The treatment of lower back pain is one of the most frustrating challenges a doctor can undertake. It is a specialty filled with misinformation, alternative views and unfortunately old outdated theories. The other problem with the specialty of treating back pain is that it is open to a wide variety of health care providers both main stream and alternative. Therefore a person suffering doesn't know where to turn.

In operating a multidisciplinary back and neck pain clinic I have had the privilege to work with a myriad of specialties including medical doctors, chiropractors, physical therapists and naturopaths and one thing is certain initially everyone has their own ideas based on what they where taught and also on their own experiences. It really is a shame because the medical literature does have many valid and promising studies published on effective treatments for low back pain.

The natural history of low back pain appears to be one of the main reasons this life altering condition hasn't been dealt with properly. For example if pain is the primary indicator used it appears that most episodes of back pain go away within 6-10 weeks. This has been the bench mark for many first time sufferers and those routinely treated in medical clinics around the world. The problem with this form of measurement is that pain in and of itself is not a valid indicator of underlying function of the spine.

A study I think best describes this is one that was published in the prestigious journal SPINE in this study first time back pain sufferers where allocated to two groups one that received traditional medical management including medication and rest and the other a specific spinal rehabilitation program focusing on the deep spinal muscles. Prior to separating the groups however, they performed diagnostic ultrasound studies on the deep muscles of the lower back and saw a 30% decrease in size of the deep spinal muscles on the side of pain.

After 10 weeks everyone recovered fully which would seem to indicate that both treatments were equally successful. The ultrasounds were repeated and only the exercise group recovered the size of the deep spinal muscles. Both groups were no longer experiencing pain however. The biggest difference came when these researchers followed up at one and three year intervals. What they found was quite remarkable, at one year a full 84% of the medically managed group had another episode equal to or worse then the previous episode and at three years 73% of the 84% had another one, compared to 33% of the rehabilitation group.

What this study so clearly indicates is that even though the pain may be gone the functional changes secondary to back pain are still present and contribute to further episodes and disability. This is a powerful example of the need for specific early management using function and not pain as an indicator of response to care. At the Arizona Back Institute every patient goes through a rehabilitation process focusing on restoration of normal spinal strength for the appropriate age and weight matched categories. This ensures the highest probability of a long term recovery. If you have suffered from a recent episode my advice is find a clinic that focuses on function and not just on pain. In a later article I will explain why treatments like epidurals and surgery rarely give the patient the best opportunity at recovery. I will also give you some very effective non-surgical options that are safer and focus on a long term solution.