For as long as I have been a physical therapist, I have been battling organizations like the Mayo Clinic and the Cleveland Clinic that suggested that most back pain was due to variations to spinal structures, such as herniated discs, arthritis and stenosis. In an absolutely shocking change of position, the Cleveland Clinic has now changed their view on this seminal point.
In the July, 2011 addition of The Arthritis Advisor, the Cleveland Clinic has now stated that “most back pain is muscular”. So clean in their position. Nothing ambiguous here. It was like sweet music to my ears. Sadly, I would suspect this was not such great information for the hundreds of thousands of people who got back surgery based on the MRI findings of a herniated disc or stenosis that was touted as the cause of their back pain prior to this revelation.
They point out that there was a little flaw in how the MRI was interpreted. “What has given spinal surgery a bad name is people having fusions for back pain, when there is no instability. They get an MRI because of the pain; it shows an abnormal disk and so they get a fusion. That’s a terrible indication, because you don’t know that the disk is the source of the pain.
Disk degeneration is a normal phenomenon of aging; everybody eventually suffers from it”. They now are delineating pain from things such as instability and deformity. “If there’s no evidence of an infection, tumor, or other rare cause of pain, stick with conservative treatment”, Dr Orr advises. “Most people with back pain will never need surgery and, because of possible complications, many people with chronic back pain will, in fact, be made worse with surgery unless they have an instability, deformity, or rare condition”.
I have proven over my 18 year career that the cause of most back pain is muscle weakness or imbalance. When pain is experienced across both sides of the lower back, a muscle imbalance between the quads and hamstrings is typically the cause. The quads have a tendency to shorten. Once shortened, they pull the front of the pelvis down causing an increased arching of the lower back. This causes the lower back muscles to shorten and lose their ability to create force and perform their functional task of supporting the torso. They strain and can go into spasm. If the pain is experienced on one side of the back, this is an indication of a strained hip muscle. The gluteus medius muscle which is a hip stabilizing muscle works in conjunction with the lower back muscles. If one of these muscles strains, the lower back muscles try to compensate and eventually strain creating pain at the lower back.
Congratulations to the Cleveland Clinic for finally getting it right.