Pain without training, What do? (Sedentary back pain, who to see?)

Pain & Rehab Forum [Moderated]
1

I posted this on the Facebook group as well, thought maybe this is a better medium though:

Question for the Docs/PTs etc Regarding sedentary back pain, and what medical professionals to go see.

My wife is currently stuck in bed with back pain and I’m not sure what I can do to help or point her in the right direction. She’s Late 30s, doesn’t workout at all but probably underweight if anything @~48kgs(105lbs) (and she’s not very short) but no chronic meds or anything.

She had a MRI confirmed “bulging disc” in her 20s, presumably after a car accident but couldn’t be confirmed that was the cause. Doctor/neurosurgeon back then put the fear of god in her describing surgery to replace the disc, lots of fear about lifting anything, doing leg presses etc. That was 20 years ago and she’s been largely ok ever since, having a child in the mean time as well.

Last 3 or so weeks, back pain returned, got worse and worse. No identifiable cause or reason we can think of.
She went to see a Biokineticist on Monday because it’s fully paid for by our medical aid, so a decent first port of call (Kinda like a physio…I don’t think it’s a thing in USA). He did some massaging/manipulations and had her stretch over a bosu ball etc but actually had her do air squats in between to “check alignment”.
Monday she got home, feeling much better…Tuesday morning, can barely move.

Repeat the process, gets home feeling a bit better, Wednesday morning, pain really bad, can barely get moving. BioK guy refers to a Chiro.

Wife goes to Chiro, says she’s skeptical, doesnt want “cracking” or anything. Chiro seems to be ok with this and does similar physio type massage stuff. Diagnoses a herniated disc (How? Does she have MRI fingers?) but after being told about the previous one in my wife’s 20s as well (Skeptical me is skeptical).
That was yesterday and again my wife can barely get up today, missing work again, really struggling with the pain. Doesn’t seem to be any numbness anywhere or nerve stuff though.

My question after all of that is what sort of medical professional should she see? I’m SUPER skeptical of the Biokineticist and Chiro so struggling to see the point of them and they clearly aren’t helping. But then I’m guessing our family Doc/GP is just going to prescribe stronger pain meds…Who would he refer her to…Back to a Chiro? Surely not?
I want to help but not sure what to do. Pain in NOT training…What do?​

2

Hey,

Sorry for the radio silence here! I don’t work for BBM but topics often get buried on occasion.

Are you familiar with BBM’s work on pain, broadly speaking? Given the title I would assume you are, but the general principles in here apply: Pain in Training: What To Do?

I’m not a qualified medical or rehab professional, but have been down the pain road and have been misled by well-meaning but ill-informed clinicians, and have walked rehab paths a few times. A few points from various BBM podcasts (will try and find the articles and references if you’re interested). Absent red flag symptoms like saddle numbness, lost of bowel control, etc:

-Imaging is not recommended as findings don’t correlate reliably with pain. TL;DR – whether or not it’s a herniation doesn’t really matter. I’m amazed and the overwhelming number of clinicians and medical doctors that are ignorant of this, to the severe detriment of their patients.

-Most randomly available clinicians seem to be very out to lunch on their understanding of pain

-Pain is very much multifactorial

-The only things that generally help with back pain long term, according to research, are exercise and education

Again, not a qualified professional, but if I were in your shoes I would consider an option like the BBM low back pain template and probably modify the upper body component to use the Beginner Template or Beginner Prescription’s work (the “Prescription” is a free first phase, see here: https://www.barbellmedicine.com/wp-content/uploads/2019/05/The-Beginner-Prescription.pdf). If you’re really stuck, and would like to speak to a professional, I would highly recommend the BBM pain and rehab team. I worked with Dr Miles for two months and he was excellent. It’s a great deal more affordable than frequent physio or chiro visits, and I would bet money it would be significantly more productive.