- Know what the goal of care is!
I will try to explain what spinal rehab might be and what the end goal of any rehab program should be. When it comes to back pain you may have 15 different treatment options to choose from, so what do you do? Know that each program should have pain relief as the immediate goal. So, how do you know what is best for you? Knowing what the cause of pain is and what the end goal of any therapy program will be is the best place to start for you.2. Proper diagnosis of the cause of pain!
There are 2 types of pain acute (new) and chronic (you have had it for a while, typically more than 30 days).
Acute low back pain is pain that is recent, consider a slip and fall on your back. The pain you feel is what we call acute pain. Several articles in the past few months have stated that Physical Therapy is the best choice for any acute low back pain. The chiropractic community has similar articles stating that the first choice should be chiropractic treatment. Well they are both right because the goal of both programs is to eliminate pain and immediately get the patient active.
The active part of the program is the part the makes the biggest difference for acute pain. Activity will help the prevention of the pain retuning so you need to know that being active is the magic for acute pain. This should also be the end goal for care. Activity! These programs will get you active and then the goal should be to give you exercises that give you stability so the pain doesn’t come back.3. Why you might not be getting better!
The problem is for chronic pain (you have had it for a while, typically more than 30 days). It doesn’t always respond to therapy the same way acute pain does.
The entire goal of acute pain spinal rehabilitation is to decrease inflammation and then strengthen the spine by focusing on the muscles. The problem is that the spine is not just made of muscles. It is also made of bones, ligaments, tendons and discs that also play a big role in the cause of pain that doesn’t go away.
When the pain is chronic it is almost exclusively related to a problem with the disc. Examples of disc problems would be herniated disc, bulging disc, degenerated disc and stenosis. The problem when you have a disc issue is that very often exercises will make it worse.4. What to do when you're not getting better!
This is where the cycle of confusion starts, you thought you were getting spinal rehabilitation and you never got better or maybe you even got worse. We call this “the pain cycle”. The back hurts so you slow down, then pain feels a little better then you do more and it gets worse again. Eventually the pain cycle wins and you stop doing all activities. (Including rehabilitation)
This is now the beginning of the end! When you have pain that doesn’t go away 90% of the time this could result from an issue with the disc. The same exercises that helped the acute back pain will very often make disc related pain worse. What you have to keep in mind is what worked within the first 30 days with the pain starting doesn’t work after that time because you start to develop pain resulting from the disc.
This is important because to eliminate chronic pain that results from the disc, you need to heal the disc. If you don’t heal the disc the exercises make it worse. When the disc is healed you will then be able to do the exercises without pain. So to key to spinal rehab is to make sure you get healing to your disc. There are several solutions to healing the disc. One solution is spinal surgery, not always the best choice. The second solution is a non-invasive drug free and surgery free treatment called Functional disc rehydration. More on both of these coming soon!