The Truth About Low Back Pain: Strength, mobility, and pain relief without drugs, injections, or surgery

By Gage Permar, Jonny Antoni and Brock Elkins

If you suffer from low back pain it's likely you've tried a number of different treatments. Some of these may have helped a little and some may not have helped at all. The reason you still have pain is because everything you've tried treats the SYMPTOM (pain). You have to treat the cause to be pain-free. This book shows you how to:

-Identify the

• Language: English
• Publisher: Gage Permar
• Release date: Mar 22, 2015
• ISBN: 9781495166075

Book preview

The Current Treatment Model is BROKEN

Primum non nocere: Above all, do no harm.

In the United States if you have low back pain you generally seek the services of a physician.  The majority of the time this will be a general practitioner.  The physician will examine you to make certain there is no pressing medical issue that could be causing your low back pain. Serious medical issues including malignancy, infection, ankylosing spondylitis, and epidural abscess when combined account for fewer than 1% of cases of back pain.  Spinal fractures and serious medical issues together account for less than 2% of low back pain cases. Pain caused by nerve root compression accounts for less than 10% of cases.   This leaves approximately 90% of low back conditions that are benign and musculoskeletal in nature (1).

Once it's determined that your back pain is the run of the mill musculoskeletal type pain, the course of treatment is almost always the same.  You're told to take it easy and prescribed pain medication, anti-inflammatories, and/or muscle relaxers.  If your symptoms do not subside, you'll likely head back to your physician.  The next step, if it was not done initially, is to take an x-ray and prescribe a refill of your pain medication, anti-inflammatories, and/or muscle relaxers.  If you are continuing to have problems with low back pain after being on anti-inflammatories and pain meds for a couple months, the next step is often an MRI.  If you're over the age of 40, an x-ray and an MRI are going to show degenerative changes.  These findings are deemed pathological and are blamed for the pain.  After the x-rays and MRIs, you may be referred to a physical therapist.  If you're not referred to a physical therapist you'll likely be referred to a surgeon who does back surgeries.  At this point your low back pain has usually been present for months.  This basic process is the medicalization of low back pain.  The traditional medical model works well for general and internal medicine.  It doesn't work well for non-traumatic musculoskeletal pain.

The reason the traditional medical model fails to cure low back pain is because low back pain is not the same as traditional medical problems.  It's much different compared to type I diabetes or hypertension.  These are medical problems that are well understood and are known to respond to specific medication and intervention.  If you have type I diabetes you have to take insulin because your pancreas does not produce it.  Without insulin your blood sugar levels are uncontrolled and will be too high after eating.  With hypertension you need to take a medication that will lower your blood pressure.  This is all very straightforward, and these conditions respond wonderfully when treated with the appropriate prescription drugs.

Low back pain does not respond so wonderfully when treated with prescription drugs.  The drugs used to treat type I diabetes and hypertension address the underlying problems these conditions present.  On the other hand, when drugs are used to treat low back pain, the symptoms are masked instead of stopping the actual cause of the pain.  Pain medications and anti-inflammatories are great for acute and subacute pain, but they don't fix the underlying problem.  They only affect the symptoms.  They don't affect what causes the symptoms.

Imagine a flood. You can attempt to divert the water by using sandbags and other tactics, but it's still flooding.  You just try to minimize the damage.  You're not going to be out of the woods until the source of water stops the deluge.  Throwing pain medication, anti-inflammatories, and muscle relaxers at low back pain is the same as trying to minimize water damage during a flood with sandbags.  The sandbags may help initially, but there is damage because of the excessive water and depending on how severe the flooding is, there may be extensive damage.  Pain medications, anti-inflammatories, and muscle relaxers reduce the pain initially but don't make it completely go away.  They basically decrease the feeling of pain to the point that it's tolerable while your body goes about doing what it's built to do, heal.  Even with these meds on board you're not going to find true relief until your body heals or whatever was causing low back pain in the first place stops.

