The global burden of disease places lower back pain (LBP) as the leading cause for years lived with disability at the top spot for the past three decades.

LBP may be treated with pharmacological therapy, surgical interventions, or rehabilitation…physical therapy, exercise, spinal manipulation, and other practices. Combination therapy and interdisciplinary approaches to LBP are considered helpful in many cases.

Everything works, but not for everyone.

Ask one hundred people what you can do to get rid of your back pain and you might get one hundred different answers. Read a hundred different articles, scientific studies, look at one hundred different videos online, you will hear and see it all.

Chiropractic care is my bias, it’s how I pay my bills, but that doesn’t make it better. Relief from pain isn’t open and shut. What works for some people won’t necessarily work for you. Doing you own research may point you in a direction, listening to experts may sway you, hearing from a friend or family member might land you in a different office. Some interventions are apparently bogus based on today’s prevailing evidence: TENS, ultrasound, and kinesiotaping for pain don’t appear to do much. Ice (cryotherapy) is also out of favor at the moment.Should Your Chiropractor Adjust Your Neck?Cervical spine manipulation is controversial, should it be abandoned?medium.com

No one has a monopoly on what works the best, because nothing works the best. There is no gold standard for effective back pain treatment. Some people respond well to one thing but aren’t going to respond well to another. Many cases will resolve on their own no matter what procedure or technique is performed.

If treating back pain is a crap shoot, why go to a chiropractor?

There are some first-line treatment recommendations that show up perennially in study after study for what works for lower back pain.

From the American College of Physicians evidence-based clinical practice guideline 2017:

Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation)

And:

For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation)

So you can see that good chiropractic care covers several of these recommendations for acute, sub-acute, and chronic types of lower back pain. A competent chiropractor is going to perform a detailed history and physical exam, provide you with a working diagnosis, and form a plan based on the best available evidence, their own clinical expertise, and your preferences and values as the patient — the key player in all of this.

Chiropractic can check a lot of these boxes, but not every chiropractor will employ multiple treatment modalities. In my own office I frequently use:

1. Nonpharmacologic treatments
2. Superficial heat
3. Massage
4. Spinal manipulation
5. Exercise
6. Yoga

Final Thoughts

As a human being, there is a good chance you will develop lower back pain at some point in your life. Most cases of lower back pain will resolve on their own with time. No matter what you try or who you see first for a case of lower back pain, it may or may not improve your symptoms.

So from my professional standpoint what you do for your back pain should be based primarily on what you value in a treatment approach. Some people are comfortable with medications or injections, others are not. Some people value exercise over more passive treatments such as massage.

In the case of chiropractic treatment most patients who seek this type of care for their lower back pain are likely attracted to it being drug-free, non-invasive, hands-on, and of a low risk of side effects.Fruit Is Not Making You FatIf you go to a health professional and they tell you fruit is bad, turn and run in the other direction.medium.com

Works Consulted:

Pergolizzi, J.V., LeQuang, J.A. Rehabilitation for Low Back Pain: A Narrative Review for Managing Pain and Improving Function in Acute and Chronic Conditions. Pain Ther 9, 83–96 (2020). https://doi.org/10.1007/s40122-020-00149-5

Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians https://doi.org/10.7326/M16-2367

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What does heart related back pain feel like?

This symptom, usually occurs in your upper back and is more likely to affect women. The pain can originate in your chest and then “move” to your back. Although most often felt in the upper back, it can also occasionally cause pain in the lower back.

Onset can be sudden and pain can wake you at night. The pain is most often described as originating between the shoulder blades. As there are many non-heart related causes for back pain, its important to consider any of the other heart attack symptoms that would indicate your pain is heart related. If you find it difficult to pinpoint the pain, this could be an indicator of heart related pain.

Why does your heart cause this symptom?

It’s a case of crossed wires. Our bodies are normally very specific when they send out pain signals. Close your finger in the door and you know which part of your body isn’t impressed with you. The heart is a little bit more complicated as it shares nerves that send out signals to our arms, head and upper body.

As a result heart related symptoms like back pain are called referred pain. In other words, although that area feels painful, it isn’t the problem. Your heart is the issue and the signals have simply gotten mixed up. The source of origin for referred pain is also more diffuse and difficult for patients to pinpoint.

Accompanying symptoms

Back pain can occur as an isolated symptom or be accompanied by pain in your neck, jaw, shoulder or chest and you may experience nausea, sweating, shortness of breath, dizziness, or lightheadedness. If your back pain is accompanied by any these symptoms, seek immediate medical help.

If you’ve recently noticed any of the following, you should also seek medical attention if your back pain is unexplained.

• feeling tired or out of breath from your normal day to day routine
• struggling for breath from activities that don’t normally tax you
• feeling tired and listless but struggling to sleep
• sudden feelings of dread or anxiousness (panic attack)

Gender prevalence for back pain

Women experience this symptom far more than men do and many women report the pain as having started in their chests and then moving to the upper back area. For women, it is a typical red flag, but men may not experience any back pain at all. Women are also more likely than men to feel their back pain while they’re resting or sleeping.

Alternate Causes of back pain

Even if you suffer from any of the conditions listed below, you may still experience back pain as a result of a heart condition. The pain may not feel the same as the pain you normally experience from an existing condition.

The most common causes of upper back pain are muscular, related to poor posture, trapped nerves or degenerative conditions of the spine and bones. These include some of the following

• Back muscle spasm, sprain or strain
• Cancers
• Degenerative disc disease
• Herniated (bulged or ruptured) disc
• Lung Cancer
• Osteoarthritis
• Osteomyelitis
• Osteoporosis
• Spinal stenosis
• Spondylitis

A life-threatening cause of back pain is an aortic dissection, a condition in which the biggest artery in your chest tears.

Are there clear signs it’s your heart?

There are a few tell tale signs that would indicate the pain in your back is related to your heart.

• Sharp pain that wakes you but you are unable to pinpoint the source of the pain
• Pain is most often described as occurring between the shoulder blades
• If the pain is accompanied by sudden excessive sweating not related to menopause
• If you find yourself suddenly short of breath from normal activities
• If your back pain is accompanied by one or more of the other heart related symptoms seek immediate medical attention

When to call your Doctor or 911

If you are experiencing upper back pain, especially pain that travels to your jaw, neck or down your arm, and are having associated symptoms of nausea, dizziness, sweating, or shortness of breath, call 911 right away.

If you are in an at risk group for heart disease (elderly, diabetic, obese, overweight, smoker or high blood pressure) then you should treat any back pain seriously. The more prolonged the discomfort or pain is, the faster you should seek medical care. Dial 911 or visit your nearest ER

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