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Got Low Back Pain? Think Twice Before Reaching for Pain Medications
Muscle spasms and strains, pinched nerves from “slipped” or herniated discs, degenerative discs, and poorly aligned hips can all cause low back pain. Whether it’s a constant dull ache along the entire low back, severe flares of pain and muscle spasms, or a sharp “electric” sensation shooting down to the glutes, knees, or even feet, low back pain will effect two thirds (⅔) of the American population throughout their lifetime, and 25% will seek medical help within a six month period. Before going to the doctor, many individuals’ first instinct is to reach for the medicine cabinet, either for their favorite NSAID (Advil, Aleve, Motrin) or for a prescription medication like a muscle relaxant or narcotic. The American College of Physicians recently released an update to their 2007 guidelines regarding recommendations for treating low back pain, and we’re excited to say cold laser therapy was named a preferential treatment over pain medication.

What Causes Low Back Pain?
The main causes of low back pain for individuals between the ages of 30 and 60 are muscle spasms and strains, “slipped” or herniated discs, and degeneration of the discs.

Muscle Strains: weak low back and abdominal muscles aren’t able to protect the lumbar spine during activities that require heavy lifting, twisting, or suddenly changing directions. Muscle strains, or pulled muscles, occur when the force required to move something is greater than the force our muscles can generate to stabilize and support the spine during the activity, which can cause a dull and achy pain when changing positions or walking, and can make the low back tender to the touch.

Herniated Discs: the spine is made up of bony vertebrae and soft, jelly-like discs that protect our spinal cord, support the weight of our body, and absorb stresses we place on the spine. Just like a muscle strain, sudden twisting or turning to lift a heavy object can cause the inside portion of these discs to “leak” like jelly spilling out of a doughnut. As the inner portion of the disc leaks or spills out of the disc, it puts increased pressure on the nerves that run to our buttocks, thighs, knees, and feet that can cause a burning, tingling, or “electric shock” type of pain in addition to noticeable weakness in these areas that’s often worse than the pain felt in the back. This burning is usually felt on one side more severely than the other and tends to be worse after sitting or standing for long periods of time without taking a break to move or walk around. Sciatica pain is a classic example of pain caused by a herniated disc.

Degenerative Disc Disease: as the body ages, tissues naturally become less flexible and more brittle. The same goes for the discs between the vertebrae of the spine. As we age, the discs become dehydrated and start to break down which decreases the amount of “shock absorption” they can provide when we bend forward, stretch backward, or twist side-to-side. This causes a more constant nagging type of pain that’s worse with sitting and will occasionally flare up with muscle spasms that can last a few days to a few months.

Sacroiliac Joint Dysfunction: the sacroiliac joint, or “SI joint,” lies close to the tailbone and is the point where one’s hips connect to the back (the back bone’s connected to the hip bone...hear the song?). It doesn’t typically have substantial movement, in fact many doctor’s debate whether to even call it a joint, but it’s responsible for transmitting all the forces from the upper body to the lower body. When the joint moves either too much or too little, one might feel a sensation very similar to a herniated disc, low back pain (and possibly hip pain) radiating to the groin, buttock, or down the leg that’s worse with prolonged periods of sitting without taking a break to change positions or walk around. People with SI joint pain may feel some relief with lying down flat or sitting in a recliner.

In addition to age, factors such as an individual’s fitness level, overall body weight and composition, and occupational demands can play a huge role in someone developing low back pain. The “weekend warrior” fitness lifestyle puts an individual in a position of more “off” days than “on” days, and since it takes consistent time in the gym to see gains in strength and cardiovascular endurance, and only a very short amount of time to begin deconditioning, the abdominal and low back muscles don’t have sufficient strength to support the lumbar spine efficiently during functional exercises like sledgehammers, tire flips, clean and jerks, and squats (just to name a few). Do your back a favor and make getting to a FitCamp or doing some sort of aerobic exercise a daily priority to avoid injury and setbacks. We discussed earlier how the discs between the vertebrae act as shock absorbers and help transmit forces from the upper body to the lower body. Excessive body weight will put unnecessary stress on these discs leading to herniation and early degeneration, and we just discussed the type of pain that can stem from that. Finally, individuals required to do heavy lifting, pushing, or pulling while at work can be at an increased risk for low back pain. Much like the functional sledgehammer exercise, if they’re required to do a lot of twisting, say to stack shelves or transfer heavy items, this only increases the risk of injury if other precautions such as regular resistance training isn’t also completed.

