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Please Reply to: Bruce Weary,D.C. bweary@xxxxxxxxxxxx or ridecamp@xxxxxxxxxxxxx
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Hello again, Dede--
It seems that you are really getting your money's worth in response to your 
questions about back pain. I was delighted to read Alan Kay's comments about 
back pain, and, while I agree on most of the issues he addresses, there are a 
few that beg clarification. First let me say that as a veterinarian and an 
internist, Alan's understanding of back pain, no doubt influenced by his own 
personal experience, is impressive for a non-spinal health practitioner. He is 
right when he says that many doctors will use oversimplified explanations of 
back pain. He is also right that the causes of back pain are multiple, in that 
there are multiple "pain generators" that can be involved. Nerve endings from 
the disc, ligaments, joint capsule, muscles and other tissues constantly 
monitor the physical activity, rate of activity and trauma the spine may be 
experiencing.The pain pathways in the spinal cord  then "funnel"the information 
from one or more sources to the brain for interpretation. Alan is again correct 
that many chiropractors still refer to a very outdated model of the spine that 
refers to "alignment" of vertebral segments as being the treatable cause of 
back problems. The advent of MRI and other technnology and anatomy advances 
have shown us that curved spines (or even degenerated spines like Alan's) can 
be pain free, and straight spines can be in agony. Very few patients have 
"pinched nerves" and only a scant few undergo surgery each year, compared to 
the number who suffer with back pain.  Alan has done well to avoid surgery with 
his history.
  While all of the above is true, I would take exception with a couple of 
points Alan made regarding back pain. First, while back pain can be 
multi-causal, diagnosing and treating back pain is not a complex mystery most 
of the time. There are a few typical patterns of mechanical back pain, and they 
differ from pain generated from a disc lesion. Pain in the back of the leg is 
quite common, but is not usually an inflammation of the sciatic nerve. Any 
astute practitioner will recognize the differences and order further diagnostic 
testing (MRI, etc.,) when the answers aren't clear from the examination. 
Fortunately, in diagnosis, when we hear hoofbeats, we think horses, not zebras. 
Most back pain is indeed mechanical, with varying levels of muscular, joint, 
and neurologic involvement adding to the picture. In this sense, Alan is right, 
there is no "sole" cause of back pain. Those that treat back pain differ in 
which of these factors they address, and to what extent.
Whoever understands the most about all the parameters, and can treat them with 
a multi-faceted approach will enjoy the most success, regardless of the letters 
behind their name.
  I disagree that physical therapy would be the best path to follow as your 
"mainstay" for treating back pain. The term physical therapy is a general one 
and encompasses everything from ice packs to complex strengthening programs, so 
I'm not sure what exactly Alan is referring to here. Perhaps he can comment.
 I had never thought of the 2-visit trial for a chiropractor, but I think it's 
an excellent idea--for all doctors you hire, for that matter. Many D.C.'s are 
prone to overtreatment, so Alan's suggestion to find one that is highly 
recommended will serve you well.




I agree that core strength is important for everyone and, until recently it 
has been the primary focus of many back strengthening programs. As our 
knowledge rarely remains static, more recently the discovery has been made that 
in many people, (especially Americans, as we sit so much)there is a significant 
loss of function of what are called the segemental muscles. These are very 
tiny, but very important muscles that stabilize the spine before you engage in 
core movement. When these become weak, they contribute to "instability" of the 
spine. If you have ever made an innocent movement, like pulling on your socks, 
reaching for a magazine or rolling over in bed and felt pain, you have 
experienced instability. Most acute back pain results from these types of 
circumstances. Most people presenting in my office have not lifted 300lbs or 
chopped a cord of wood to cause their back pain. They usually get in trouble 
from performing their normal daily duties. After proper treatment,these muscles 
are retrained with new exercises performed while you are on an unstable 
surface, such as an exercise ball. It has been shown that if these are 
performed 5x a week with a well back, the recurrence rates of back pain goes 
WAY down.
 So, follow Alan's advice-- stay active, work with someone who comes well 
recommended and has a plan for your recovery, and, I would add, don't delay 
treatment when a problem or injury arises.
   I will leave you with my favorite chiropractor joke:
    Q: How many chiropractors does it take to screw in a light bulb?
    A: Just one. But it takes 20 visits!
   All the Best, Bruce Weary, D.C.


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