3505 Richville Road
Manchester Center, VT 05255
Phone: (802) 366-1144
Walk off back pain?
By Dan Robbins, MD
As pointed out recently in the national best seller Born to Run, the human race evolved to walk and run in an upright position with appropriate balance. That balance is easily disturbed by many factors including age, weight distribution and deconditioning.
The alteration of normal posture and subsequently alignment leads to a variety of orthopaedic problems from spine pain to plantar fasciitis and other lower extremity disorders which account for personal misery and suffering.
The vast majority of mechanical complaints are additionally met with the assurance from health care professionals that the symptoms will eventually get better. This understanding of the natural history (what happens if you do nothing) unfortunately does not allow the individual to understand, or correct intrinsic changes in their body that will eventually lead to more chronic and less easily treated problems when we start using our bodies “gears” (or joints) in an inappropriate manner.
Over the last 28 years of training and practicing orthopaedic care both with surgical and non-surgical techniques, I have strived to minimize aggressive surgical intervention and its imperfect answers to multiple mechanical and neurological conditions.
The key to our ability as a species to prevent or correct these speed bumps on the road of life are found in the understanding of the source of these pains and thereby the insight to understand, demystify and reduce the inherent stress associated with their onset in our lives.
An analogy that may make sense is when you have a charley horse in the calf. We all know from experience that teh best way to rapidly address this pain is by walking off the cramp and stretching.
But when it comes to back pain, we effectively walk on our proverbial tip toes trying to decrease the pain rather than reduce the body’s normal response to abnormal motion/stress, thereby prolonging the symptoms and not correcting the source. In other words, with the Charley Horse analogy, what if we could put the back in a neutral position that begins to lessen back pain naturally.
This need is seen in the issue that most people deal with in the face of back and lower extremity degenerative changes with pain is the experience of pain in transitions (sitting to standing as an example) between activities. The underlying source of this type of pain is a general diminishment of motion in response to pain and stiffness that creates a tearing or ripping phenomena that the body identifies as abnormal.
The analogy I use frequently is that if you were to clench your hand in a fist, comparable to shortening the capsules of the mobile finger-like joints of the spine (facet joints) for 30 minutes you would literally pull the fingers open to achieve relief.
The same is true for your spine as the tightening of the joints shorten the length of your muscles, already in spasm. Creation of normal motion throughout the day, almost comparable to wiggling your fingers/toes or breathing needs to be ingrained to both desensitize the irritated tissues and diminish the daily stress one applies to our spine if not properly cared for.
Unfortunately like any bodily function you cannot expect long-term benefit unless there is a continuous interaction with your body just as you would check your dashboard or side view mirrors while driving a car.
Given a better understanding about your body’s signals, there can be a significant diminishment of pain and anxiety associated with many common symptoms encountered.
Surgical and nonsurgical care results are linked to decision-making in identifying the source of the pain. The use of selective blocks for both diagnostic and therapeutic benefits can help discern the path of treatment. The information obtained from responses to both the pain management blocks and self directed application the above mentioned mechanical adjustments is absolutely needed by anyone facing the prospect of a surgical answer to neurologic /mechanical pain.
Many of us are able to recall acquaintances and loved ones with less than ideal results from surgical interventions. Although there are known complications from any surgical intervention there is usually a common link. Lack of true understanding about the source of pain and the long term consequences of surgical intervention including standard techniques that create collateral injury for an otherwise appropriate surgical plans lead to less than ideal results seen nationally.
The appropriate application of minimally invasive spinal techniques, used in surgical intervention that is needed in the face of failed conservative care and persistent pain/ dysfunction is a topic best left for another article.
Returning to the best selling book that we previously mentioned, Born to Run has spawned a renewed interest in barefoot running, as we have discovered that supportive running shoes do not decrease the incidence of running injury. In fact there is clear indications that the opposite phenomena is occurring. The basis of this increase is linked to diminished tactile feedback runners perceive with these significantly padded sneakers. Heel strike while running or walking leads to increase extension of you knee as well as increased arching of your spine, which substantially increase forces propagated across these and other joints.
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