Investigating the Cause of Chronic Back Pain Symptoms

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By Dr. Kevin Bloom
Published on April 23, 2014


A thorough history and examination will often lead a doctor or therapist to conclude that a problem is musculoskeletal in nature.  There are cases whereby the clinical presentation is such that provision of an actual musculoskeletal diagnosis is reasonably possible.  However, in many cases, it is often difficult to accurately structurally diagnose a musculoskeletal problem.  Patients tend to become quite frustrated and overwhelmed due to the wide array of medical opinions that have been provided by different health providers.  For example, a 65 year old male patient experiencing low back pain might be told such diagnoses as osteoarthritis, strain/sprain injury, or joint dysfunction by three different health providers.

The issue of adaptation and compensation, two terms often used interchangeably, becomes quite pertinent in this discussion.  As an example, let’s take a female patient with right-sided lower back pain that does not resolve on its’ own.  For whatever reason, this patient might decide not to begin therapy (chiropractic therapy, physiotherapy) for a few months.  During these few months, the patient is likely to adapt/compensate on multiple occasions, especially if this patient tries to remain at least somewhat functional across her regular activities of daily living.  As an example of adaptation, this patient might limp on multiple occasions during the first week while favouring her left side/lower limb when the symptoms are most acute in nature.  During this limping, spinal and/or buttock/lower limb muscles and joints are working differently and abnormally compared with how they would normally work.  A possible net result of this adaptive limping might be muscles staying in a shortened/tightened position in comparison to prior to limping.  Such adaptation is difficult to prove and typically does not show up on routine musculoskeletal diagnostic testing.  That being said, and speaking from my own clinical experience, one often needs to try to locate and treat these adaptive sites in order to achieve the long-term, sustainable therapeutic gains that patients ultimately seek.  In other words, in the above example, solely treating the lower back region might prove unsuccessful.  In my experience, and using chronic low back pain as an example, often it is necessary to treat and work on multiple musculoskeletal tissues from the middle back all the way down to the buttock regions in order to achieve the best results possible.

Such a process often involves some component of trial and error.  As a result, it is imperative that the patient works closely with the doctor and/or therapist.  Clinical focus is commonly placed upon resolution of functional impairments, such as improving limited ranges of motion, and increasing strength where there appears to be weakness.  In my clinical experience, resolution of such impairments located closely above and below, and near the involved region might lead to a greater and more sustained recovery in comparison to solely treating the actual local painful region itself.