I know first hand how important it is to tailor treatment to the individual, and over the past 40 years I’ve gotten better and better at doing that.
Unfortunately, the diagnostic labels that doctors apply to low back patients haven’t kept pace with the insights developed by clinicians. Fortunately, the gap between the textbook and actual practice is starting to narrow.
What’s fading out is “anatomy-based diagnosis”: trying to identify the specific spot that’s generating pain signals.
There are just too many limitations with anatomy-based diagnosis.
For example, if you take an MRI to look for disc problems, you’re likely to get way more than you bargained for – a complex pattern with multiple levels of disc degeneration and bulging with little relation to symptoms. Good luck making sense of that.
And even if you’re confident in your anatomy-based diagnosis, you’re still facing a second hurdle: how do you treat the problem? Different doctors have different opinions about the most effective treatment. So you still have to try something out to see if it helps.
The improved version of diagnosis that’s emerging is “treatment-based grouping.”
Here’s how treatment-based grouping works for people with low back pain.
Low back treatment will never be standardized. We don’t treat all patients the same way, and each practitioner makes treatment choices based on personal experience and preference.
We have confidence in our methods, but at the same time we want our results to be even stronger and more reliable.
The authors sort patients into five groups based on factors such as:
- indication of a pinched nerve
- person’s age and how long the symptoms have lasted
- presence of joint stiffness
- which positions alleviate or heighten pain
- presence of hip joint problems
- presence of fear, anxiety or depression
- patient’s ability to control low back motion
For these five different groups, they recommend one of five treatment approaches:
- traction (also known as flexion-distraction)
- spinal adjustments
- psychosocial interventions
- end point loading exercises (McKenzie-inspired exercises)
- core strengthening
The treatment-based grouping approach to low back pain represents a huge advance in our thinking. It will lead to better targeting treatment to the needs of each individual.
Of course, in my practice, I make use of elements of these five treatment approaches along with several others, too. And I typically use them in combination, rather than rely on a single method.
Interested in finding out more how a targeted approach to low back pain can enhance your healing? Call (212-400-9663) or e-mail me ([email protected]).