Sunday, November 28, 2010

Back pain troubles, chiropractic, and the multifidus

I've had back pain for just about as long as I can remember, but it is usually mild and somewhat intermittent. Lately it's gotten worse. I know basically why I have back pain: I sit a lot - but at the same time, lots of people sit a lot without as much back pain. I also have bad posture.

The last time I had back pain this bad was a couple years ago, after driving straight for a couple days. I went to a chiropractor and he gave me a quick adjustment for cheap. He first applied heat, and then solidly cracked my bank (spinal manipulation) manually. I felt way better. I don't generally have faith in chiropractic, but I figured I should try it again. This time, the (new) chiropractor first made me go through a whole diagnosis session with an "Insight Subluxation Station", X-rays, and a lot of stretch "testing". Then chiropractor then gave me an adjustment with an "activator gun" which gave relatively little relief. The subluxation station apparently showed my back as registering all sorts of out of whack and out of balance electrical signals, and the X-rays showed evidence of compression in the past (big surprise) but not much else. I would have preferred to look at an MRI scan to see if I have any herniated discs, out of curiosity, but the x-ray is interesting too.

The subluxation station is essentially a surface electromyograph (see THE SCIENCE & VALIDITY BEHIND THE INSIGHT MILLENNIUM SUBLUXATION STATION). I'll try to scan the results and post them later. I'm a bit skeptical, but I'm willing to see how it goes. It does not surprise me that it showed messed up results. I was able to feel my muscles and legs twitching with spasms when I had the really bad pain. I'm guessing that's not uncommon when you have back pain as bad as mine. But now the twitching has basically disappeared and it seems likely that the readings would be a fair bit better - acute back pain is often transient and self-limited, like most infections. The chiropractor seems to want to test me again after doing a dozen or so more adustments, and I imagine the reading will be much better - unsurprisingly. He's also saying that he wants to keep going until my legs are equal length, which is something the activator gun wiki article (linked above) discusses as somewhat dubious. The chiropractor is now expecting me to be a long-term customer, which I'm not really interested in - but I'll play it out for a bit longer (cheap with insurance). In the picture below, the right is me and the left is a healthy control (balanced).

One of the reasons that I will no doubt feel much better is that I'm doing a lot of research and paying careful attention to posture. I've been aware of the Alexander technique, which had a very positive clinical trial published in the BMJ not too long ago. The easiest takeaway from that is to lay down on your back and lift your knees, which is a very relaxing and pain-relieving way to spend some time. I've also been reading through Dr. Jolie Bookspan's articles, and have been particularly intrigued by her article on hyperlordosis as a cause of lower back pain. My back pain is mainly from sitting (the article identifies hyperlordosis as related to standing) but I feel that my back is caused by hyperlordosis. I've tried to implement posture advice and it may have been partly counterproductive - I've been trying to arch my back too much, and every time I do it I can feel the pain and stress it causes. Ironically, in reviewing my x-ray results the chiropractor said I had too little curve and arch, which I think is completely wrong.

Bookspan's research led me to research which has identified more fatiguable trunk muscles in those with lower back pai (see, e.g., Chok et al 1999). Daneels et al (2000) found that only the multifidus was smaller in those with chronic low back pain, and in 2002 Daneels et al found that those with chronic low back pain weren't activating their multifidus. The Musculoskeletal Consumer Review suggests feeling for the multifidus and then exercising it mentally to help activate it, but I can't seem to do that. Suggestions at the SlowTwitch forum include the "pointer dog" exercise, which I imagine looks like the following. There's also the The Multifidus Back Pain Solution: Simple Exercises That Target the Muscles That Count book, which I'll probably buy. The "activation" problem is mentioned by one of the reviewers. The reviewer recommends Spinal Stabilization instead, but interestingly enough the first reviewer of that book similarly complains that there's no real discussion on how to activate these muscles or know if they are activating properly. This article describes how to activate these muscles, and apparently the practice also does real-time ultrasound imaging (RTUS) tests to confirm the activation (unfortunately not in my area). It's so mysterious that I don't know whether I'm activating them or not, and thus I can't blame a couple physical therapists at a forum for ranting a bit about the newest "fad" (although they still annoy me). UPDATE: This is called the motor control exercise in the literature, and a systematic review was published not long ago.

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