The Low Back Pain Epidemic

Of all the injuries a strength athlete can sustain, low back pain is often the most frustrating and debilitating. Not only does an injury to your back instantaneously drain you of your power and strength, it can also have an intense psychological effect that leaves you feeling like a shell of yourself.

If you’ve ever had a back injury, ask yourself if this story sounds familiar.

Ryan is a 24-year-old CrossFitter. During a recent competition he felt a small ‘pop’ in his low back while finishing up his round of 30 clean & jerks at 135 lbs. He struggled through the rest of the competition and has since been dealing with constant pain that only worsens when he tries to lift the barbell. After two months of dealing with this aggravating pain and frustrated that his training had started to stagnate and decline, he finally decided to go see someone about it.

After meeting with his doctor he was told he needed an MRI scan of his spine to see what was going on. So, after shelling out hundreds of dollars on expensive scans he made another appointment with his doctor and patiently waited. He thought to himself, “The doctor will know exactly how to fix my pain. Right?”

MRI

Unfortunately, that isn’t usually the case.

After anxiously waiting another 1-2 weeks for his next appointment, the day finally came. During the short 6-minute face-to-face time, the doctor looked at the previously taken scans of Ryan’s spine and proceeded to give him a diagnosis of a “bulging disc” and “degenerative disc disease” as the exact cause of his pain. He was given a prescription for some heavy pain medication and told to stop weight training, take it easy for the next few weeks, and follow up with a physical therapist.

A week later he ended up at a run-of-the-mill outpatient clinic working with a PT who looked like he’s never touched a barbell in his life. Ryan spent half of his “rehab” time lying on a bed stretching his hamstrings and low back next to an 80-year-old man rehabbing from a total knee replacement. The other half was spent performing “hollowing” core exercises to strengthen his transverse abdominus muscle followed by some electrical stimulation and an ice pack or heat pad before he leaves.

After 6 weeks of therapy his pain started to decrease, so Ryan does what every athlete at this time would do. He went back to the weight room! However, after only a week back into the gym his pain started to return. He heartbreakingly went back to see his doctor again who gave him the fateful prognosis that surgery or injection is likely the best option at this time.

doctor surgery.jpg

Sound familiar?

If so, you are not alone. Year after year, millions around the world are dealing with low back pain. Research has shown that up to 80% of adults will experienced low back pain at some point in their life.4 An even more troubling statistic is that many of these people will likely experience recurring episodes.7

Lifting weights (especially the squat, deadlift or the Olympic lifts) places a tremendous amount of force on the low back.6 It should not be surprising that that low back pain continues to be one of the most prevalent injuries sustained by strength athletes (as Ryan found out the hard way).1-5

Klokov

Unfortunately, the way traditional medicine approaches this injury today leaves many addicted to painkillers (or in a constant revolving door of back surgeries and/or injections) in an attempt for a quick fix at resolving pain. Finding a true solution for low back pain requires a non-traditional route of understanding when a minor ailment can be self-treated with corrective exercises and active rest. Also for more serious back injuries, it may require you to seek treatment from a physical therapist or chiropractor that understands movement analysis and the nuances of barbell lifts.

What I want to do is walk you through every step of this past story. I want to expose the holes in it and show you why our medical community has largely gone about treating low back pain the wrong way.

Then I want to show you how things should be done. I want to give you a step-by-step plan you can use to empower yourself to understand and fix your pain.

Let’s start with the first problem in the previous story: the idea that your doctor knows why you have back pain by just looking at your MRI.

The Picture Isn’t Always What It Seems

Have you ever heard the expression, “a picture is worth a thousand words?” It means the idea behind something can be summed up better in a single image than a lengthy description. This phrase should not have any place in the diagnosis of back pain.

XRAY.jpg

In the previous story, the doctor Ryan met with blindly diagnosed his back pain by simply talking with him and looking at an expensive “picture” of his spine. Many medical doctors commonly see “abnormal” findings (like a bugling disc) and interpret them to be recent developments. Basically if they see something that looks “off” on the scan, they assume it to be the exact cause of the newly developed pain!

