FASCIA AND CHRONIC LOW BACK PAIN: SHOULD WE DISCARD THE TERM ‘MECHANICAL BACK PAIN’?
Before we jump into the meat of today’s post, allow me to show you some quotes from studies and articles on “mechanical back pain,” which is often referred to as “nonspecific low back pain” or NSLBP. Be aware that in many cases the culprit of chronic back pain is not as “hidden” as you’ve been led to believe. In fact, back in June, I wrote an article about NSLBP, talking about chronic inflammation and fascia as the twin missing links (HERE).
- “Many clinicians dislike low back pain because the pathophysiology of low back pain syndromes is poorly understood, the physical examination is generally unrewarding, and diagnostic tests typically are negative or false positive. Innumerable treatments exist, yet many are illogical, most are unproven, and only a minority are better than simple observation. Mechanical low back pain encompasses the vast majority of back pain syndromes. The tissues responsible for mechanical back pain are generally not identifiable [with imaging tests], but appear to include muscles, tendons, ligaments, and discs.” Harvard’s famous spine researcher, Dr. Jeffry Katz, from the Arthritis Foundation’s 1993 article, The Assessment and Management of Low Back Pain: A Critical Review
- “Back pain is one of the most common patient complaints brought forth to physicians. Mechanical back pain accounts for 97% of cases, arising from spinal structures such as bone, ligaments, discs, joints, nerves, and meninges. Common causes of mechanical back pain include spinal stenosis, herniated discs, zygapophysial joint pain, discogenic pain, vertebral fractures, sacroiliac joint pain, and myofascial pain. A wide variety of treatments are available, with different treatments specifically targeted toward different causes.” From Current Pain and Headaches Report (What is Mechanical Back Pain and How Best to Treat it?)
- “Given the incidence of Chronic Mechanical Low Back Pain (CMLBP) due to benign disorders, it is important that an accurate diagnosis be made and appropriate therapy applied. The diagnosis of CMLBP is solely clinical; however, imaging studies may show degenerative spondylosis. Like asymptomatic individuals with lumbar disk herniation and spinal stenosis on imaging studies, there are individuals with imaging abnormalities consistent with excessive motion in dynamic flexion/extension who do not have clinical symptoms referable to those abnormalities.” From a decade old article that was published in the Journal of Neurological and Orthopedic Medicine and Surgery (Chronic Mechanical Lower Back Pain)
- “Acute mechanical back pain is a common medical problem. Acute pain is pain that has been present less than 4 to 6 weeks. Mechanical means the source of the pain may be in the spinal joints, discs, vertebrae, or soft tissues. Acute mechanical back pain may also be called acute low back pain, lumbago, idiopathic low back pain, lumbosacral strain or sprain, or lumbar syndrome. A precise anatomic cause of mechanical back pain can be identified only 20% of the time… 80% of the time, the specific source of the pain is not found. Fortunately most people recover in a relatively short period of time with simple treatment.” From the Cleveland Clinic’s article, Acute Mechanical Back Pain
- “How Low Back Pain May Become Chronic: Chronic low back pain can be better described as multiple acute spinal micro trauma(s) that accumulate throughout the day. The damaged tissues become sensitized and small movements can create pain that may become more intense and longer lasting. It’s like hitting your thumb with a hammer. Once your thumb is sensitized, it only takes a slight bump to cause more pain. If your thumb is never allowed to heal, the pain continues to worsen. That scenario is the same for patients with chronic low back pain. Everyday movements, postures and loads matter!” From Dr. Kai Tiltmann’s article for Spine Universe, Is Your Low Back Pain Mechanical?
A quick search of PubMed shows that there are over 2,500 articles on mechanical low back pain. Although we are really only going to cover a recent article written by Dr. David Seamans for the American Chiropractor (Is Mechanical Back Pain an Unscientific Myth that Should be Abandoned?), I want to take a moment to break down the quotes from above so that you understand what the conversation is about.
The first thing to remember is that as seen in the quotes above, imaging low back pain isn’t nearly what we’ve been led to believe it is; true whether we are talking about MRI for discs (HERE), plain film x-rays (HERE), or CT. Furthermore, CT provides doses of radiation that are beyond freaky (in many cases, the equivalent of over 1,000 x-rays). Secondly, chronic problems are typically acute problems that accumulate over time. What is it that actually “accumulates”? Easy — FIBROSIS, which is what the medical community calls scar tissue.
Thirdly, if you fail to take care of these injuries, the nerves in the area have the propensity to become hyper-sensitized (“Super Sensitivity”) by the large amounts of local inflammation — a problem made much much worse if a person is “SYSTEMICALLY INFLAMED“.
And lastly, although inflammation is involved in mechanical low back pain / musculoskeletal back pain, the difference is that in “inflammatory” low back pain, the inflammation is being driven by autoimmune processes that attack tissues of the spine (ANKYLOSING SPONDYLITIS, RHEUMATOID ARTHRITIS, and potentially dozens of others). Now; allow me to show you what DR. SEAMANS is saying.
