You finally gave in. After months of enduring your lower back pain (LBP) and trying to self-diagnose yourself on the Internet, you decided to visit the doctor. First, the good news, you don’t have a serious condition requiring immediate hospitalization and/or further testing. However, the bad news is that your doctor doesn’t know what the exact cause of your pain is. It may have occurred as a result of poor posture or an accidental injury and may or may not get better. This is hardly comforting feedback, but it turns out, you are not alone.
LBP is one of the most common reasons for a visit to the doctor, and only about 15 percent of cases can be given a specific diagnosis. This leaves the vast majority of individuals with LBP without a pin-point diagnosis, as no exact cause is identified. Herein lies the challenge: If you don’t have a specific diagnosis and know the exact cause of the problem, how do you go about finding the solution?
Thankfully, there are treatment options. These options vary and, depending on the cause and presentation of your symptoms and presentation of your symptoms, can range from conservative methods such as physical therapy and home exercise programs to more invasive methods such as steroid injections and complex surgical procedures. (The previous sentence probably captures the information you found while searching for “back pain treatment” in Google.)
Depending on the nature and severity of LBP, along with the functional limitations that it is causing, any option may be viable. You should know that for many cases of LBP, invasive and conservative treatments yield both similar short-term and long-term results. Typically, as long as red flags such as cancer and infection have been ruled out and risk for additional damage is minimal, your physician will recommend physical therapy as an initial option.
How can physical therapy assist in resolving your pain and symptoms? In the past two decades, significant research has been published identifying specific treatment-based categories for patients with LBP. Why is this important, and how is this useful? Patients whose back pain is difficult to diagnose can be classified into specific treatment categories based on the presence of variables. This is commonly referred to as a treatment based classification (TBC) system. In this system the more variables a patient exhibits within a specific category, the higher the likelihood of success with the particular treatment associated with that category.
Within a TBC system the therapist aims to identify the mechanical causes of the patient’s LBP. Mechanical is a term used to describe symptoms which may be arising from the bones, joints and tissues that make up the spine.
The most obvious indicator of a successful intervention, invasive or non-invasive, is the alleviation of LBP and associated symptoms. This means that you should be able to attain a level of functional mobility that allows you to pick up where you left off before you experienced LBP, while reducing the risk for future episodes. Remember, if the cause of your back pain is mechanical in nature, then the solution must also be mechanical. The TBC system is an approach that allows physical therapists to both classify the patient and identify the appropriate solution.
- Written by Rajat Kumar, Physical therapist at Sinai Hospital. He specializes in offering treatment to patients with lower back pain. If you have low back pain, have questions, and are looking for advice, tips, and solutions, please feel free to contact him here.