Personalized Chiropractic Lifestyle Medicine in the Treatment of Low Back Pain
A basic approach to treating low back pain (LBP) can be summed up in 9 words; spinal adjustment, stretching exercises, magnesium, dairy-free, abdominal palpation.
The following is a simplified version of my approach to LBP as it has evolved over the last 30 years.
At Palmer College of Chiropractic, in 1979, I was taught that spinal adjustment was an effective treatment for LBP. I was also taught that minimally displaced vertebrae, subluxations, were the primary cause of LBP. The “bone out of place” concept didn’t make sense to me then, nor does it today. I went with the minority opinion at the time, that loss of intervertebral joint mobility, as determined by palpation, was the most valuable indicator of spinal dysfunction. Since skillful spinal adjustment clearly restores joint mobility, and consistently reduces or eliminates LBP, the model continues to be valuable.
I was not in practice long before realizing that most of those that I treated for LBP either had chronic, systemic health issues that brought about their pain, or had a clear-cut mechanical injury that was then hampered by chronic systemic health issues that interfered with its natural resolution. While a remarkable therapy, spinal adjustment was often not enough by itself to overcome the negative effects of systemic, pre-existing imbalances. Without addressing the imbalances, resolution of LBP was slow, or simply never occurred.
Though not covered in any depth at Palmer, common sense, and my own yoga practice experience, easily made full-body-stretching exercises a routine recommendation for all my patients with LBP.
Magnesium was the next tool I added. With each and every LBP patient, one component of the condition that I found was tight muscles; whether splinting to protect the injury, or chronically tight. When I learned that magnesium is required at a sufficient level in the body to allow muscles to fully relax, and when I learned that magnesium insufficiency is common in the United States, I began to ask all patients to take magnesium glycinate or magnesium chloride daily as a part of their treatment. Epsom salts (magnesium sulfate) baths were also recommended as an effective means of getting magnesium into the body. Absorbing magnesium through the skin does not have the same tendency to provoke the digestive tract that oral magnesium sometimes does. Magnesium is an effective treatment modality for LBP, and in some cases can be a successful stand-alone treatment.
Three years into practice, 35 years old, and dealing with digestive problems myself, I quit eating dairy products, hoping for some relief . Before long, not only did my gut improve, but my chronic low back condition of 25 years, also began to resolve. From age 10, when my back pain began, and age 16 when my digestive issues became obvious in the form of a duodenal ulcer, not one of the many MDs that I consulted ever suggested a possible relationship between my gut and my back. From age 27-35, I was treated by a number of chiropractors, and sat through 4 years of lectures in chiropractic college; the importance of the interconnected function of the internal organs and the back was not stressed, but when mentioned, was primarily unidirectional; back problem causes visceral problem. It is interesting to note that while both medical and chiropractic students are taught in anatomy and physiology classes about viscerosomatic and somatovisceral reflexes, nerve pathways that bidirectionally interconnect the internal organs with structural components such as muscles and joints, that little attention is paid to their role in LBP and other conditions.
As my ulcer and back improved as a result of the removal of dairy products from my diet, I began to read more, ask different questions, and encourage patients to do experiments of temporarily removing dairy from their diets. My reading and questioning made me aware that many practitioners and laypersons before me had come to the realization that diary product consumption commonly causes health problems and can be a factor in, or the cause of LBP. As the years rolled by in my practice, it became clear that the majority of my LBP patients responded better when off of all dairy products.
Upon awakening to the critical importance of the functional connection between the viscera and the musculoskeletal system, I began to palpate each patient’s abdomen. Most individuals with LBP have a tender abdomen. Not infrequently during abdominal palpation, the patient feels the tenderness in the gut, and simultaneously feels a radiating connection to their LBP. With this physical experience of connection, it makes sense to the patient to make lifestyle changes to support the reduction of inflammation in the abdomen as part of a program to heal the low back.
To my knowledge, spinal adjustment, magnesium, dairy-free, and abdominal palpation are not common components of LBP treatment in the United States. I would like to suggest that their inclusion would improve outcomes, reduce expense, and help both doctors and patients consider and better understand LBP in the context of the whole person.
These are just some of the basics as I see them. As you know, the devil is in the details.