The good doctor starts out by revealing that the term “mechanical back pain” was invented in 1980 after a survey given to a professional organization of surgeons. They described two types of pain — “radicular,” which is the sort of thing caused by abnormally stretching or tensioning nerves, frequently leading to ARM PAIN or LEG PAIN; or “mechanical pain” that could be either induced or relieved by moving, stretching, or changing positions. Seamans minces no words in describing his opinion of this scenario.
“Mechanical back pain is an unscientific concept that was invented by outspoken critics of the chiropractic profession and subsequently embraced by chiropractors who refer to themselves as being “scientific” and “evidence-based. Mechanical back pain merely means musculoskeletal pain and nothing more, so why not just use the acurate and descriptive term “musculoskeletal pain” instead? My suggestion would be to abandon the term “mechanical back pain””.
Seamans went on to explain why he would abandon the term, touching on something that I wrote about almost four years ago in a very short post titled The Three Types of Pain (HERE). Seamans also believes there are three types of pain (two types of nociceptive pain and neuropathic pain), describing the type two nociceptive pain as “axons that fire spontaneously when exposed to inflammation“.
While I referred to this in my post as Type II Inflammatory Pain, we are both essentially saying the same thing —- that when “There is a local accumulation of pain-producing inflammatory chemicals and exudates that causes the classic signs associated with local inflammation,” it leads to Super Sensitivity. These are the people the medical literature refers to as “CENTRALLY SENSITIZED“.
The bottom line is that even though our three types of pain are not exactly the same (he is probably more correct than I am), we agree that no one wants any part of CHRONIC PAIN. This is where the nerves become spontaneously activated in a pathological sense, continually firing messages to the brain in the form of pain that there is tissue damage present.
The problem is that this type of firing goes on long after the tissue has healed; in many cases to perpetuity. The wrench in the machine, however, is how we define the term “healed” above. Realize that if there is serious FASCIAL ADHESION present, it will not be imaged on standard tests or with the average PHYSICAL EXAMINATION, and you’ll be told that the pain is all in your head (HERE).
Seamans went on to refer to these folks as “non-responders” —- patients who do not respond to the care that you are giving in your clinic. He then provided a profile of the most common nonresponder; a person who DOESN’T SLEEP WELL (SYMPATHETIC DOMINANCE), leads a sedentary lifestyle, and eats a crappy (“inflammatory“) diet. Diet is Seamans’ pet topic.
And while probably not politically correct, he has referred to the average American who eats the SAD (Standard American Diet) as “DIETARY CRACKHEADS“. Because dietary crack is actually more addictive than real crack for a substantial part of the population (HERE), I’ve written a slew of articles on how to break free from SUGAR, CARB, AND JUNK FOOD ADDICTIONS.
And while you might feel you are a nonresponder, for many of those struggling with true chronic pain (central sensitization), in my clinic I frequently suggest that you try ONE TREATMENT with me because in many cases it can be almost impossible to tell a class II from a class III without seeing how they respond to treatment (HERE). Furthermore, if you don’t truly grasp the importance of the THORACOLUMBAR FASCIA (or HERE) as it relates to chronic low back pain, even a good understanding of inflammation can leave you spinning your wheels as far as solutions are concerned.
Seamans ends his article by talking about the long term consequences of living in a state of perpetual inflammation. Once you understand just how many health issues are directly caused by inflammation (HERE is a list), it’s not only easy to see how the average patient is essentially sabotaging their own health (spinal health included), but just how little their doctor is doing to address the underlying causes. Sorry folks, but throwing the “BIG FIVE” at these people all day long doesn’t count. It’s also why I continue to beat the drum of DIY and ‘self help’.
The unfortunate truth is that there is no such thing as a miracle drug for the vast majority of you reading this post with tears in your eyes. The sooner you come to that realization, the sooner you’ll grasp that old cliche; “if it is meant to be, it’s up to me.” It’s sad that it has to be this way but the harsh reality is that the drugs you’ve been living on do not change underlying physiology and they certainly don’t promote homeostasis (HERE). What’s the solution? How about creating an EXIT STRATEGY?
Although most doctors cannot stand the internet as it pertains to learning about health-related issues, I would take exception. The world wide web, while full of junk, sale pitches, and self promotion, has also leveled the playing field as far as the average person’s ability to get their hands on life-changing information is concerned. And while I certainly promote myself and what I do on my site (HERE), I do not try and sell you anything as I feel that would dampen my credibility.
Instead I’ve provided an entire category on my blog I refer to as UNIVERSAL CAUSES & UNIVERSAL CURES. The post in this group that I most frequently refer patients to is THIS ONE. Because knowledge really is power, I would suggest that you study and increase your knowledge, and use it to “EMPOWER” yourself and others in your circle, particularly your family and closest friends. Other than simply sending them a link, the easiest way to reach the people you love and care about most with awesome information is by liking, sharing, or following on FACEBOOK.