Cold Laser Therapy and Low Back Pain
The American College of Physicians compared numerous non-invasive, conservative modalities ranging from pain medication to cold laser therapy to guided exercise programs and their effect on pain intensity, function, and global improvement of their patients’ condition. Medications like acetaminophen (Tylenol), NSAIDs (Advil, Aleve, Motrin), and corticosteroid injections showed little to no difference in decreasing pain intensity or improving function in patients with acute low back pain when used by themselves, and muscle relaxants only showed short-term pain relief when compared with a placebo treatment. When using these medications for chronic low back pain, NSAIDs showed small to moderate improvement in pain intensity with no improvement in function, and opioids only showed small short-term improvements in pain with no improvement in function because they don’t fix the source of the problem. They simply mask the pain.

Seeking out alternative types of therapy for low back pain is beneficial in more ways than simply reducing pain and improving function. It’s well-known that extended use of NSAIDs can lead to stomach ulcers and bleeding, kidney problems, and heart problems. Opioids can cause nausea, dizziness, constipation, and vomiting, and muscle relaxants can cause issues with the central nervous system. Using anti-depressants or getting a cortisone injection can cause fatigue, light headedness, insomnia, and nervousness. Why put your body through all those negative side-effects using a medication that may only give you a small amount of temporary pain relief, if it even works at all? In over 1200 studies there have been no reported negative side effects to using cold laser therapy. Check out more specifics in our brochure on back pain.

What the American College of Physicians did find beneficial were things like using cold laser therapy, superficial heat (such as a very warm wet washcloth, a heating pad, or Thermacare wraps), and guided exercise programs to strengthen the lower back and abdominal muscles. Acute to subacute low back pain (that is, pain lasting a few days to less than 12 weeks) tends to resolve on its own, regardless of treatment. With that in mind, their first recommendation for people suffering from acute or subacute low back pain who don’t want to, or can’t, decrease activity until the injury heals, is to begin with non-invasive treatments such as superficial heat. Cold laser therapy was shown to accomplish the same decrease in pain intensity and improvement in function in a fraction of the time by healing muscle strains and decreasing inflammation caused by herniated or degenerative discs without the negative gastrointestinal, renal, and neurological side effects of medication.

Their recommendation for individuals suffering from chronic low back pain (that is, pain lasting 12 weeks or more) consists of things like completing a guided exercise and stretching program individually designed by a physical therapist, utilizing cold laser therapy, seeking multidisciplinary rehabilitation consisting of a physician, physical therapist, and other specialties, and initiating progressive relaxation techniques as these resulted in improvements in pain and function both in the short and long term without the negative side effects listed above.

Do You Have Low Back Pain?
M&B Wellness Solutions offers multiple services to help relieve the low back pain and heal the source of the injury. Whether it’s cold laser therapy, our PT Squared Program where our physical therapist works together with the highly experienced trainers at iThinkFit to help athletes train through the recovery process, or traditional insurance-based physical therapy, we offer all the above mentioned services recommended by the American College of Physicians to help athletes recovery quickly and stay at the top of their game. An old client of ours who was suffering from chronic low back and SI joint pain would get cold laser therapy before and after every single workout she had at iThinkFit. Here's what she had to say: "Cold laser therapy really helped calm my back down. The most effective was a pre workout treatment and post workout treatment everyday. My back pain is fairly extensive and the daily treatments seemed extreme but it truly did help especially preventing flare ups."

The best way to start your road to recovery is to see a healthcare professional specializing in movement and rehabilitation who can assess your range of motion, strength, and quality of movement to determine if your pain is due to a strain from strength and flexibility imbalances, or something more severe like a herniated disc or degenerative disc disease. Stop by M&B Wellness Solutions located inside iThinkFit Gym for an evaluation with a licensed physical therapist so we can get you on your way to moving the best you possibly can.

Michaela Cantral, PT, DPT

                                                                                                                                                                                                   March 9, 2017