Blog Post ✍️ : Why Low Back Pain Makes You Feel Lost | A Comprehensive Guide
- christophernetley
- Feb 14
- 6 min read
Who is this blog for?
This blog is for people who struggle with low back pain and need help. It’s for people who want more information and better options. I'm speaking to the lost and frustrated people who haven’t achieved their desired results.
Why is low back pain such a problem?
Low back pain is one of the most significant causes of disability globally. About 80% of the population will eventually deal with low back pain.
This issue is complex. Many feel like they don't have control, and some live in fear. They're afraid of the pain, and they're afraid of specific activities that may increase the pain.
Many people get sold products and services they don't need because feeling fragile and scared influences their decision-making. It's easy to be led down the wrong path when you’re confused and looking for help.
Low back pain is a big problem, and sadly, we're not very good at dealing with it. Even as chiropractors, we struggle. Chiropractic adjustments don’t necessarily outperform other therapies like acupuncture, massage, or exercise. And none of these options appear to be exponentially better than placebos or waiting for the pain to fade naturally (a.k.a. natural history).
Low back pain is common, and it's easy for healthcare providers to become apathetic; “I’ve heard it all before because I see low back pain patients all the time.” There is a tendency to lump people into a single category; “It's low back pain again.” This tendency is strong, making it more challenging to manage lower back pain. Categorizing patients based on their complaints makes it difficult for healthcare providers to see people as individuals. This tendency results in shorter doctor-patient interactions and cookie-cutter healthcare plans.
Sadly, many healthcare providers who have been in practice for a long time and treat large volumes of patients tend to settle into a rhythm. They appear confident, but confidence is not competency. They ask fewer and fewer questions, which can lead to assumptions and recommendations based on preconceived notions. If the standardized treatment doesn’t work, it’s easy to recommend more treatment or discard the patient and move on to the next person in a busy schedule. This type of environment makes people feel lost and increases feelings of frustration.
Why isn’t your lower back pain treatment more effective?
There could be several reasons why treatment isn’t producing the desired results.
The diagnosis could be wrong; therefore, the treatment plan may send you in the wrong direction.
The diagnosis could be correct, but the treatment is inappropriate for that diagnosis.
The diagnosis could be correct, and the treatment could begin appropriately, but it may never progress enough to achieve your desired results.
The main diagnosis could be correct, but multiple other diagnoses could be missed.
The main diagnosis could be correct, but there may be numerous other factors contributing to the pain that are not addressed. For example, someone may be recovering from a disc injury but not eating enough protein, not sleeping well, and suffering from severe stress. These factors could slow the healing process and exacerbate pain.
The diagnosis could be correct, and the management plan could be appropriate and comprehensive; however, you may not understand the plan. If you don’t understand, you may be less motivated to adhere to the plan consistently enough to achieve your goals. Additionally, if you don’t understand the plan, you may worry excessively and exacerbate your pain based on your expectations. This is called the nocebo effect. Most people understand the placebo effect; positive expectations can produce positive results without “real” therapy. The nocebo effect is the opposite; negative expectations produce negative results. Simple misunderstandings can drastically impact the effectiveness of a care plan.
There may be no distinct diagnosis; therefore, searching for a “root cause” is fruitless. Maybe there was a “root cause” at one point, but that diagnosis resolved with time, and the pain has transitioned into a chronic condition for other reasons.
Your expectations may not be realistic. Sometimes, abolishing pain entirely is not realistic. Completely eliminating low back pain may be an impossible goal. And even if you can return to a state of 0/10 pain temporarily, your pain will likely flare up periodically throughout your life. In these instances, goal setting becomes essential. Understanding and accepting that pain may be a consistent part of life allows people to ask different and productive questions.
What can I do to reduce the pain when it flares up?
How can I manage the pain without always needing clinical care?
What can I do between painful episodes to improve my pain management abilities?
How can I keep doing my fun and important activities when I’m dealing with pain?
What are the chiropractic guidelines for managing low back pain?
The American Chiropractic Association (ACA) adopts but is not limited to two primary documents for guidance on the appropriate management of low back pain.
Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians.
The clinical practice guideline from the Clinical Compass (formerly the Council on Chiropractic Guidelines and Practice Parameters). This document provides specific guidance in managing or co-management a patient within a chiropractic office.
These recommendations were ratified by the ACA House of Delegates in 2017.
Additionally, I recommend considering the guidance from a systemic review published in 2020: What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines.
What should you expect before chiropractic care begins?
A chiropractor should ask thorough questions about your main complaint(s).
In addition to a detailed discussion about why you seek care, a chiropractor should learn about your comprehensive health history.
Because mental and social factors influence pain, a chiropractor should be curious about factors that may delay recovery or amplify pain (e.g., mood or sleep disorders, work-related factors, stress levels, nutrition, and physical activity).
“Yellow” flags predicted poorer outcomes. It is recommended that chiropractors consider your other medical conditions, your beliefs about pain and treatment options, and your fears and concerns.
You should receive a physical examination.
A chiropractor should not use X-rays to identify the pain source in the absence of red flags. If a chiropractor X-rays every patient, they are not necessarily practicing within the clinical guidelines approved by the American Chiropractic Association. Imagining should only be considered under the following circumstances:
No improvement after a reasonable course (4-6 weeks);
Red flags on history or physical exam;
Severe and/or progressive neurologic deficits;
Severe spinal trauma;
Suspected severe anatomical deformity.
Understanding is essential to shared decision-making. Without understanding, you may be unable to provide informed consent.
A chiropractor must explain procedures (examination, diagnosis, treatment/no treatment options).
You should receive an explanation of the potential benefits and risks of treatment and forgoing treatment.
There must be an open dialog, allowing time for questions and answers.
A chiropractor should use terminology that you understand.
What should you expect from chiropractic care?
A chiropractor should design a management plan based on the information gathered in the discussion and examination.
You should receive education and encouragement to self-manage. Self-efficacy is important to develop.
A chiropractor should use active interventions as early as possible: exercise, rehab, nutrition, meditation, yoga, or other lifestyle modifications.
Passive interventions may be useful in the initial stages of patient care for pain management. Manual therapy should only be applied as an adjunct to other evidence-based treatments. Passive Interventions include medications (co-management required), chiropractic adjustments, massage, and modalities (e.g., laser, e-stim, and shockwave).
Clinician philosophy/attitudes or financial considerations should not play a role in clinical care recommendations.
A chiropractor should provide a short trial of care for people with acute pain (acute pain = pain for less than 6 weeks).
Most people suffering from low back pain will improve over time, regardless of treatment.
There is low-quality evidence supporting the efficacy of chiropractic adjustments for low back pain; however, the American College of Physicians lists spinal manipulation as an acceptable therapy option.
What next?
If you’re struggling with low back pain and unsatisfied with the results of your treatment, please use this blog and the references to evaluate the quality of your chiropractic care.
It is important to note that even though there is low-quality evidence to support the use of chiropractic adjustments over other forms of therapy, spinal manipulation for low back pain is associated with a reduced likelihood of the use of opioids and adverse drug events. Spinal manipulation for low back pain is also associated with a reduced likelihood of surgery.
However, you deserve better healthcare than treatment plans primarily consisting of spinal manipulation. Chiropractors who use chiropractic adjustments as the primary treatment tool are not necessarily practicing within the guidelines approved by the American Chiropractic Association (ACA). Chiropractors who routinely X-ray patients to look for sources of pain are not necessarily practicing within the guidelines approved by the ACA or the American College of Physicians. These statements are not based on my opinion. My references are listed below if you would like more information.
References:
Where to find Chris Netley:
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