Low Back Pain – Finding The True Cause

When a patient has low back pain, what
they have to realize, what they should realize, is that–number one,
there’s never one pain generator, hardly ever. It’s always multiple pain
generators. Remember, folks, you’ve got big joints there that are
covered and housed in ligaments, and there’s these ligamentous and fascial
and connective tissue attachments all through this back portion of the
spine. Then you have this canal way where you have the spinal nerves traveling
through. And then you have these little passageways where the individual nerve roots travel through. You can have a compression of the nerve through discs
bulging from the front and arthritic changes coming from the back and
narrowing passageways through the nerves. The ligaments and joints of the spine, or
facet joints, are a common source of back pain. So now you can have multi-level,
multi-segmental problems. Flip that spine over and look at it from the front, and
you’ve got discs and you’ve got vertebral bodies. The disc itself is, the
rings and fibers of the disc itself, is one of the most sensitive structures in
the spine. And when you tear and damage that disc, the disc itself can become
painful. So now you have a patient who comes in with chronic back pain with or without buttock leg and leg pain. Patients
come in with an MRI, “Well, I have a disc bulge. I have degenerative…” What does that
got to do with your pain? That MRI is not a “pain-o-gram.” That MRI just shows you
the state of your structural tissues and the state of pathology, but it
doesn’t show you that one particular area is a painful structure. This is a
problem because you can go into the surgeon and they’ll say, “Oh, my back is
hurting me, my leg is hurting me.” They look up and they say, “Well, there’s a
bulging disc. Let’s intervene.” And then they intervene only
to find out a year later, when their symptoms persist and the leg pain
persists, that it was actually a tear in the disc below the disc bulge. Because
nobody explored all of the potential pain generators and did a comprehensive
job of picking apart, piece by piece by piece, all those tissue-specific,
localized areas that could be causing pain. So patients are getting kind of a
raw deal out there. Because they’re going from this practitioner to this
practitioner. I was a chiropractor before I went to medical school. I understand
the manual medicine world. I studied osteopathic manual medicine
after that, and I’ve spent years with physical therapists, have been influenced
by everyone, and one of the things that I learned is:
number one, everyone does it differently, so every single person you go see has a
different theory about what, you know, what causes back pain and what’s important.
And those experiences have helped me today make decisions about special
interventions because I can see why things didn’t work and be able to sort
through that diagnostic. I think, in summary, what a patient can expect to
receive when they come here is, hopefully, one of the most comprehensive
consultations, in depth consultations, that they’ve had, that has
explored their diagnosis down to a target-tissue, specific diagnosis–where
we know exactly what’s going on. We have image confirmation of this
diagnosis; we have put this all together, and we have now come to a point
where, let’s look at what our options are. Most patients, especially our baby boomer
population, they’re looking for non- operative methods. They’re looking for
non-surgical options. And the more advanced this world of interventional
regenerative orthopedic medicine grows, and as it is expanding and growing so
rapidly, my toolbox is getting so big that we can start selecting and
combining various methods to then try to augment and change integrity of joint,
structural instability improvement, improve pain, improved function, healing
soft tissues, healing ligamentous injuries, and augmenting the healing of
tendons, which has been a very difficult thing to do. So, all of a sudden I think
now a patient can have a place to come where their orthopedic musculoskeletal
aches and pains… They can find answers.

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