I see this all the time in my practice: Patients tell me their back was fine until they bent over to tie their shoes or pat the cat or even just brush their teeth when — wham! — there was a sudden, intense pain in their 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?”
It has happened to me, personally. Like a lot of doctors of chiropractic, I was a chiropractic patient first.
The answer lies in the nerve supply to the spine. Our ability to feel pain and everyday sensations, such as touch and movement, is very 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; 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 similar to the stomach: You can feel some things, but the pain threshold is relatively high. So the pain of an ulcer or back problem builds up gradually over time and only seems to come out of nowhere when the damage is advanced enough.
It is 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 is in the joints. As with muscles, stress and inflammation can build up in them without any signs or symptoms until it reaches the point the body decides it is more important to protect that joint than to bend over. Much of the spasm associated with a back attack actually is 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 another will occur. If this cycle is not stopped, it may lead to chronic low back pain, which is so common it has been estimated to have the highest “chronic disease burden” in the world.
When a patient has a history of back attacks, we tell them the first goal of treatment is relief of the acute pain, but the next phase is to correct 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 them to continue to take their condition seriously, after the acute pain has responded to treatment. Many patients don’t get this idea until they go through several “rounds” of care for these acute episodes. This is especially true if the episodes start to get more and more frequent, are more easily triggered or start to involve some leg pain.
If the underlying problem is not corrected, it does 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.