Back Pain

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Understanding Back Pain-One of the most Common & Expensive Health Conditions in the United States

Back Pain-The 2nd Most Common Reason For Missed Work

If you have ever experienced back pain, you are not alone.  Back pain is the 2nd most common reason for time off of work (behind the common cold).  If you have experienced back pain (80% of the population has) you know that it can be both frustrating and sometimes debilitating.  Often episodes are triggered by trivial tasks such as putting on a sock or shoe!  Once present, back pain can interfere with many hobbies, work, activities of daily living and even sleep.

Research has shown that your first point of contact dramatically determines your surgical risk.  In the journal Spine, researchers showed that 1.5% of workers with back injuries who first saw a chiropractor went to surgery.  However, when the first point of contact was a surgeon or M.D., 42.7% went to surgery!


When we refer to the back we are actually referring to the spinal column which is made up of vertebrae, discs, joints and ligaments.  The muscular system protects the spine and controls movement.  There are many layers of muscles that work together to stabilize and move the spine.  When each muscle group/layer is healthy the back remains strong flexible and coordinated.  

Whether you are aware of it or not, the muscles support and control movement for all of your activities – putting on socks or shoes, vacuuming, changing positions, carrying a bag of groceries.  If any of the muscles surrounding the spine become tight, weak or uncoordinated, it will place increased load on the adjacent muscles, ligaments, tendons, discs and joints.  Repetitive trauma, poor posture, deconditioning, acute injuries, lack of mobility and prior injuries can all result in altered function and health of the spine and core musculature.  When these areas become compromised injury risk increases.  Often times the changes in function precede the injury.  

Repetitive trauma, poor posture or acute trauma will all cause strain to your tissues.  Over time this strain will develop into micro-trauma (small scale damage that occurs in muscles, tendons, ligaments, joints and discs as a result of strain/load).  Interestingly, micro-trauma may not be painful initially.  It may also be perceived as a mild ache or tightness in the muscles.  Even though the damage is small, repair is necessary.  The body responds to micro-trauma by laying down irregular piles of scar tissue to fill in the damaged areas.  Over time the layers pile up and accumulate into adhesions.  Adhesions restrict motion, decrease blood flow, restric joints and increase tightness/stiffness.  These changes cause additional load or strain on the spine and cause additional scar tissue, weakness and dysfunction.  Essentially, a strain – micro trauma – scar tissue/adhesion formation -injury cycle is created.

When we consult with patients, it is common to hear them say they have had some sort of ache, tightness or pain for weeks, months or even years prior to their injury.  


Traditional approaches to relieve back pain include anti-inflammatory medication, rest, ice, braces, ultrasound (US), muscle stimulation (E-Stim), stretching, and exercise. Unfortunately most of these traditional techniques generally require a long period of time before they provide only temporary relief from symptoms instead of fixing the underlying cause of the problem.

The main reason that these approaches are often ineffective is that they fail to address the underlying scar tissue adhesions that develop within the muscles and surrounding soft tissues. It is these adhesions that are binding the tissues together, restricting the normal movements, and interfering with the normal flexibility and contraction of the muscles in and around the spine.           

Passive approaches such as medications, rest, ice, and steroid injections all focus on symptomatic relief and do nothing to address the muscle restrictions and dysfunction. More active approaches such as stretching and exercises are often needed for full rehabilitation of the condition and to restore full strength and function of the muscles, however, they themselves do not treat the underlying adhesions. In fact, without first addressing the scar tissue adhesions, stretches and exercises are often less effective and much slower to produce relief or recovery from back pain. 

Our Approach: ART® – A Better Solution

ART® stands for Active Release Techniques®. It is a new and highly successful hands-on treatment method to address problems in the soft tissues of the body, including the muscles, ligaments, fascia, and nerves. ART® is highly successful in dealing with back pain because it is specifically designed to locate and treat scar tissue adhesions that accumulate in the muscles and surrounding soft tissue. By locating and treating the soft-tissue adhesions with ART®, it allows the practitioner to, 1)Breakup restrictive adhesions, 2) reinstate normal tissue flexibility and movement, and 3) more completely restore flexibility, balance, and stability, to the injured area and to the entire kinetic chain.     

You can think of an ART® treatment as a type of active massage. The practitioner will first shorten the muscle, tendon or ligament, and then apply a very specific pressure with their hands as you actively stretch and lengthen the tissues. As the tissue lengthens the practitioner is able to assess the texture, and tension of the muscle to determine if the tissue is healthy or contains scar tissue that needs further treatment. When scar tissue adhesions are felt the amount and direction of tension can be modified to treat the problematic area. In this sense, each treatment is also an assessment of the health of the area as we are able to feel specifically when the problem is occurring.

An additional benefit of ART® is it allows us to further assess and correct problems not only at the site of pain itself, but also in other areas of the kinetic chain, which are associated with movement compensations and are often contributing factors to the problem. This ensures that all the soft tissues that have become dysfunctional and are contributing to the specific injury are addressed, even if they have not yet all developed pain.    

One of the best things about ART® is how fast it can get results. In our experience, back injuries respond very well to ART treatment, especially when combined with the appropriate home stretching and strengthening exercises. Although each case is unique and there are several factors that will determine the length of time required to fully resolve each condition, we usually find a significant improvement can be gained in just 4-6 treatments. These results are the main reason many elite athletes and professional sports teams have ART® practitioners on staff, and why ART® is an integral part of the Ironman triathlon series.

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