Spoon, Fork, or Knife – What Treatment Is Better For Low Back Pain?

While treatment options are many, solutions are but few!

31 million Americans experience low back pain at any given time!  Read that again.  10 percent of the population in the United States experiences low back pain every day!  Unfortunately, that number is also on the rise!

Low back pain is already the single leading cause of disability worldwide, and also one of the most common causes of missed work!  Shockingly, low back pain is the second most common reason for a visit to the doctor, just behind upper respiratory infection.

In the past few decades there have been significant improvements in technology and treatments aimed at eliminating low back pain.  So why does the low back pain epidemic continue to rise?  What is the solution moving forward?

A few years back, the New England Journal of Medicine posted an article on a comparison of physical therapy, chiropractic manipulation, and an educational booklet for the treatment of low back pain.  The results fueled a lively debate among providers in regards to effective treatment for low back pain.  Their conclusion found no difference in outcomes between low back pain patients being treated with chiropractic manipulation, physical therapy with McKenzie exercise, or the educational booklet!  Future studies have also found similar conclusions!

These results can be demoralizing to those seeking help from low back pain!

So what are we doing wrong?  It is highly likely we are not being specific enough with our diagnoses and treatment options!  In all these studies, low back pain was being treated as a single entity with only one cause.  In the aforementioned study, chiropractors diagnosed sprain or strain in half of the patients and facet syndrome in another 30 percent.  Physical therapists diagnosed a disc derangement 92 percent of the time.  Furthermore, these diagnoses are inconsistent with the expected percentages of each pathology.

What an incredible error!  While this seems simple, a treatment applied must match the accurate diagnosis for the patient!

Adhesion, disc injuries, stenosis, nerve entrapment, strains/sprains, tears – all of these things cause pain.  All of these items can be found in the low back.  However, each of these items require different treatment options.   All of these problems can be found at a chiropractic, physical therapy, or medical office.

While all of these problems can be found in the any of these clinics, most treatment is predetermined.  Chiropractors are going to adjust, PT’s are going to stretch and strengthen, and MD’s are going to prescribe pills or provide cortisone.  Treatment is applied, in most cases, without regard for the diagnosis.

If I were to ask you which is better – a knife, fork, or spoon – you may want to know what food you are eating.  By analogy, if I were to ask you which treatment is better for low back pain -chiropractic, physical therapy, or an educational booklet – would you answer the question before knowing what is actually wrong with the patient?

In order for the low back pain epidemic to go away, we have to have providers be more specific with their care!

 

At Thrive Spine and Sport, we pride ourselves on finding the right solution for you!  As the most advanced Integrative Diagnosis providers in the state of Iowa, we offer advanced diagnosis and treatment solutions.  Most patients have seen multiple providers before finding their real cause and solution for their pain.  Not everyone is right for our care, but patients leave our office knowing what is wrong and what needs to be done moving forward!

If you have been struggling with low back pain, we invite you to schedule a consult to meet with one of our highly trained doctors over your condition.  Call 319-423-0925 or click below!

Low Back Health Exam

Over 80% of the population will be affected by low back pain at some point in their life.  25% have suffered low back pain in the last 3 months alone!  Low back pain is one of the leading causes of disability and lost production in this country.  Solutions to the problem aren’t often easy and far too many people are left looking for answers for why their back always hurts.  Low back pain is a REALLY BIG DEAL!  Keeping your low back HEALTHY should be a PRIORITY!

If you struggle with low back pain, wouldn’t it be nice to know WHY your back always hurts?  Or maybe, if you’re one of the lucky ones not currently in pain, wouldn’t it be nice to know your low back pain risk and what you need to do to prevent it?

Now you can by taking the test and trying these 5 tests at home!  Why these 5 tests?  These 5 tests are the most basic, functional movements of the low back.  Every healthy person should be able to perform these tests!

So here’s how it goes.  Perform each test below – some may need the help of a partner.  Rate yourself by the grading chart for each test.  Add the scores together at the end to get your score.  Follow the directions to fix your low back!

Let’s get started!

TEST #1:  Straight Leg Raiser

You will need a partner for this.  Download a “bubble level” app on your phone.  Make sure the app measures angle as well.  There are a ton of free ones out there that work well for this.  I recommend “Clinometer” for Android and “iHandy Level Free” for iPhones.

Lie on your back with feet extended out in front.  Place the phone with the bubble app open in the middle of the shin.  One leg at a time, have your partner lift the leg with the knee straight.  Move the leg until it can no longer stretch or the hip or opposing leg starts to lift off the ground.  Record the degree.

20160706_182837

85-90 Degrees = 2 Points          75-84 Degrees = 1 Point          Less Than 74 degrees = 0 Points

 

TEST #2:  Knee-To-Chest

While still laying on your back, one leg at a time, pull your knee to your chest.  The front of the leg should touch the bottom of your rib cage without any pinch in the anterior hip.  If you cannot get the front of your leg to touch your chest, measure how far away by placing fingers between your chest and leg.  Record the distance.

20160706_183142_001

3 Finger Restricted Knee-To-Chest
3 Finger Restricted Knee-To-Chest

Leg Flat On Chest W/ No Anterior Hip Pinch = 0 Points        Leg 1-3 Fingers From Chest = 1 Point          Leg  More Than 4 Fingers From Chest = 0 Points

TEST #3: “Cat Stretch”

You will need a partner and a pencil.

With hands and knees on the floor arch your low back as much as possible by trying to bring your hips to your chest.  Have your partner place a pencil on your lower back.  What does it look like?

