So, what’s up with low back pain? Well, here’s what’s up with mine:
To quote from The Book of Pal:
Just below the L4-L5 disc, behind L5 vertebral body on the
right side, there is evidence of a large extradural soft tissue density
measuring approximately 1.5 x 0.8 cm in its maximum vertical and
anteroposterior dimensions respectively. This has the appearance of a large
extruded disc fragment within the epidural space, compromising the right L5
And we say, “Amen.”
An MRI of the lumbar spine consists of hundreds of images; I’ve pulled one out for you. It turns out that science is still beating superstition. Visible on the MR images is a disc fragment pushing on nerves that happen to correspond exactly with my symptoms. If someone were to view this MRI without my story, they would predict how I feel correctly. Conspicuously absent from the pictures—subluxations, qi, worms.
What does the evidence have to say about my treatment and prognosis?
Clinicians should inform all patients of the generally favorable prognosis of acute low back pain with or without sciatica, including a high likelihood for substantial improvement in the first month.
Self-care education books based on evidence-based guidelines, such as The Back Book, are recommended because they are an inexpensive and efficient method for supplementing clinician-provided back information and advice and are similar or only slightly inferior in effectiveness to such costlier interventions as supervised exercise therapy, acupuncture, massage, and spinal manipulation. Other methods for providing self-care education, such as e-mail discussion groups, layperson-led groups, videos, and group classes, are not as well studied.
Basically, there are no particularly strong recommendations to follow for the treatment of low back pain, primarily because it gets better on its own most of the time. This isn’t just great news for patients, but also for doctors and quacks. It’s good news for patients for obvious reasons—there misery will go away on its own. For doctors and quacks, it’s hard to screw this one up. Whether you prescribe ibuprofen, physical therapy, homeopathy, or goat sacrifices, your patient is likely to improve, and you get to take the credit.
At this point, I’m staying away from the woo, and I’m going to let nature take its course.