I want to start this blog by acknowledging something that for obvious reasons, I virtually never see even mentioned in any advertisements, websites and various other marketing efforts directed at
treatments/prevention of back pain. I am referring to what is sometimes called the “natural history” of back pain. The natural history refers to the fact that the overwhelming majority of all back pain gets better by itself, without any treatment whatsoever. (The catch is, it oftentimes continues to recur). But let me start at the beginning:
It is astonishing, but in the last half-century, a time when we have seen some almost unbelievably
exciting advances in medical science, we have not advanced with regard to reducing the incidence of what is one of the most expensive problem in all of health care: spinal pain. Along with diabetes and ischemic heart disease, back/spinal pain comes in as the 3rd member of what I call the “Big 3”. These are the three most expensive health related issues in the entire country.
Here’s the not-so-dirty little secret about lower back pain that few chiropractors or physical therapists will openly reveal: well over 90% of all back pain, even the sharpest of pains, will be significantly better or fully abolished in 6 weeks or less if you do nothing. That’s right, if you seek no formal treatment, just “take it easy” for a few days to a few weeks, and …voila! Your back pain will, in all likelihood, be gone or nearly so, in relatively short order. The mere passage of time is enough to oftentimes have a dramatic pain relieving effect.
Here’s the dirty part of the secret that nary a physical therapist, chiropractor or anyone else who makes a significant portion of their living from treating back pain patients (count me as one of them) will divulge: Virtually any treatment, be it any of the various forms of traction, heat, cold, ultrasound,
electrical stimulation, decompression, injections, medications, massage, manipulation, surgery (laser-surgery or any other kind), yoga, weight training, tai-chi, myofascial treatments, trigger point
therapy, core strengthening, stretching, spinal stabilization, pain management or any of the hundreds of pills, potions and lotions that are available over-the-counter---any and all of these treatments will almost assuredly make the patient better or “cure” them.
This puts a back care practitioner like myself in a great position; as long as I don’t do anything too
aggressive with a patient, as long as I don’t do anything to the patient that even temporarily or slightly increases their pain, I am assured of a success rate with my patients that will be well in excess of 90%. That’s a great success rate by anyone’s judgement. In fact, it gets even better for me; although the patient’s pain has, in reality, been relieved simply by the passage of time alone, most patients will give me and my treatments the credit for relieving their suffering. Not only is this gratifying for my ego, but it also enhances my bottom line. Here’s how: I have, by way of my treatments (any treatment) of the patient (treatments which were worthless but harmless), now set up a powerful Pavlovian response in the patient: The next time this patient experiences a bout of back pain, they will instantly remember what they believed to be the course of action which previously relived their pain, i.e. they need to come and see me…and ching, ching. I have now, in effect, created the most sought after commodity for any spinal clinic patient: The repeat customer. After all, it only makes sense; I’m in pain now, so my brain automatically recalls what it believes relieved my pain the last time around. Meld this powerful conditioned response to the current culturally reinforced belief concerning healthcare, namely that any time we are in pain, there should be someone else who will fix it for me. This provides the back-care specialist the perfect combination of conditioning and dependency to assure a continual flow of patients and dollars.
Oh, I know you’ve heard from many physical therapists that they strive, above all else, to educate the patient thus making the patient self-reliant, free from the need for a physical therapist, physician or chiropractor for the treatment of future painful episodes. But in reality, the overwhelming majority of clinics want patients to keep coming back over and over, ad infinitum. The last thing they want is self-reliant patients who have been effectively educated to the point where they are able to treat subsequent episodes of pain independently. What all too many healthcare practitioners really want is a long line of patients who have a strong sense of dependency on them and the “treatments” they provide. They want patients who are highly conditioned to seek them out each and every time their pain recurs.
Yes, there is a better way. I will address this in another post, as well as the ultimate question: If there is another way and it’s so effective, why isn’t everyone doing it?