Bulging Disc.jpg

What if I told you that “bulging disc” and “degenerative disc disease” is a common finding. Many people walking around today with a “bulging disc” or “degenerative disc disease” have absolutely no complaints of low back pain or dysfunction.

Research has estimated that almost a third of healthy pain free 20-year-olds currently have a disc bulge in their spine!18 This number increases 10% every decade, meaning 45-50% of people between the ages of 40-50 have a disc bulge but with no back pain at all. It is highly likely to have abnormal scary findings on the MRI if you’re above the age of 60 but many of these individuals have no low back pain at all.

Can a disc bulge create back pain? Sure. But just because there is one that is picked up on an MRI does NOT necessarily mean it is the root cause of your pain.9-11

In 2006 a group of researchers collected MRI scans of 200 individuals without any history of back pain.10 During the study, those who developed severe back pain had new MRIs taken and their results were compared with the previously taken scans. You may be surprised to hear that 84% of those who developed horrible back pain had absolutely zero difference in their spine from their original scans. Some people even had improved markers compared to their first MRI!

There’s no question that the technology we have today is amazing. It is able to pick up the smallest “abnormalities” and can find disease and tissue injury like never before. However, MRI or CT scans cannot always tell someone WHY they have pain, especially when it comes to the back.

Where Do We Go From Here?

Where the story took a downward turn was when Ryan was ordered an expensive and unnecessary MRI. Too often, people undergo back surgery or get injections when their low back symptoms can be treated with conservative care. A picture is usually worth a thousand words but in this case, low back MRIs can cause more psychological harm to those dealing with low back pain.

What I want to do now is walk you through what a good evaluation would look like. We’re going to start next week with a little education on how the back really works and a few of the mechanisms that would cause a strength athlete to develop an injury.

Until then,

Author Photo
Dr. Aaron Horschig, PT, DPT, CSCS, USAW

With

Kevin Photo
Dr. Kevin Sonthana, PT, DPT, CSCS

References

  1. Calhoon G, & Fry AC. Injury rates and profiles of elite competitive weightlifters. Journal of Athletic Training. 1999l34(3):232-238
  2. Brown EW & Kimball RG. Medical history associated with adolescent powerlifting. Pediatrics. 1983; 72(5):636-44
  3. Keogh J, Hume PA, & Pearson S. Retrospective injury epidemiology of one hundred one competitive Oceania power lifters: the effects of age, body mass, competitive standard, and gender. J Strength Cond Res. 2006 Aug;20(3):672-81
  4. Dreisinger TE & Nelson B. Management of back pain in athletes. Sports Med. 1996 Apr;21(4):313-20
  5. Keogh JW & Winwood PW. The epidemiology of injuries across the weight training sports: a systematic review. Sports Medicine. 2016 June.
  6. Chandler TJ & Stone MH. The squat exercise in athletic conditioning: a review of the literature. National Strength and Conditioning Association Journal. 1991, 13(5):51-58
  7. Andersson GB. Epidemiological features of chronic low-back pain. Lancet. 1999. 14;354(9178):581-5
  8. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. Am J Neuroradiol. 2015;36:811-16
  9. Jensen MC, Brant-Zawadzki MN, Obuchowski N, et al. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994;331(2):69-73
  10. Carragee E, Alamin T, Cheng I, et al. Are first-time episodes of serious LBP associated with new MRI findings? Spine J. 2006; 6(6):624-35
  11. Fukuda K & Kawakami G. Proper use of MR imaging for evaluation of low back pain (radiologist’ view). Semin Musculoskelet Radiol. 2001;5(2):133-6

 

 

 

 

 

 

 

 

 

 

 

 

 

Published by

Dr. Aaron Horschig

Doctor of Physical Therapy, CSCS, USAW coach and athlete.

9 thoughts on “The Low Back Pain Epidemic

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