Dr. Nathan Kadlecek, PT
Is a physical therapist committed to providing high quality health information, largely focused on lower back pain and the gross overuse of diagnostic imaging, medication, surgery, low quality treatment methods, and the over-diagnosis of pain conditions. He's also a powerlifter, pain nerd, macro-scale thinker, and wants to help you think differently about pain, healthcare, and life.
There are a few “conditions” that i’ll share below that are complete nonsense. You’re not “stupid” for believing these, a multitude of practitioners still peddle in falsehoods (unknowingly) and outdated treatment paradigms. I’m not going to go into full detail into each of the conditions in this article as it would likely become a books length, but i’m going to keep it short and to the point. (at some point I may update this article to become more exhaustive)
Bulging discs and degenerative disc disease
These are normal findings. Let me repeat, these are normal findings in most adults. (insert disc degeneration findings)
Please refer to my first sentence saying “I’m not saying these things never contribute to pain.”
As you can see from this graphic, in people who have NO PAIN whatsoever, these findings are present.
You might be saying, “well, I have pain, and I have those findings, so those don’t apply to me.” Absolutely. I think the disconnect between the statement above is that providers will tell people “oh hey, good news, that’s normal,” but then the patient, or you, thinks, “okay… well if that’s normal, then WHY DO I HURT?”
Sadly the conversation often stops right there and everyone is just as confused as when they first walked into the appointment.
There are several reasons “why you hurt,” which we are going to discuss later on in this article/video.
Disc herniations (pinched nerve)
Large disc herniations can certainly be a direct cause of symptoms as they may compress spinal nerve roots to a large degree causing decreased blood flow to the nerve root, resulting in metabolite build up, leading to more “danger signals,” being sent up to the brain, resulting in a painful sensation down the leg. The challenge with this though, is that not everyone who has compression of a nerve root actually has severe symptoms. This is why it’s important to do a clinical exam prior to getting an X-ray, or an MRI. Additionally, the larger the disc herniation, the higher the likelihood that it will resorb (heal) naturally, with time.
Again, this can cause some cord compression or if it’s foraminal stenosis can cause compression of nerve roots. But, as we discussed above, this can cause symptoms or people can have little to no symptoms.
While it’s certainly true that some people who have scoliosis have more back pain, it’s also true that most people will be able to improve their symptoms even if they have scoliosis. In more severe cases of scoliosis where the curve is excessive and causing breathing issues, surgery can sometimes be indicated. In the majority of cases a small degree of scoliosis is actually pretty normal, and by making some lifestyle improvements you can actually reduce a lot of the symptoms.
Lots of people experience these. They are incredibly painful and often times they come out of the blue from movements as simple as picking up a sock off the floor, sometimes bending and twisting, etc. The interesting thing is, that it’s not always from lifting heavy objects. Often times people will experience back spasms in their lower back from doing simple, low effort activities. Causes of back spasms, again, goes back to our body trying to protect itself, even if it doesn’t necessarily have to.
Subluxations or bones going out of alignment.
This is complete and utter nonsense that needs to die a fiery death. (can you see how much I disagree with this teaching from so many practitioners). It’s simply not true, it’s not supported by the research, we can’t reliably find differences in bone positioning or bony landmarks between different providers, it’s useless.
I’m going to link to a few different articles you can read about this.
Pelvis is rotated or twisted
This is complete nonsense. The only way for this to happen is with severe trauma, or potentially ligamentous laxity with childbirth. So… this doesn’t happen, it can’t be correct by muscle energy techniques, or massage, or a hammer and chisel… it just doesn’t happen and you can’t correct something that is imaginary. I expect to get a lot of hate from this one even though I clearly articulated in the beginning of this video of what the true nature of pain is.
I’m going to link to a few different articles you can read about this.
Leg length discrepancy (hips are off)
Complete BS and utter nonsense.
Subluxations, bones out of alignment, and leg length discrepancies or rotations all make a critical error, that our body isn’t adaptable to various positioning of our bones and joints. And, there aren’t even reliable measurements to show these things happening under randomized controlled trials.
Why people feel better after getting these things corrected has an explanation too, which put simply… is because people trust the provider and believe that it will help. If there is nothing to correct, but you believe there is something to correct, and then that person “corrects it,” and you immediately feel better, wala, problem solved.
When I type in “why does my lower back hurt?” or “what causes lower back pain,” this is what comes up.
