The iconic exchange between Tom Cruise and Jack Nicholson in A Few Good Men highlights my feelings when people ask, “What is causing my lower back pain?” With this question patients are looking for the SOURCE of their lower back pain otherwise known as a STRUCTURAL diagnosis.
* If you aren’t familiar with the clip then take a second before moving on. Even if you’ve seen the movie, it’s too good not to watch again.
“What is causing my lower back pain?”
“You want answers!?”
“I want the truth”
“You can’t handle the truth”
Truth is, most lower back pain is categorized as ‘Non-specific lower back pain’, meaning there is no one particular source or structure to blame. This is a hard to swallow truth for both patients and clinicians. Because there is not one specific structure causing your pain, it requires a more holistic approach. Part of the approach we utilize at OMNE Chiropractic involves a thorough history and movement assessment so we can arrive at a FUNCTIONAL diagnosis. Read more on this topic in a previous blog post -> HERE.
Many patients may see this as a cop out. They may feel their clinician is incompetent because they are unable to tell them what exactly is causing their pain. In my opinion, one of the reasons the healthcare system in the United States spends so much money on lower back pain is because we spend way too much time and money trying to find the source of uncomplicated lower back pain rather than accepting the truth that there likely isn’t one and getting on with it.
In 2016, among the 154 conditions, low back and neck pain had the highest health care spending with an estimated $134.5 billion.
Source: Dieleman JL, Cao J, Chapin A, et al. US Health Care Spending by Payer and Health Condition, 1996-2016. JAMA. 2020;323(9):863–884. doi:10.1001/jama.2020.0734
In our quest for specificity of diagnosis we have become blind to the individual experience. With that being said, I believe that getting away from a structural way of thinking can actually be freeing and liberating. We have all heard the phrase “The Truth Can Set you Free”. The truth is that pain is complex and multi-factorial. There may not be one particular cause but there is a list of factors that may be contributing to non-specific lower back pain. As a clinician, I can still be thorough in my questioning and examination to help the patient uncover the meaningful factors. That truth should fill you great confidence because many of those factors are modifiable.
List of potential factors linked to lower back pain:
- Sensitivity to flexion based movements
- Anxiety of potentially requiring surgery
- Unable to perform meaningful activities
- Stress due to loss of time at work
- Fear of never getting better
- Lack of a positive support system
Thinking of lower back pain in this way allows clinicians to address you as a whole person. It doesn’t think of you as a patient with a bad L5 disc. It addresses you like the person you are who has lower back pain but more importantly is stressed and worried about it because it doesn’t allow you to play with your kids or perform well at your job. The ironic thing is that a diagnosis of ‘Non Specific Lower Back Pain” can result in treatment that is more specific to you as a patient.
If you are stressed about your lower back pain or any musculoskeletal pain, I am here to help you uncover the factors that matter so you can start addressing them. As always, thanks for reading and keep following.