When you look at a picture of the muscles in the human body, it’s easy to see how they are all connected. This interconnectedness is what lets us move our bodies in different ways, but it’s also what makes it so hard to diagnose and treat lower back pain.
Lower back pain is the fifth most common reason for all doctor visits in the United States. In spite of that, the causes of lower back pain are often a mystery. Dr. Evan Johnson, Director of Physical Therapy at The Spine Hospital at the Neurological Institute of New York, cites literature showing that doctors can diagnose a definite cause for non-specific lower back pain only about 15 percent of the time.
In a talk he gave to physical therapists at NewYork-Presbyterian Hospital, Dr. Johnson explained that part of the reason it’s so difficult to diagnose lower back pain is that elements of the spine are interdependent and may respond to the normal stresses of everyday life in a variety of ways.
The spinal column with all its associated joints and ligaments, the intervertebral discs and the systems of muscles around the spine all affect each other as well as the nearby pelvis and hip joints. This can make it difficult to tell exactly where the problem lies.
For example, hip problems and spine problems are closely related. Doctors call this hip-spine syndrome. Problems with the hip can place increased pressure on the spine, causing lower back pain. Similarly, problems in the spine can radiate pain into the hip, causing hip pain.
The spine and the hip can also affect each other at the same time, Dr. Johnson said. Lower back pain can cause muscles to spasm and shorten, which in turn can reduce hip mobility. This reduced mobility can then place a greater load on the spine in everyday activities, which results in—you guessed it—lower back pain.
“Even in the age of highly sophisticated medical technologies,” says Dr. Johnson. “A thorough physical exam is often necessary to identify and most effectively treat a patient’s condition.” In service to this notion, Dr. Johnson has published and lectured on the principles of physical exam of the spine to audiences of neurosurgeons, orthopedic surgeons, pain medicine physicians, physical therapists and chiropractors in venues throughout the United States.
Interdependence isn’t limited to the physical body. Dr. Johnson also told the group of physical therapists that when lower back pain is chronic, fear plays a large part in how the patient recovers. He said patients sometimes develop “fear-avoidance behaviors” that keep them from going back to work or exercise, or from doing anything they fear might result in more pain.
The problem is that avoiding activity allows the muscles to weaken, which results in more pain. Dr. Johnson said this cycle of fear-avoidance behaviors often leads to disability and sometimes depression.
Dr. Johnson said physicians have to examine the patient carefully, taking the interdependence of the spine and the rest of the body into account, to find and treat the actual source of the pain. They also have to remember the role pain and fear play in healing, and to help patients not only regain physical health but manage their fear of back pain as well. It’s all connected.