When it stops flooding, what do you do?  You attempt to improve the infrastructure of your town, city, or neighborhood so when that next flood comes, you're ready and the damage won't be as great.  You don't leave the sandbags out there and add to them.  That wouldn't really do much for another serious flood.  It may be a temporary solution, but it's not a long-term answer to the basic problem.  Taking pain medications, anti-inflammatories, and muscle relaxers over long periods of time to treat low back pain is the same as using sandbags to control flood waters instead of changing the infrastructure of the area and diverting water permanently so damage from a flood is less likely.

To successfully treat low back pain, movement impairments and muscle performance impairments must be corrected.  This is the foundation and infrastructure of your body, much as the levee is to prevent flooding.  Faulty movement patterns and muscle performance impairments eventually lead to low back pain.  To be free of low back pain, these impairments must be dealt with.  If they're not, you can treat the symptoms forever and never experience permanent pain relief.  Those of you who have been through the process know this all too well.  You don't need a tissue specific diagnosis (pinched nerve, pulled muscle, facet joint arthritis, sciatica, herniated disc, etc.); you need a functional diagnosis.

A functional diagnosis basically determines what movement patterns and sustained positions make symptoms worse and what movement patterns and sustained positions make symptoms better.  Once you know this, you'll know what motion patterns need to be focused on to rehabilitate the spine and what muscles and muscle groups require improved strength, endurance, and neuromuscular control.

Drugs reduce the sensation of pain or reduce inflammation or decrease muscle tension depending on what you're taking.  Momentarily this will reduce symptoms, but it's not a long-term solution.  Drugs make symptoms tolerable so your body can heal and should be reserved primarily for acute low back pain.  Injections decrease inflammation at the injection site.   A strong anti-inflammatory is the primary drug in spinal injections, and this may or may not help.  Even if it does help, it will only be temporary. Whatever is causing the inflammation (faulty movement patterns and muscle performance impairments) still exists, so after the strong anti-inflammatory wears off, the pain and inflammation are coming back.  Surgery will either remove part of the disc thought to be at fault or fuse the spine together so the region thought to be pathologic just won't move.

The problem is that after surgery, you're still going to have the same faulty movement patterns and the same muscle performance impairments.  The pain is coming back.  That is why the current treatment model is so ineffective.  Because low back pain is a result of a dysfunction of the movement system (muscles, bones, and joints), the movement system must be treated.  Simply treating the tissue that's painful BECAUSE of the dysfunctional movement system will not solve anything.  Low back pain is due to lifestyle choices, similar to type II diabetes or high blood pressure.  Your lifestyle (how much you move, how you move) has to be changed in order to successfully treat the condition just like changing your diet and exercise level is the best way to treat type II diabetes and hypertension.

To further explore the ineffectiveness of medicalizing low back pain treatment, we will look at how well prescription painkillers (oxycodone, oxycontin, etc.), NSAIDS (ibuprofen, etc.), injections, and surgery address the issue of low back pain.  This is eye opening; these treatments account for the lion's share of the $100 billion per year expenditure on low back pain in the United States.  And they make pain worse! Or at the very least do nothing.  Seriously, check out the evidence yourself.  References are at the end of the chapter.

Prescription painkillers account for more overdose deaths in the United States than all illegal drugs combined.   Approximately 16,500 people die every year due to opioid overdose.  There are a half million ER visits yearly as a result of opioid overdose.  The prescription painkiller business is worth nine billion dollars per year (5).  Until the early 1990s opioid pain medication, which is now a go-to treatment for low back pain, was reserved for cancer patients who were in debilitating pain because physicians were rightfully wary of the addictiveness of these drugs.  How and why it changed is beyond the scope of this book.  It's only essential that you, the healthcare consumer, understand the facts and implications relating to treating pain long-term using prescription opioids.

Prescription pain medication does have its place in treating pain. It is often required post-surgically and following acute injury and is truly effective.  The problem arises when it's used as a long-term solution.  Some people can take opioid pain medications for long periods without becoming dependent on them or addicted to them.  Others become seriously addicted to the painkillers.  There is no way to tell who will and who won't become addicted to opioids.  With the high incidence of addiction and the consequences that come with addiction, people with low back pain need to ask themselves if taking narcotic pain killers over a long period is the best option for them.  Is that a chance you want to take?  For some it may be, but for most I consider it a horrible