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Understanding spinal disorders.

1: No two spinal problems are the same
Do not expect your recovery to be the same as your brother, sisters, aunts, or friends. Spinal tissues are injured in different ways. Your genetics are not the same. Your tissue health is not the same. Your age is not the same. Do not compare your recovery rate or response to treatment like others. Try to avoid everyone's opinion on what you should do. Their injury is not the same.

2: You do have a high likelihood of re-occurrence.
Unfortunately, this is true. Low back pain is the second-highest reason for doctor visits, right behind the common cold, and it is estimated that once you have a problem, you have an 80 percent chance of re-occurrence. It should be every patient and practitioner's goal that works with spinal disorders to minimize the chance of re-occurrence.

3: Spinal problems affect the whole loco-motor system. Injuries create a disturbance. Tissue restriction and altered biomechanics change the movement of the spinal system. If your pelvis is suddenly restricted in certain motion, energy and demands are transferred to other areas. This often results in distal strains. A simple case is a lower back problem that causes neck pain and headaches because of extra stress transmitted to this area from poor stability in the lower spinal system.

4: Most pain will resolve, but it often changes movement patterns permanently, and this is where the danger is. Inflammation causing pain will usually resolve over a long time, but how a person moves is usually altered. A simple case is how lower back pain inhibits hip extension. This loss changes the whole system's loco motor dynamics, often leading to force generation transmitted to the shoulders and neck from the weak hip extension.  It can also reduce propulsion force on the toe-off portion of the gait resulting in whole system changes. Sometimes we can adapt, and sometimes we cannot. The law of energy conservation states that energy cannot be created or destroyed in isolated systems but rather transferred and constant.

5: There are three levels of care
a: Conservative low-tech low-risk care: Chiropractic, physical therapy, acupuncture, and massage. Treatments include spinal manipulation, stretching, exercises, modalities, dry needling, etc. This should always be the first level of care except in severe trauma, possible infection, or cancer.
b: Moderate level intervention and risk care:  this includes imaging such as MRI's and procedures such as steroid injections.
c: High-risk, high-tech interventions: These are primarily forms of surgery. This is your last resort. The risk is high, and outcomes are highly variable.

6: The correct goal is to resolve the spinal problem as fast as possible with the least amount of risk (conservative care) and no residual changes to the spinal function or stability. It has been shown that the more prolonged pain is established, the more permanent the alteration in these functions. The deepest layers of muscles can become atrophied (they shrink in size). With muscle atrophy, the spine's stability and function are compromised, and the re-occurrence of injury is much more likely. Also, larger muscle groups become tight, and others become weak and inhibited. This adds further strain to the system.

7: Long-term medication usage is hazardous. There are dangers with different types of medication. Anti-inflammatory medication used longer than several weeks can cause GI bleeding, and longer-term use is associated with kidney damage. Narcotics are addictive and not valid for long-term chronic pain.

8: Finding the proper treatment. In most cases, there is a conservative approach that will work for your condition. In my practice, I utilize a combination of spinal mobilization of various methods, most of which I have developed based on biomechanical knowledge. I combine the whole system, including fascia and muscle stretching. I teach in office and home exercises that are specific to your problem.

9: Imaging is not very helpful for most spinal disorders. If you don't improve with care in four to 6 weeks, then imaging is warranted. Symptoms that do require investigation by imaging are fever, night pain, trauma, and a possibility of cancer. MRIs give much more information than plain x-rays in spinal disorders. Rarely are x-rays used anymore. They miss so much information that MRIs are so much better. Most pain and dysfunction is from soft tissue. X-rays image only bone thus of not much help unless one has red flags.

10: The importance of internal locus of control. Research has shown that your psychological profile has a very high correlation with your ability to get well. People who are actively involved with their care and are thinking they will get better do.

11: Recovery is never just one thing. Recovery involves lifestyle, nutrition, exercise, the proper treatment, sleep, hydration, age, and stress levels.

12: Some people will have lifelong problems. Yes, some will have long-term residuals of pain and altered function, and disability.  One should never expect this and always work with everything possible to avoid it. Even with the best of efforts, there will be a small group of individuals in this category. They usually are the unhealthier groups that smoke and drink alcohol and do not exercise. Your ability to heal is a reflection of your overall health for the most part.

13:  Injuries take time. In some severe disc problems, I have seen it take up to a full year for resolution. Pain is very wearing, so time goes slow. Think of the big picture. Never look at an hour-to-hour progress but in days, weeks, and months for severe injuries.

14: Don't stop living if you have chronic pain. Do not avoid living. This leads to fear avoidance behavior and makes the problem worse.

15: focus on sleep, nutrition, posture, stress, body fat, and lifestyle to reduce inflammation and promote good healing.


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