Sherlock Holmes and the Painful Low Back

Sherlock Holmes Cartoon

By Emma Maaranen

We see many athletes each week with back pain. Some of these clients have disk, joint or nerve injuries that cause their pain, but more times than not, back pain does not come from a diagnosed injury or pathology. However, just because there isn’t a diagnosed problem does not mean that this pain is not real, debilitating or needing to be solved. Although we feel for your pain, we love these cases! It allows us to practice our detective work and help to solve the mystery of back pain!

It is a rare person who gets through life without experiencing a bout of back pain at some point. You may experience constant soreness, a biting pain that prevents you from standing, or momentary stabbing pain when you twist. The pain may last for a period of a few weeks to a few months, and it may be a one-time ordeal or a recurring theme. After serious injury has been ruled out as the cause of pain, we at Focus Bodywork put on our detective hats and get to work.

I hate to break it to you, but your lower back is not perfect. Each low back has a slight deviation from anatomical perfection: a small tilt in the pelvis, too much (or too little) curve, micro-scoliosis, tiny bone spurs, thin discs, extra-fat nerve sheath, etc. These deviations may not cause any grief and, if “fixed”, may actually cause a lot of new pain! In fact, when MRI’s are taken on people with no back pain and no history of back pain, the MRI’s often reveal bulged discs, arthritis or degeneration. (Click here for a nice NPR story about this.) Currently the spinal orthopedic world is revisiting commonplace spinal surgeries, such as fusions and micro-discectomies, and finding that for some patients these surgeries are not alleviating their pain and may in fact be making it worse. It could be that for these individuals, the pathology seen on an MRI was not the cause of the pain. Back pain is frustrating!

We love to search for clues to back pain. We start by watching you move (sitting down, standing up, walking, squatting, lunging, twisting, balancing on one foot, etc.) to spot odd patterns of motion. For example, we may notice that one hip does not rock back when you sit down. Or perhaps your low back is very stiff, and we notice it causing your mid-back to overcompensate by doing too much of the motion. Or maybe your gluteus muscles are too weak to stabilize your hip when you balance on one leg, which forces excess load onto your spine.

Clues to back pain can also be found in your story. An athlete’s training plan, if too strenuous, may not to allow tissue to heal. For others, a new diet plan to get to race weight may not provide sufficient nutrients to support tissue repair. Often insufficient (or absent) warm-up and cool-down procedures are suspect.

In addition to our eyes and ears, our hands are our top-secret tool for solving these mysteries! Through palpation (feeling your low back and surrounding tissues) we often detect adhesive scar tissue, taut fascia bands and trigger points in muscles that are contributing to low back pain. Now we know enough to set a trap to catch the culprit!

Focus Bodywork therapists are able to address problems in soft tissue that are contributing to low back pain, but often we need to call in experts from other fields to put away the problem for good. Depending on what we have uncovered in movement patterns, your story and palpation, we may recommend a manual physical therapist to manipulate joints, a movement practitioner to retrain faulty posture, a sports nutritionist ensure you meet your diet goals without compromising your health, or an acupuncturist to reduce nerve pain.

Just as Sherlock Holmes leaves no stone unturned, we are determined to guide you in solving the mystery of your low back pain.

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