Why Does My Back Still Hurt?
I get this question a lot from patients and practitioners. The majority of people that are asking say that they have already received a variety of care, but expectations were not being met. Back pain is the #1 neuro-musculoskeletal problem in the world for many reasons. And in way too many people, back pain can become chronic with recurring episodes.
In this newsletter series, I am going to describe numerous considerations regarding evaluation and treatment options. I am going to start with the basics. "Basics," may seem rudimentary for clinicians. But there are also patients reading this newsletter. It is important for those suffering to know what to expect when looking for help and the value of an integrative practitioner provides over any one-dimensional clinicians. During the exam and first treatment, I may do more than what will be discussed in these numerous newsletters. Other comprehensive variables are continually expanded in Performancepractic TV and Fitness Integration Technique (F.I.T.)® for the clinicians who always strive to learn more and desire to transfer their head knowledge to hands-on application. My goal is to keep each newsletter short and to the point, but not to sacrifice the quality of care or how you may integrate any information into your current methods.
The discussions I am going to provide are not personal injury or Medicare documentation specific. It is just important information to help any person (acute, chronic, healthy, or non-responsive to previous care at any age), who genuinely want to get better, with or without insurance. The case scenarios described are all applicable to chronic back pain and some modification may be necessary in those with acute episodes. Chronic pain is defined as any pain lasting more than 12 weeks.
The complete patient history and personal intake cannot be understated for importance. Think of this as a crystal ball. If you ask the right question, you will get the correct answer. And you have the answer sheet right in front of you…..the patient!
When beginning to work with a patient, who has been to numerous clinicians of different licensure as well as previous chiropractors, I do not want to perform what has already proven not to work. Be aware they had already filled out numerous intake forms of similar questions such as, when did your pain start, what makes it worse or better? Age, weight, any previous accidents, and knowing what medications (supplements) they are taking are all contributing factors to their outcome. The patient history can start "here we go again" in the patient's mind unless the clinician knows how to use the information and get more out of it.
Clinical Pearls When Taking a History:
Ask the patient "Is your back pain better or worse with movement?"
If pain is worse with movement, better with rest, it is highly likely there is an actual tissue injury such as significantly sprained ligaments and herniated discs, torn muscles, or any combination. Current daily activities and overall health of the organism has not allowed healing to occur if the pain is significant and not improving after 12 weeks or more. Especially if pain increases during movement. In many cases integrated physical, nutritional (chemical), and emotional factors are being missed in previous treatment regimens before you have seen this patient.
Using Low-Level Laser Therapy for pain (acute or chronic) is a significant integrated advantage. For low back pain 10 – 20 minutes of cellular enhancing mitochondrial laser love, symptom-specific, has been proven in Level 1A research study and granted an FDA Clearance using the FX635!!!! You may combine ice and laser at the same time.
If pain is worse with ALL movement this is one of the many advantages of FDA Cleared Low Level Laser Therapy. Place the patient in the most comfortable position possible. Refer to the FDA study protocols and press the start button. Modify if needed for what is best for the patient and your office procedures. Remember healing takes time but sometimes you may need to change protocols. The standard settings of 9, 16, 42, 53 (for the hand held lasers) are always appropriate for any acute or chronic condition. The current FX635/FX405 has a preprogrammed button specifically for the Low Back FDA Clearance and the FX635/FX405 Manual has 6 pulse settings per condition and provides the clinician with many additional options. That may be using different pulse settings on your laser: disc, neurogenic inflammation, chronic pain are all good options and clearly displayed in the A-Z Manual specific to your Erchonia Laser.
If pain is better with movement (and maybe even hurts worse while resting), that tells me there is NOT a severe connective tissue pathology. I can start by being a little more aggressive with all my treatment decisions (within reason, of course). This includes clinical exercise specific to the priority distortions(s) affecting the symptomatic area combined with chiropractic adjustments immediately.
No matter how you practice, unattended Low Level Laser therapy stations are a great asset to increase efficiency and clinical outcome. You just need to be prepared by having additional tables / stations so you keep adjusting patients and then delegate the best pre / post adjustment therapeutic laser session.
Low level laser (no heat) is very safe and can be left unattended in a separate room or the concept of unattended laser sessions works equally well in open room adjusting concepts and keeps the flow of the clinic while providing an increase in services. You can only adjust one person at a time but your patient history and clinical exam will identify areas that can benefit from 5 - 20 minute therapeutic dose Low Level Laser Therapy. So it is very easy to treat 3 or more patients at the same time when your office is set up with stations to compliment the adjustment you give. When you create treatment stations it opens up an entire different level of efficiency for services charged.
Click here to find out about some of my favorite tables to use for unattended therapy and why.