“My back pain is all from my muscles, Doc.”
Many of my patients come to me with their back problems all diagnosed, at least in their own minds. Patients assume their back pain is caused by one of three things: muscle pain (not too serious), arthritis (worse) or a disk (really bad). But the problem that underlies almost all back pain is none of these things.
As a doctor of chiropractic, my training was focused on the one key component missing from that list: the joints. Joint problems — chiropractors call them subluxtions — are the most overlooked cause of back pain.
But patients don’t include joint problems in their list of causes for pain. The first few patient visits often require a lot of education on my part, explaining that while muscle spasm is a problem, the cause often lies in the joint. An inflamed, misaligned joint is a huge irritant to the body, and it responds by tightening up the surrounding muscles to guard the joint. This chronic muscle tension can lead to outright spasm after a time, and of course, the patient thinks all of their pain is coming from these tight, spastic muscles. Joints also can be painful, but typically any pain caused by the joint is blamed on the muscles.
Also, in some patients, the joint problem is painless, which allows it to build up slowly, without the patient having any idea there is a problem. The first sign is when the back “goes out” during a sneeze or a simple bend.
I’m not saying muscles don’t need treatment; treating both joints and muscles together is more effective than treating either alone. As doctors of chiropractic, we are trained in many different ways to address problem muscles, including exercises, trigger point therapy, different types of electrotherapy, and stretching. Almost every patient gets some stretches, and even core exercises, as they improve. But I have seen patients try for months or even years to strengthen or stretch the muscles of the back without any success, only to have the muscles relax on their own when the underlying joint problem is treated.
Actually, arthritis and even disc ruptures can benefit from treating the spinal joints, although the treatment may have to be modified. Even patients with a “pinched nerve” from a disc find that if the joints in the back are out of alignment, it can worsen the problem considerably, and when the joint is corrected, the pain improves.
A few signs that the joints of the spine are a problem: any popping or cracking noise. These noises only come from the joint, not the muscles. Many patients tell me their backs and necks actually “quiet down” after a course of chiropractic care. If there is too much damage to the joint surfaces, as in arthritis, the noise may not go away completely, but even when there is arthritic damage to the joint, manipulation can be very helpful.
Another sign is pain on the side you are bending towards, as opposed to the side you are bending away from. This is more obvious in the neck. If you bend your neck to the right, and there is pain on the left, it is usually because of tight muscles being stretched. But if the pain is on the right, it is typically because of inflamed joints being compressed together.
Patients usually start to get the idea of how joint problems affect muscle tension when I show them how a tight muscle in their back relaxes immediately after I treat their joints. Many of the muscle-based exercises that were too painful or not helpful before become very helpful, and actually feel good, once the joint problem is corrected.
Dr. Michael Noonan practices chiropractic, chiropractic acupuncture and other wellness therapies in Old Town. He can be reached at firstname.lastname@example.org.