Most low back pain is the result of an injury such as muscle sprains or strains due to sudden movements or poor body mechanics while lifting heavy objects. Low back pain can also be the result of certain diseases, such as: cancer of the spinal cord or a ruptured or herniated disc.
Upon reading this, you might think, “yep, that makes total sense. If I bend or twist the wrong way or use poor mechanics while lifting heavy objects, then that’s definitely a cause, and, it’s an injury.”
What if I told you though that this line of thinking is old news from the early and mid 1900’s?
And… that it’s unhelpful, leads to more disability, and lower quality of life.
Do you really want to be stuck in that old way of thinking?
I really hope the answer is no. Let’s jump into the 21st century.
(Yes, there are some instances where this is the cause, but most of the time it’s not those injuries/diseases stated above, AND, there is the context around it… read on to find out more)
Currently, in the United States, it’s estimated that there are 16 million people who have chronic lower back pain.
“Some 16 million adults — 8 percent of all adults — experience persistent or chronic back pain, and as a result are limited in certain everyday activities. Back pain is the sixth most costly condition in the United States. Health care costs and indirect costs due to back pain are over $12 billion per year. “
As you can see, it’s a huge issue. And that $12 billion per year, that’s just on out-of-pocket spending. When you combine neck and lower back pain together it’s $380 billion, with a B. That’s more than Jeff Bezo’s net worth, every year.
Pain is protective. Pain informs us of potential or actual tissue damage and potential or actual danger.
Pain tries to protect us from dangerous stimuli, to keep us alive. The frustrating part though, is that pain is NOT ALWAYS associated with true danger, oftentimes we feel and experience pain, even when there is no actual danger or tissue damage.
Pain is like a smoke alarm… when your smoke alarm is working properly it notifies of danger due to a fire and you get to safety. Pain does the same thing if you fracture something or experience some other type of trauma. It notifies you that you need help.
But… our smoke detector doesn’t always work so well… it malfunctions… you’ve experience it...
Cooking a delicious meal and an invisible amount of smoke reaches the smoke detector. It trips the smoke detector and all of sudden the house is in a panic, trying to find a pillow to wave rapidly over the detector to turn it off (kind of like us rubbing a sore spot).
Keep this thought in mind as we go through the rest of this video.
There are two leading causes of muscle cramping that have been studied to date.
1. Electrolyte imbalance
You have a higher risk of cramping if you meet a few criteria:
3. Low fitness levels
You can develop a cramp from being overhydrated or underhydrated because both scenarios will lead to your electroytes being less balanced.
It terms of low fitness levels, routinely exercising and pushing your muscles to fatigue is a great way to protect again muscle cramping and spasms, particularly if you like to perform higher intensity activities in high temperature environments.
Please share in the comments below what you've tried to improve muscle cramping/spasms, and what's worked/not worked!
Do you have low back spasms and you're having difficulty moving or walking? If so this video will answer a lot of your questions.
There are a few different strategies to help in the first couple days of a back spasm.
Step 1: Try not to panic. When we panic, things get worse. Panic never solves any problems and we need to avoid this.
Step 2: Use heat, ice, NSAIDs (non-steroidal anti-inflammatory drugs) as prescribed by your doctor.
Step 3: Move, even if it hurts a bit. It's important to stay moving, walking if you can. You'll likely not feel like it as there may be significant pain with it, however it's important to get the muscles moving and the body moving. Resting for multiple weeks at a time is almost never the solution to a back spasm and early + often movement is the best strategy to address low back spasms.
This three step strategy can be carried out over the course of a 0-5 days and each person is going to respond differently.
If you've had lower back spasms for longer than a couple weeks, or, it keeps coming back, then you'll likely want to work with someone, preferably a physical therapist who can help you come up with long term solutions to your lower back pain, rather than just slapping on a band-aid, and hoping it goes away.
Most people come to me and ask me the same question... I want to improve, however i'm worried and concerned about trying new things that might make my pain worse.
In this video we are going to talk about how to reduce the risk of making things worse, and why low back pain and high levels of it, doesn't always mean high levels of tissue damage.
Bear with me, as this is a counterintuitive topic! Please ask any questions you have in the comments below!
All or nothing. A strategy that has left many millions of people broken, in it's wake.
Life doesn't have to be all or nothing. Exercise doesn't have to be all or nothing.
All or nothing is not sustainable. It's important to recognize that while taking action is incredibly important, so is the recovery process. You must be resting and recovering to perform at your highest potential. Don't forget that.
#recovery #energymanagement #takeaction