Low back pain is a constant topic in American life. Eighty percent of us experience it at one time or another and it is the second most common reason for doctor visits. Over the last two decades, physiatrists at New England Baptist Hospital’s Spine Center have pioneered a science-based approach to low back pain that is resulting in dramatic reductions in pain and disability for sufferers.
For the last thirty years, the “cumulative injury model” of low back pain has been widely accepted. This model proposes that we wear out the discs and joints of our backs through strenuous daily activities. However, studies have not validated this model. Exposures to stress and strains during work and daily activities actually contribute very little to degeneration of the spine or development of chronic low back pain.
Scientific study of pain has produced evidence that most chronic low back pain actually represents a malfunction of the nervous system. The neurons that monitor the spine become overly sensitized and produce pain signals from everyday activities, such as bending over. Back pain is relieved when the pain neurons that monitor the spine adjust and accept (and therefore ignore) the degeneration that is present. Failure of adaptation of pain neurons results in persistence of pain.
New England Baptist physiatrists, medical doctors who specialize in physical medicine and rehabilitation, focus their research not on back injury, but on how to incorporate science into the treatment of chronic low back pain. Among their findings are:
Treatment at the Spine Center begins with a thorough assessment including history, physical examination, and imaging, as well as an evaluation of the patient’s functional status and goals for therapy. If appropriate, the physiatrists recommend an exercise program—fondly referred to by former patients as “boot camp”—customized to each patient’s age, gender, size, and personal goals. The exercises include cardiovascular work, stretching and strengthening, and are carefully and successively increased as progress in physical performance and pain reduction occur.
After boot camp, patients are stronger and have improved flexibility and strength, less back pain, increased function, and more confidence.