Low Back Pain (LBP) has long reached epidemic proportions in the Western world. Acute LBP is one of the leading symptoms that force an individual to seek medical attention. At the same time the chronic back pain is responsible for enormous cost to health care and society.
It has been traditionally, although incorrectly, believed that acute LBP episodes resolve themselves within a relatively short period of time. This mistaken belief has led to the symptomatic management, consisting mostly of the bed rest and pain medication, which is proven to promote chronicity. A scientific consensus gradually emerged over the past ten years that deemphasized the role of the structural findings by MRI and/or X-RAY as being decisive in LBP diagnostics and treatment strategies. By far the most common painful locomotor system conditions are in fact the ones called idiopathic (without an apparent cause) because no structural pathologies can be found.
An alternative had been suggested advising encouraging LBP patients with reassurance that there is no serious life-threatening disease involved and that the only sure road to the complete recovery goes through the measured resumption of normal activities and restoring function. Implementation of this approach resulted in significant decrease in LBP chronicity and consequent disability in part by eliminating the psychological impact of pain on the nervous system.
Restoring function has only recently become the standard in physiotherapy and chiropractic. However the restoration of function is mostly attempted by the practitioners through the purely mechanical means. They commonly fail to acknowledge that functional pathology is not just altered biomechanics, but rather a response of the Central Nervous System to pain and dysfunction by altering motor control a programs residing in the brain. Therefore, it is motor control of the Central Nervous System and not the biomechanics that should be addressed when formulating the treatment of LBP.
It must be also realized that by no means can people complaining of pain with non-identifiable origin be labeled malingerers, nor should their condition be identified as psychogenic. The somatic origin of their symptoms can be easily established. Clinical examination usually reveals the multitude of signs and symptoms of physical origin of pain. And here lies another problem. Because functional aberration can be objectified through the physical examination, it is routinely treated as a mechanical disorder, the approach which, as we stated above, is inadequate and leads to poor treatment outcomes.
When treating the function it is important to realize that the mechanical change is a source of information processed through the Central Nervous System, which in turn makes the locomotor control programs react in a coordinated fashion. Even when mechanical changes are obvious and structural pathology is objectified, it is the disturbed function that should be the primary target of the treatment.
At Dynamic Neuromuscular Rehabilitation we engage a team of specialists covering wide spectrum of medical disciplines. They examine patients from various view points and arrive to the diagnosis based on the medical consensus that involves multiple areas of expertise. This allows formulating the most decisive and efficient treatment strategy that brings to our patients rapid recovery and lasting relief.
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