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Low Back Pain is Common

1 in 2 Americans Suffer

Almost everyone will have low back pain at some point. It is estimated that 60-80% of the general population will experience this ailment during their lifetime. Low back pain is the most common reason to seek a health care provider.  Approximately $87.6 billion a year is spent on back and neck pain and it is the number one cause of pain and disability in the world. 

What is the Cause of Low Back Pain?

Poor Posture & Repetitive Movements

The number one cause of low back pain is poor sitting. The number two cause is repetitive movements, such as bending.  Our bodies are made to move and thrive in an environment that features mobility.  We get into trouble when we stay in one position or have constant or repetitive movement in one direction without going into the opposite direction.  If you take your finger and bend it backwards over and over again, it will begin to hurt.  It hurts because you moved it too far, stressed that one direction too many times or held in that position for too long. Repetitive and sustained positions cause stress to the soft tissue.

Chemical vs. Mechanical Pain

What type of pain you have determines your treatment

Pain is your body’s way of telling you that something has gone wrong. It is a warning signal to change what you are doing before damage progresses.  Not all pain is the same, nor is all pain bad.  Knowing what type of pain, you have is of utmost importance for, without the proper diagnosis, you cannot receive the proper treatment.  Too often we assume that all pain is inflammatory and overuse NSAIDs and steroids, but most musculoskeletal disorders are mechanical and will not respond to these treatments.

When your pain continues, instead of the anti-inflammatories not being strong enough, could it be that your pain is not from inflammation?


Definition of Mechanical & Chemical Pain

Mechanical Pain occurs when stress is placed on a joint or soft tissue, such as when you bend your finger all the way back.  If you go back far enough, you will feel pain.  As soon as you release, the pain immediately abates.  There is no injury or damage to the tissue.  Mechanical pain arises when a mechanical force stresses a tissue.  It is resolved when a different movement or positions remove the mechanical stress. Bending your finger backward produces a mechanical stress that causes pain.  Movement in opposite direction relieves the pain.  Mechanical pain is usually intermittent, but it can be constant as when the stress is constant – holding your finger backward.  When you have pain that comes and goes or changes with different movements and/or positions it is mechanical.

Chemical pain, on the other hand, is caused by the body’s inflammatory response to injury.  It is a complex chemical reaction and occurs to aide tissue damage by releasing chemicals from the blood, fibroblasts and local macrophages to clean up the area and start the healing process.  An example of chemical pain would be hitting your thumb with a hammer or a toothache.  Chemical pain is described as throbbing, constant and does not change with movement.  Pain that comes and goes cannot be chemical.  Back pain that is worse with sitting and bending but a bit better with walking is not chemical or inflammatory pain, because it changes with movement and will not respond to chemical treatments such as anti-inflammatories and muscle relaxers. Inflammation can be uncomfortable, but it is part of the miraculous natural healing process. It usually lasts only a few days to weeks.  Symptoms of a localized injury that continue after a few weeks are the result of re-injury / re-tearing of poorly healed tissue or an unresolved mechanical problems.

Initially, these conditions may have an inflammatory component and may be helped by anti-inflammatories early on, but the main cause of pain will be mechanical, not chemical.


Treatment Differences Between Chemical & Mechanical Pain

Mechanical pain only responds to a mechanical treatment or a CHANGE of position or movement. Mechanical treatment must therefore be targeted to a specific joint or tissue to change the current position or property of that tissue.  An example of a mechanical disorder would be a shoulder dislocation.  A dislocation is very painful and requires heavy narcotics to mask the pain for relief.  But, if you are able to relocate the shoulder, 90% of the pain is instantly resolved because the mechanical stress or dislocation is resolved.

Chemical pain on the other hand is constant and no movement or changer in position will reduce it, such as a toothache or closing the door on your finger.  

Chemical pain is the result of the inflammatory process that the body initiates to start the healing process.  The body releases chemicals to clear and clean the area and then begin the tissue healing process.This process does causes swelling, increased warmth and discomfort.  Medications can assist in decreasing the swelling and pain caused by this chemical process.

Differentiating between pain that is caused by a mechanical or a chemical irritation is critical, because in order to get relief you must first know if you need to remove a mechanical stress or an inflammatory component.  Chemical and Mechanical pain are different and so is their treatments. 

Only a correct diagnosis will produce the proper treatment and outcome.

Examples of Mechanical Disorders

  1. Hernaited disc
  2. Dislocations
  3. Meniscal or labral tears
  4. Scarred and shortened muscle or tendons that have healed but are not fully recovered.

Initially, these conditions may have an inflammatory component and may be helped by anti-inflammatories early on, but the main cause of pain will be mechanical, not chemical.

Should I have an MRI?

Is the MRI Still the Gold Standard or are They Passe?

When you are in pain, you want to know the cause and look to an MRI as the gold standard for determining the underlying problem.  However, a radiographic picture is simply a black and white photo.  Taking a picture of your computer will not tell you if it is working or damaged.  Only through testing the connections and applications can you ascertain if your computer is in good working condition.  Similarly, an MRI will not tell you if the individual has low back pain or nerve involvement.  

