Appraising quality of life (QOL) should be evaluated when case-managing the LBP patient. Oral and injectable medications are commonly prescribed by the medical doctor for pain, inflammation, and spasm. When medications become the first-line or ‘gold-standard’ in LBP case-management, contributors such as lifestyle, work/rec activities, patient expectations, and underlying faulty movement patterns are never evaluated or considered. Medications have side-effects including addiction. Medicating does not involve patient education regarding the underlying problem, it only addresses symptoms. Medications can’t correct spinal stability.
Surgical consulting, as a first-line of LBP case-management, attempts to correct a picture of a spine, and not the function of a spine. Protecting the patient’s QOL standards should insist on employing a rigorous conservative-care approach specifically to establish spinal stability. Surgery causes permanent re-configuration of tissues into scars that cause further complications since scar can’t contribute to the physio-chemo sense-signaling required to activate spinal stability. “The spinal column has 2 functions: structural, and as a transducer. Transducer signals generated by mechanoreceptors are corrupted… the muscle response pattern is corrupted…producing high stresses and strains leading to inflammation; inflammatory tissues… have abundant supply of nociceptive sensors and neural structures.” (Panjabi, 2006) Scar has no mechanoreceptors. “Somatosensing, as well as… mechanotransduction [is] the conversion of mechanical forces into biological signals, a… process that reveals environmental features to an organism… dysregulation leads to peripheral neuropathies.” (Chatterjee, 2018) “… sodium current reduction, along with increased fibrosis and impaired intercellular coupling, could lead to a marked decrease in conduction velocity.” (Arnal, et. al. 2012) Due to scarring and excision of spinal structures, surgery may complicate attempts to re-correct spinal stability. Since surgery does not contribute to motor mapping, it can’t correct spinal stability.
Physical therapies are prescribed by medical doctors in an attempt to provide palliative and conservative care. PTs use massage, temperature, ‘plug-in’ modalities (IR, US, IF, etc.), and pre-formatted exercises from charts and handouts. While temporary QOL may be addressed with palliative care by the PT, the therapy can be inconsistent, non-specific, ineffective, inaccessible, and in large part passive.
Passive exercise does not command much of the patient’s experience to establish spinal stability if the patient is laying on the floor doing ‘dead-bug.’ Most, if not all, PT exercises are absent of: spinal acceleration into deceleration, producing-accepting spinal loads, many spinal neutrals mimicking real-life ‘near-injury’ drills that require quick thinking, instant judgement, fast reaction, sequencing and synchronizing of the hips and CORE. PT routines are performed in isolation because the prescription identifies an ‘area’ to be treated, instead of the ‘whole patient approach.” PT is performed until the patient’s pain is resolved or reduced, but spinal stability is not addressed or corrected.
Manipulative therapy (CMT) involves manipulations of the spine at a segment or joint that is identified as subluxated; this is the classic ‘bone out of place’ chiropractic reductionist theory explaining LBP. The LBP patient’s QOL can be reduced if the patient is required to attend many appointments over a long period of time, with only promises of getting better. “It is rare that a patient would require 4 visits per month to manage advanced or complicated low back pain… it is not in the patient’s best interest for the DC to use the least-evidence-informed chiropractic techniques as their first-line approach.” (Globe, et. al., 2015) Manipulative therapy, as in medical care and physical therapy, does not address identifying, evaluating, diagnosing, and correcting spinal stability.
The gold-standard for case-managing the LBP patient would be to employ the ‘Whole Patient Approach’ (WPA Dean, 2016)) since it addresses the underlying mechanisms and contributors of spinal stability, patient values and expectations. The WPA does not ‘fit’ into a box of medical practices or beliefs. This means any physician or clinician can employ it. The WPA combines science with an equitable perspective that re-imagines better patient outcomes. The WPA involves a brief consultation with the patient to explain the value of movement and spinal stability in their course of care that can begin the same day.
The clinician’s failure to identify and treat spinal instability can cause a poor QOL experience for the patient. Patients commonly do not want delays in diagnosis, delays in care, endless referral appointments… and, these days, are increasingly concerned about pain-drug addiction and side effects. The clinician can re-frame their care to offer better patient outcomes by improving patient QOL, instead of focusing on pain, since ‘pain is not the only problem.’
LBP Blog General information
These articles intend to (1) re-evaluate the prevailing clinical practices thought to manage low back ‘pain’, (2) submit and debate novel low back ‘pain’ contributors and mechanisms, (3) meet patient expectations & satisfaction and clinically meaningful results, (4) recommend a conservative non-surgical course of care to over-ride ‘pain’ instantly, and (5) restore ADLs and patient confidence on the first visit at low cost. This article has a companion podcast.
Dr. Dean Bio
Forester Dean is a chiropractic and physiotherapy sports medicine doctor practicing in Los Angeles, California. Dr. Dean is a lifetime athlete, and currently teaches tennis, track, boxing, yoga. The Core X System™ Campus flagship location was opened by Dr. Dean in 2020. www.preformancecxs.org
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