Healthy "Cat Stretch" Test
Healthy “Cat Stretch” Test

                                            Pencil Ends Off Back = 2 Points                                              

Flat Pencil Test
Flat Pencil Test

Pencil Flat = 1 Point

Severely Restricted "Cat Stretch" Test
Severely Restricted “Cat Stretch” Test

Pencil Ends Touching, Middle Not = 0 Points

 

TEST #4: Lunge

Standing up, take a large step forward and drop the back knee to the ground.  Keep your body upright.  Place a ruler under your back leg.  Measure how far the front of the hip extends out from the ruler.

Lunge Test
Lunge Test
Overhead View of Healthy Lunge Test Of The Ruler
Overhead View of Healthy Lunge Test Of The Ruler

More Than 12” = 2 Points          9-11.5” = 1 Point          Less Than 9” = 0 Points   

 

TEST #5: Toe Touch

Standing upright bend forward and try to touch the floor in front of your toes.  Use a ruler to measure how far away the tip of your finger is away from the floor.

Healthy Toe Touch Test
Healthy Toe Touch Test

Finger Touching Floor or Palming Floor = 2 Points

Fingers Less Than 2” From Floor = 1 Point

Limited Toe Touch Test
Limited Toe Touch Test

Fingers More Than 2” From The Floor = 0 Points

 

Now that you have gone through all of the tests, add the score of each test together.  What did you get?

9-10 Points = 90-100% Low Back Function = Congratulations!  You have a VERY healthy back!

7-8 Points = 70-80% Low Back Function = Chances are you may not have low back pain now, but you should try to improve the tests that are lagging with some simple daily mobility, stretching, and exercise.  In pain currently?  See below.

Less Than 6 Points = Less Than 60% Low Back Function = Your back is in trouble!  Most of these tests are limited or restricted.  You have less than 60% function of your low back!  That’s a failing grade in school!  Just like in school when you failed a test and you looked for some help to get better grades, you should seek the help of a local musculoskeletal expert for solutions to fix these movements and solve your low back pain!

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It is important to note these 5 tests above are assessments used in the Integrative Diagnosis system.  The most common cause of limited range of motion and pain for these tests are due to muscle adhesion.  Integrative Diagnosis is the most advanced diagnosis and treatment system for solving musculoskeletal problems.

At Thrive Spine and Sport, we are currently the only full body Integrative Diagnosis providers in the State of Iowa. Our treatment fixes adhesion!  If you have been looking for answers to your low back pain, click the appointment request here, or call us at 319-423-0925.

3 Easy Tests To Help Figure Out Low Back Pain

According to the National Institute of Health (NIH) lower back pain will affect 8 out of every 10 people at some point in their life.  On top of being the leading cause of disability worldwide, lower back pain will cost Americans $50 billion dollars this year!  While some cases of low back pain will go away after a couple days on its own, a majority of cases will become chronic in nature!  So why do some cases go away, while others become chronic? Let take a look!

If you do any kind of research online, you will likely find the same recommendations for pain relief repeated – rest, ice, stretch, warm up better prior to activity, NSAIDs, maintain good posture, get better shoes, etc.  While this may sound like sound advice, none of it really works, otherwise we wouldn’t find so many of us in pain.

Since most people start treatment of low back pain by visiting their PCP, or Primary Care Provider, they are often recommended rest and NSAIDS.  After a couple weeks of inactivity, these same people often find themselves right back where they started once they get back to their daily routine.  Sound familiar? So what went wrong?

The problem is that the rest and NSAIDs temporarily raised your symptom threshold, but did nothing to address the real issue. Stretching may provide temporary relief but no long term benefits. The shoes may have taken some stress off your feet, but didn’t touch the low back pain.  None of the above recommendations address long term fixes!

The problem with all of this, and why your pain has become chronic, is that there was not a single, specific diagnosis made to identify the real problem initially!  In my experience, most people with low back pain have some limiting range or motion in their low back, hips, or both. This limited range places extra stress on the low back, causing weakness and pain!

So how do you know if this limited range affects you and your low back pain?  Fortunately, there are some at-home tests that you can do right now to find out where you’re limited and options to finally get your low back pain under control!

The first test is the Standing Toe Touch.  While this may seem simple, most people with low back pain are unable to bend at the waist and touch the toes to the floor without pain or tension in the back of the knees and calves.  The test should be effortless and without pain.

SLPF
Full Standing Toe Touch

 

Knee-to-chest is the easiest way to test hip flexion.  Lie flat on the floor with both legs extended out in front of you.  Bring one knee up to your chest until the front of the thigh is flat with the chest.  If the opposing leg raises up, pinching is felt in the front of the hip, groin, or outer leg, or the thigh falls short of the chest, the test is limited and a possible cause of low back pain.

Hip Flexion Test
Hip Flexion Test

Hip Extension is vital to the stability of your spine.  To test, start in a lunge position, leaning as far forward onto one hip.  Place a ruler in line with the rear leg just in front of the knee.  Drop a plumb line from the front of your hip to the ruler below.  Normal range should fall between 10-12 inches.  Decreased range or pain with this test is a positive finding for this test.

Kneeling Hip Extension
Kneeling Hip Extension

If you or someone you know suffers from low back pain and cannot perform these very simple tests, there is a good chance they can find relief in our office.  At Thrive Spine and Sport, these tests, and a few others from the Integrative Diagnosis system, are used to gain a clear picture and full diagnosis of what causing your low back pain.  By obtaining a full diagnosis and applying the correct treatment, resolution for your pain is possible!

Simply fill out the appointment request on this page or call our office at 319-423-0925 to get to the bottom of your pain today!  Any questions can be sent to Dr. Cody at dr.cody@thrivespineandsport.com.

Thanks for reading!

 

 

***Special thanks to Ally Thompson of Heat Yoga and Dr. Carl Nottoli of Functional Spine and Sport for the photos****