens inside our mouths. But the nerve supply is quite different to the deeper structures of our bodies, such as the stomach. When we chew food, we can taste and feel it until we swallow. Once the food gets to the stomach, we only partially feel it, and once it goes deeper into the digestive tract, we totally lose track of it. Because of this lack of sensitivity, it is not unusual for an ulcer to develop without any symptoms at all.
The nerve supply to the spine is like the stomach; you can feel some things, but the pain threshold is pretty high. The pain of an ulcer or back problem builds up gradually over time and seems to come out of nowhere when the damage is advanced enough.
It is commonly assumed that when the back gives out, tension that has been building in the muscles finally causes it to go into spasm. This is only partly true; often the real problem lies in the joints. Stress and inflammation can build up in them without any signs or symptoms until the point that the body decides it is more important to protect that joint than to bend over.
Much of the spasm associated with a back attack is actually the muscles protecting an inflamed, misaligned joint. This is the type of problem that responds to manipulation; stretches and other kinds of exercises cannot put a joint back into alignment.
Most patients try to wait it out when their back goes into spasm, or just get a prescription for a painkiller. But one episode tends to lead to another, and each episode makes it more likely that another will occur. If this cycle is not stopped, it will lead to chronic low back pain, which is so common it’s estimated to have the highest “chronic disease burden” in the world.
When there is a history of back attacks, we try to teach that treatment is not only for the acute pain, it’s also for the underlying joint and muscle problems that caused it in the first place. These are problems that can be completely painless.
One of the most difficult parts of treating a patient with this problem is getting him or her to continue to take their condition seriously, even after the acute pain has responded to treatment. In my 30 years of practice I have seen many patients back for several rounds of care for the same underlying problem, even though the acute episodes may be separated by months or even years. If the underlying problem is not corrected, it will not go away on its own.
Dr. Michael Noonan practices chiropractic, chiropractic acupuncture and other wellness therapies in Old Town. He can be reached at firstname.lastname@example.org.