Stubborn Back and Neck Pain

By David Groneck, DC, FASA

Back and neck pain affect millions of people everyday. It is so common that it is often accepted as a part of life.  Many have sought multiple types of treatment for their pain with some to no affect and have resolved themselves to living with their pain.  The focus of this article is directed towards areas of treatment that I often encounter with my patients with this type of chronic pain.  Pain from fractures, infection, and cancer will not be discussed here.  Although this article will focus primarily on neck and back pain, much of this article can apply to other joint pain such as elbow, shoulder, knee, etc.  Although the standard medical treatment for back and neck pain can be helpful, often it is merely a band aid to the problem. 

Routinely, the medical course of treatment is analgesics, muscle relaxers, cortisone injections, physical therapy, and ultimately surgery if the previous treatments do not help.  Fortunately, there are many other treatments available that are very effective.  But the first thing that needs to be done is find the causes of the problem.  I find that it is often more than one cause that needs to be addressed before relief is possible.   

Nerve compression. These can be ruled out or in by several methods including neurological tests, MRI, CT, etc. A thorough neurological evaluation can often identify where the problem lies. The most common cause of a nerve compression is due to a spinal disc bulge or herniation.  The size of the herniation and its position will largely determine a course of action.  Sometimes surgical intervention is the only option.  However, there are many instances that a conservative approach is ideal.

Muscle weakness/dysfunction. Since muscles move bones and support the surrounding joints, it would be wise to check the neurological integrity of the muscles that stabilize the joint.  When I see a new patient that has been treated by other doctors with little success, I know I will find muscles that are neurologically inhibited on examination.  For instance, when examining the low back I will check the low back muscles as well as the obliques, abdominals, and hip stabilizers. I usually check about 15 muscles but it varies with the situation.  It just makes sense: If the muscles of the low back and surrounding areas are not functioning properly, how can the low back be strong and healthy?

Joint misalignment. There are grades of misalignment ranging from a chiropractic subluxation which is a very small misalignment to a full blown dislocation.  I am referring to the subtle misalignments of the spine here.  Chiropractic adjustments can provide great relief from pain in these situations. 1, 2,3,4,5

Acupuncture meridians.  Acupuncture is a very effective treatment for relieving pain. The main goal of acupuncture is to correct the subtle shifts in our body's electricity or energy.  Meridian therapy has been used for thousands of years which speaks to its effectiveness, however, many recent studies have shown the effectiveness of acupuncture. 6,7,8,9

‚ÄčNutritional deficiencies. There are certain nutrients that specifically support the disc, ligament, tendon, and other joint structures.  If these nutrients are depleted, the disc and ligaments will weaken over time and eventually be injured. Adequate supply of nutrients in the right form is necessary not only for the health of the low back, but for every process in the human body. 10,11,12
 
 TMJ dysfunction. Did you know that if the jaw is misaligned, problems such as low back pain (among others) could occur? The jaw plays a major role in balancing the entire body. This is often overlooked and can result in lifetime of pain and discomfort for the patient. 13,14,15

Referral pain.  There are many types of referral pain patterns to the low back and neck.  Pain can come from muscles, ligaments, and the viscera. For instance, prostate dysfunction such as prostate enlargement, kidney dysfunction such as a kidney infection, uterine dysfunction such as endometriosis, and an abdominal aneurysm can manifest as low back pain. 16,17,18,19

Addressing the causes of joint pain can be a complicated process.  Having a knowledgeable practitioner familiar with multiple treatment options may greatly increase the possibility of minimizing or even eliminating one’s pain.

 
References:

1. Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis.  Spine J. 2004 May-Jun;4(3):335-56.

2. Chiropractic management of mechanical neck and low-back pain: a retrospective, outcome-based analysis. J Manipulative Physiol Ther. 2000 Jun;23(5):307-11.

3. A practice-based study of patients with acute and chronic low back pain attending primary care and chiropractic physicians: two-week to 48-month follow-up. J Manipulative Physiol Ther. 2004 Mar-Apr;27(3):160-9.

4. Manipulative therapy in lower back pain with leg pain and neurological deficit. J Manipulative Physiol Ther. 1998 May;21(4):288-94.

5. A series of consecutive cases of low back pain with radiating leg pain treated by chiropractors. J Manipulative Physiol Ther. 1995 Jul-Aug;18(6):335-42.

6. Effectiveness of Acupuncture for Low Back Pain: A Systematic Review. Spine:1 November 2008 - Volume 33 - Issue 23 - pp E887-E900

7. Observation on lower back myofascitis treated with penetration needling on yang meridians of the back and electroacupuncture as compared with Western medication. Zhongguo Zhen Jiu. 2010 Oct;30(10):816-8.

8. The short- and long-term benefit in chronic low back pain through adjuvant electrical versus manual auricular acupuncture. Anesth Analg. 2004 May;98(5):1359-64.

9. Acupuncture for chronic low back pain: a randomized placebo-controlled study with long-term follow-up. Clin J Pain. 2001 Dec;17(4):296-305.

10. Glucosamine, chondroitin, and manganese ascorbate for degenerative joint disease of the knee or low back: a randomized, double-blind, placebo-controlled pilot study. Mil Med. 1999 Feb;164(2):85-91.

11. Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain. Surg Neurol. 2006 Apr;65(4):326-31.

12. Clinical efficacy and safety of Lyprinol, a patented extract from New Zealand green-lipped mussel (Perna Canaliculus) in patients with osteoarthritis of the hip and knee: a multicenter 2-month clinical trial. Eur Ann Allergy Clin Immunol. 2003    Jun;35(6):212-6.

13. Back pain in relation to musculoskeletal disorders in the jaw-face: a matched case-control study. Pain. 2007 Oct;131(3):311-9.

14. Correlation between cervical spine and temporomandibular disorders. Clin Oral Investig. 1998 Jun;2(2):54-7.

15. Association of neck pain with symptoms of temporomandibular dysfunction in the general adult population. Scand J Rehabil Med. 1999 Mar;31(1):17-22.

16. Myofascial Pain and Dysfunction, The Trigger Point Manual. Second Edition. p. 944 (Vol 1); p. 429 (Vol 2) Travel, Simons 1992

17. Differential diagnosis of endometriosis in a young adult woman with nonspecific low back pain. Phys Ther. 2007 Jun;87(6):801-10.

18. Differential diagnosis of a patient referred to physical therapy with low back pain: abdominal aortic aneurysm. J Orthop Sports Phys Ther. 2008 Sep;38(9):551-7.

19.  The prostate and its influence on low back pain. Cal West Med. 1925 Aug;23(8):993-9.