By the time you are 40, you will have a 60% chance of having an asymptomatic disc bulge, 33% asymptomatic herniation.  By the time you are 50, you will have an 80% chance of having a disc bulge and arthritis without any symptoms. The only way to find out if someone is in pain is to ask, and the only way to determine if back pain is causing a problem with movement and function is to assess the movement. Over the past 25 years, we have jumped to conclusions based on MRI findings, and have all to often overlooked the real cause of pain. If the majority of disc bulges and herniations are asymptomatic, then MRI findings can NOT be a reason for surgery. MRI findings have invoked fear and caused fear avoidance behaviors and are part of the reason for the significant increase in disability rates among those with low back pain. MRI findings should also come with an explanation of natural age-related changes, similar to normal blood work ranges. A mechanical assessment that determines directional preference is not only more accurate than an MRI but also identifies the correct treatment.

Cost of Low Back Pain Continues to Increase

The Cost of LBP has Increased by 129%

With all of our advancements in medicine the cost and disability rate of low back pain continue to increase.  Our current treatments are not only failing but they are causing delayed healing, increased surgical rates, reliance on medications, and increased disability with loss of function and ability to work.

The rate of lumbar fusion surgeries have dramatically risen by 137% from 1998 -2008 and the cost has grown.  Research has also shown that 70% of those with definite surgical indications or severe initial symptoms recover.  

What is the Average Length of Time for Back Pain to Resolve?

6 Weeks

Most low back pain resolves by itself in less than 6 weeks.  Disc reabsorption naturally occurs and many with nerve compression from herniation or stenosis improve within a month. Natural history studies have also demonstrated that the largest herniations have the most significant degree of resorption, whereas contained herniations demonstrate the least.

Best Treatment Options for Low Back Pain.

Low Back Treatments that Work

Research backed treatments that have been shown to have a positive influence on back pain:

1. Education to empower, reducing fear and avoidance behavior. Empowerment enables and puts the person in charge rather than a passive patient role.  When you are empowered, you have power and are in control.  It reduces fear and fear-avoidance behavior.  Fear is disabling.  Catastrophic thinking or focusing on the worse case scenarios can lead to disability.

2. Mechanical Evaluation to assess for Directional Preference. Directional preference has been associated with excellent outcomes and has also shown to reduce fear and anxiety. ACOEM reviewed all the current research and found directional preference to be the only treatment with a positive outcome.  Idiopathic back pain means that we have not figured out the cause, but the cause does exist.   Finding the true diagnosis or cause of symptoms is the foundation for treatment.  Without a solid foundation, there is nothing to base treatment upon.  Other therapies that are currently widespread lack evidence for effectiveness.

3. Maintain activity and keep working   Keeping the individual suffering from low back pain moving has a better outcome than any manipulation, mobilization, release or surgery! There are times when activity does need to be modified, but modification should only be for a short period.  The goal must always be to return to full function/work duty as achievable.  Aerobic activity has also been associated with positive outcomes.

Treatments to Avoid for Low Back Pain

Avoid Passive Care

Research has found that passive treatments are directly linked to poor outcomes.  Passive treatments include: bed rest, manipulations, massage, pills, surgery, etc.  When you receive passive care, you are no longer in the driver’s seat of your own care.  Fear and avoidance behavior lead to delays in recovery and if the fear avoidance becomes aa cycle, you develop a disability.

Don't Underestimate the Power of EMPOWERMENT


Don’t underestimate the vital role that EMPOWERMENT plays, not only in rehabilitation but also in our lives. Patient empowerment is directly linked to the best outcomes.

A herniated disc with sciatica to the foot has traditionally resulted in weeks of disability and high medical costs. When a patient is provided education on the cause and effect of symptoms, they are then in control. This empowerment reduces fear and anxiety and speeds up recovery because the patient understands the cause of their pain and how to reduce it.

“A herniated disc is simply a cut in the disc similar to a cut on your elbow. When you bend your elbow the cut will open causing bleeding to go further down your arm. Similarly, when you bend in the direction that opens the cut in the disc (usually sitting) there will be more pressure on the nerve causing symptoms to go further down your leg. Changing the position that causes increased pressure on the nerve, such as moving from slouched sitting to walking causing the symptoms to move up from your foot, closer to your back known as centralization.”

The first stage of healing is to apply overpressure or avoid bending your elbow/back for a few days, until scar tissue forms. The next stage is to test the integrity of the scar tissue. If you begin to bend your elbow and it starts to bleed again, then the scar tissue is not yet strong enough. Similarly, if you try to bend your back and your symptoms return then you need to allow more time for healing. It is also vital to stretch the scar tissue as soon as it is stable by regaining full bending flexibility.

A mechanical assessment that determines ‘directional preference’ along with patient education leads to remarkable outcomes as compared to traditional care.

Traditional care starts with a visit to the primary doctor. Medication (anti-inflammatory and a muscle relaxer) are usually given along with a prescription for an x-ray. If your symptoms do not improve after 2 weeks you may be advised to consult an orthopedic specialist and receive an MRI. The orthopedist will then provide you with a prescription for traditional physical therapy 2-3 times a week for 6 weeks. This process takes on average 12 weeks, costing $4,880.00. (This does not include indirect costs of travel, lost work time, etc).

You do not have to go through this long process and instead you can go directly to a musculoskeletal specialist. Virtual Physical Therapists is an app that allows instant access to only the highest trained clinicians in the mechanical assessment, via a live 2-way video.

Our outcomes:

2 visits totaling $178.00 and 3 weeks before retiring to full pain-free function.

Our difference:

1. Our clinicians are all Certified in MDT, they are highly specialized in assessing and treating musculoskeletal injuries.

2. Our focus is on patient empowerment so you understand the cause of your pain and can control your symptoms. Not passive care, where you rely on someone or something else to fix you. Healing is an active process, best achieved when you are in the driver’s seat!