Whats non-specific back pain
Some of you written to be asked to explain what i mean by non- specific back pain. Some of them even pointed out they can actually find the “cause” for low back pain. So, i like to throw some light on the issues which surrounds the cause and pathology of Low back pain.
Broadly Low back pain is traiged into 3 types:
specific back pain (red flags)
non- specific back pain
radiculopathy- sciatica.
specific back pain - is when you know the pathology- from major trauma to infection.
As i have already written about sciatica i am hoping to clear the air about non-specific low back pain.
What does non-specific Low back (NS-LBP) pain mean?
It means we don’t know the exact pathology. I know many of the readers could have read a list of pathological reasons for back pain. The usual suspects are: degeneration (hence the name spondylosis), disc bulge (can’t drive anywhere without seeing this from a siddha clinic to ortho clinic), sprains and strains, facet joint syndromes, alignment, posture and more.
If you had spent a good amount of money you could have read about newer suspects like: trigger point, the fascia (with or without train) alignment and much more.
aren’t any one of these the patho-anatomical reason for back pain?
Determining cause and effect, known as etiology (A causing B), is one of the most challenging problems in science. Our lack of understanding and poor teaching about the scientific process to determine causal pathway makes it more confusing.
Lets take the common causal pathological reason attribute for back pain, the degeneration of spine, the disc herniation.
How will i determine these changes are the pathology of low back pain?
Determination of cause is fairly complex, but we will look into some scientist use to tease out the causative agents. One such method involves observing whether the causative pathology resolves after treatment. For instance, in the case of an infection, the bacteria responsible should either be eliminated from the body or present in minimal amounts after treatment. However, in low back pain, if pre- and post-treatment imaging such as X-rays or MRIs do not show a resolution of degeneration, it suggests that the underlying cause may not be degeneration or something went wack with the spine.
Another challenge in identifying the pathoanatomical cause of low back pain is temporality, which refers to the cause preceding the effect (the disease). For instance, if a bacteria enters the body through food consumption, it should lead to a stomach upset before any subsequent symptoms, such as low back pain, manifest. Therefore, it is crucial to determine if the hypothetical cause occurred before the onset of the patient's low back pain.
Did the mystery trigger points arise in the muscle first, followed by the onset of low back pain in the patient, or was it after the occurrence of low back pain that you noticed the trigger points? Did the fascia, muscle, or other soft tissues become tighter first, leading to the development of low back pain, or did the low back pain precede the tightening of these tissues?
If no they are basically symptoms not pathology
Strains and sprains are a good candidate for causal pathology. But due to the numerous muscles and degree of freedom the pattern of symptoms are again- non-specific to ascertain the pathology. (Here non specific refers to varied pattern of pain and movement restriction)
It's worth noting that pioneers in manual therapy such as Maitland and Grieves focused primarily on understanding patterns of symptoms and developing treatment strategies rather than claiming to have identified the underlying pathology of problems. I believe there are valuable lessons to be learned from their approach.
Evolutionary biology emphasizes that humans possess an innate tendency to seek patterns and infer causal factors based on these patterns. However, relying solely on pattern recognition is not always accurate. It is essential to employ rational and scientific thinking, along with experiments, to accurately tease out causal factors.
Science for now seem to suggest- low back pain is non- specific.
Tigers got to hunt, birds got to fly:
man got to sit and wonder “why, why, why?
Tiger got to sleep, birds got to land:
Man got to tell himself he understand.
- Kurt vonnegut
with so much love
K Hariohm
Completely agreed sir. It's quite difficult to convey the pts with low back pain that the cause is unknown . The term non specific is less favoured by the pts as it gives the feeling of uncertainty. Also gives the impression that the healthcare professional is clueless about what am dealing with.
How to better communicate these uncertainty sir.