The most critical first step is to get the correct diagnosis.

There are many different issues that can cause back pain and it is impossible to treat without a proper diagnosis. The problem with getting a diagnosis is that even most doctors don’t know how to figure it out. If you receive your care from a primary care physician or just a Physician’s Assistant or Nurse Practitioner, they may not have the necessary skills or knowledge to determine the cause expeditiously. Every day I see patients with spine pain who have had generic treatment with NSAIDs, self directed exercises and work limitations who fail to recover. This care can go on for months before they are finally referred to a specialist.

If there is an intact neurological system, no chronic fever or weight loss and waxing/waning pain, most likely it isn’t dangerous. If there is a doubt, an MRI will give good information about the state of your spine. Tumor, infection and spinal cord or cauda equina compression are surgical emergencies. Pretty much everything else can be addressed later and doesn’t require urgent care. Even a disc herniation with sciatica is rarely an emergency that needs immediate surgery. Normal neurological function is the key factor.

Even without insurance, a Lumbar spine MRI without contrast is about $350.00 if you pay cash. Many insurance carriers block access to MRI imaging without a period of treatment ranging from 30-90 days or so. This is why it can be beneficial to simply procure MRI imaging on your own. Most physicians will order one if you ask and it can make treatment much easier to plan since it will often help point to a diagnosis, or at least provide peace of mind by demonstrating that there is no problem which requires urgent care.

Once it has been established that no surgery is necessary,
you can take care of things in your own.


Phases of Treatment

At each stage of progress, it is vital that you understand that pain is not dangerous, otherwise you won't succeed. Most people never even get up and get moving because they believe the pain means they are being injured and are too afraid to risk further injury.

You have to know your diagnosis and understand what it means. The slightest doubt about the correct treatment course can prevent you from getting better. Many people get bogged down with concern that something is very wrong with them and they are in danger of getting worse if they don’t behave as if they are very fragile. They stop activities and treat themselves like they are broken. Rather than healing, their symptoms worsen due to the inactivity. We have known for decades that rest, beyond a few days, is a bad idea and leads to worse outcomes. If somebody recommends bed rest for generic back pain, I’d stop listening to anything that person has to say about how to manage your back or any other problem for that matter. They’ve just demonstrated that they don’t know what they are doing. 

is simple and usually the most overlooked. It is walking. It is stretching slowly and easily at first and then becoming more and more intense over time. Without an exception, this is the most important part of breaking free from pain. If nothing else, you must do this. Every single patient who stops requiring my care walks. Every day for an extended period. 30 minutes per day minimum. This doesn’t include merely counting steps while working. It is restorative to actually get out and walk. Even better if you do it with someone else.

Even attending physical therapy regularly isn’t a good long term solution because you are still dependent on someone else to help you. The instruction can be great. But you have to move on and be independent to truly recover.

means opiates, tobacco products and as many medications as you can give up. Don’t stop life saving medications, but do stop as many symptom relieving medications as possible. There is a high likelihood of drug interactions and negative side affects with each medication.

Nicotine interferes with blood flow to tissues. Without blood flow, oxygen and healing factors can’t reach the injury and you will never heal.

Limit alcohol. Limit over the counter analgesics. Limit supplements. The rule of thumb should be if man made it, don’t consume it. Just as processed foods are less healthy than unprocessed foods, so are processed medications and supplements less healthy.

means good exercise program in addition to general daily walking.

While doing all of these things you need to change the way you think about your pain. This is the component most people leave out and why they are never able to stick with the 3 main items – mobilize, strengthen, detox. Once it is understood, it can be applied anywhere in life and will give you a competitive advantage.