AndrewL wrote:
You’ve experienced the traditional medical model for lower back pain and it’s obviously awful. There is no reason you can’t return to full health and functioning without meds in a reasonably short period of time. It should be noted that I’m a PT with an orthopedic and spine specialty focus.
First, consider that back pain is episodic in nature and virtually everyone will experience it at some point in their lives. If you remain active, without aggravating it, back pain is typically self limiting and will resolve.
Second, consider that we don’t know what structure in your back is causing the pain. Half of all people over 45 have disc pathology and everyone over 70 has it. Also, we all begin to show degenerative changes (arthritis)of the spine from 20. All this means is that our spine ages. Changes from aging don’t hurt. An MRI can rule out cancer or other nasty things, but is generally unhelpful in uncomplicated LBP.
Third, you went to a bad PT. It’s good you got out, but you should have found another who could reasonably talk to you about the McKenzie approach. This is a method to evaluate and treat LBP, irrespective of pain causing structure. This is NOT a set of exercises to perform, rather it identifies a mechanical preference for treating the spine- a direction to bend or move regularly that will reduce and abolish your pain.
Fourth, on your own you’ve tried a mishmash of things that have taken you through various positions. You likely haven’t found the right one in the right way for the right amount of time.
Back pain is mechanical in nature and research shows that meds, imaging, injections provide little relief. Individuals who treat according anatomical structures from MRI will generally not help unless they’ve found the needle in the haystack. Note that research does not support this approach. More than half of all fusions end in poor outcomes for the patient. Rolling, dry needling and core strength are not supported in the literature as a way to treat acute onset LBP. Research supports being active and avoiding bed rest is good treatment.
Find a good PT who is skilled and credentialed (certified or diplomat) in the McKenzie approach and get a mechanical evaluation. They will look at how you move and find your directional preference. Do the exercises and stay active. Seek physician advice for prescription management.
Generally a very good post. I want to adress this part that I've bolded.
Some back pain is mechanical in nature. Not all. Some back pain is neuropathic in nature. Some back pain is nociplastic in nature. If you've had mechanical (nociceptive) back pain for quite a while, you can be certain that there is nociplastic changes that will increase the likelyhood of additional pain flares. The more nociplastic the patient is the less success will ANY approach that aims towards the periphery (spinal structures in this case) will be.
I second that one needs a proper examination from a physical therapist that knows this modern pain neuroscience and can act as a guide through the very murky treatments that OP is being continously offered.
Endurance coach | Physiotherapist (primary care) | Bikefitter | Swede