Where Did your Back Go?
By: Dale J. Buchberger, PT, DC, CSCS, DACBSP
Last year I wrote, “It is not uncommon to hear the phrase “My back went out!” The question is, where did it go and when will it be back?” A better question would be, what is meant by the phrase, “my back went out”. As common as this phrase is very few people can offer a viable explanation for it’s underlying meaning. Recently I have had several patients come in and state, “I went to my chiropractor and they told me, my hip was out”. I never really understood this type of terminology. To me it just meant it was easier to come up with some quick commonly used phrase than to take the time to explain to the patient what is actually wrong with them. This is no different than a medical doctor, physical therapist or athletic trainer telling a patient they have tendonitis when there is a more complicated problem occurring. It is just easier and faster to say, “your hip is way out” or “you have tendonitis”.
If your hip or your back actually went “out” you would have a medical emergency on your hands and you would more than likely be in an emergency room under sedation or on an operating table. So what does this actually mean? Saying that your back “went out” is a generic phrase commonly used when you experience acute back pain or a level of back pain that prevents you from functioning as you would normally. There are many conditions or incidents that can cause the “back to go out”; generalized weakness, sprains, degenerative conditions such as arthritis, degenerative disc disease, disc herniation, spinal stenosis, etc. So if your back goes out you shouldn’t settle for an answer such as “your L4 is out” or “you threw your back out”. You should press your health care provider or a more sound “cause” of your back pain based on the regional anatomy and the current state of scientific evidence. For the most part when we experience pain there is an anatomical and physiological reason for the pain. As a healthcare provider it is my job to figure out what that cause is and do my best to explain it to the patient. My experience has been that when I can do a good job explaining the patients condition and they have a good understanding of the problem they are more compliant with treatment and are more dedicated to following through with home care recommendations. This usually leads to a better outcome.
Along the lines of the spine is the subject of patients “cracking” their neck or back. This makes me very nervous when patients say, “when my neck gets stiff I crack it like this (actually demonstrating the maneuver) and it feels better for a while. But the pain comes back”. First of all when you crack your neck or back it is referred to as “auto manipulation” meaning that you perform the manipulation to yourself. Not only is this counter productive it is potentially hazardous. Typically when there are spinal joints that don’t move well there are also areas that move too much. Auto manipulation usually fails to address the poorly moving or tight joints and over manipulates the excessively loose joints making them looser. In the neck or cervical spine patients who “crack” or “auto manipulate” their own neck have an increased risk of a self inflicted stroke. If you find yourself “cracking” your neck or back, on a regular basis (more than once a day) you should seek the opinion, of a healthcare provider trained and skilled in the area of manual therapy and/or spinal manipulation.
While the internet can be a powerful research tool it can also me very misleading. If you do perform research on your condition before seeing a healthcare provider be cautious with the information you find. Remember that just because it is on the Internet it does not make it true. Wikipedia is not a scientific reference source so please don’t rely on it for your healthcare choices. If you would like to do a quick search for information on the internet and you find PubMed or Medline to be too cumbersome you may want to try Google Scholar. This will filter out much of the advertising based information and keep the search predominantly scientific and peer reviewed. If you do bring information from the Internet to your healthcare provider you should print it and bring it with you so that your provider can place it in your medical record. Having this information will also allow your provider to check the information and give you feedback on the reliability of the information. Remember, it all comes back to clear communication with your healthcare providers. The words we use matter.