There is no one-size-fits-all therapy for back problems
DEAR DR. ROACH: I feel the need to comment on your recent column on chiropractic therapy for back pain. Having 27 years of back pain, I want to give S.B. some additional thoughts. Seventeen years ago, before my neurosurgeon implanted a titanium device in my lower spine, he asked about other corrective efforts that I’d made before deciding on surgery. I mentioned to him the years of chiropractic therapy I’d tried.
His reaction was swift. He said that if my pain had been due to nerve encroaching on bone or nerve on muscle tissue, chiropractic manipulation would have been helpful; he then explained that I had neither of those. He felt, in my case, that chiropractic treatment was severely wrong. The wearing away of my disc would be worsened by the constant grinding movements of the manipulation procedure; this just promotes further deterioration!
I’d like to tell S.B. one more thing about living with back pain: neither chiropractic, nor surgery, nor painkillers have given me a pain-free life. The most helpful coping skills have come from physical and occupational therapies, which have promoted the skills and understanding of how to live with my degenerative condition.
Unfortunately, as with many ailments, there is no “one size fits all” approach to back pain. I know this only because I’ve tried every single one of them. I hope S.B. will not lose hope, but will gain confidence and understanding that help support his travel along a path I know all too well. — S.S.
ANSWER: Thank you for your thoughtful letter. Back pain is a symptom coming from a wide spectrum of diseases and the therapies we have are appropriate only for some types. However, most young people with no identifiable structural cause for their pain will do well with several types of therapies, including medication, physical therapy or manipulation. If people aren’t getting better with a therapy, it’s time to re-evaluate the whole situation, consider imaging studies to find out what is wrong and, in a very few cases, consider surgery.