Brain Chiropractic – Rules for the Direction of the Mind

02 Feb Brain Chiropractic – Rules for the Direction of the Mind

This isn’t a sequela to Rene Descartes’ work on an unfinished treatise regarding methods for scientific and philosophical thinking. This is just a simple blog about a not so simple subject relating to mind games and low back pain (LBP).

I recently had a patient who complained of a relapse in his LBP from several years ago. A few years ago they had a cycling accident and were treated for several injuries including low back. Records indicated they had no structural injuries, no fractures. It was a moderate-severe case of a paraspinal muscle spasm. Past treatment records indicated in only about 2 weeks the patient was back at full function and had no reoccurrence of their LBP. Until about a week ago when they were skiing and felt the pain return in the same spot as a few years ago. The fear of the injury including body’s internal reaction caused to spark the fire.

Many people with LBP not only experience these kind of episodes but essentially are living in that over-reactive, seized up state. Their back can react to just about every minor occurrence and becomes a continuous reality for chronic patients. This chronicity is further exacerbated by our psychological state. I often witness people buying into the idea that their backs are somehow structurally problematic and they react to every challenging stimulus as though it were a lumbar cataclysm. They literally fear their own spine! I had a patient once who was so sure that they have scoliosis of the spine that was the main cause for their back issues. When I performed a spinal check I re-assured them that the reason behind some of their relatively minor complaints was surely not scoliosis. In order for scoliosis to have any clinical significance it has to be firstly presented in adolescence, be over 20 degrees for closer monitoring, develop further at a rate of greater than 1 degree per year and other clinical factors taken into account. In a well matured individual well in their 40’s, scoliosis that is even 35 degrees that has not been increasing isn’t even warranted for surgery. That’s 35-40 degrees! When I looked at this patient I knew there was no more than 5 degrees to their curve. However the patient was new and after further education, I could tell wasn’t confident that scoliosis wasn’t the cause for their so called “problems”. I place this word in quotation because that’s exactly how they claimed it – “I know it’s my scoliosis that’s causing me all these problems”.  So I decided to run an x-ray to show the patient through visual observation that they didn’t have scoliosis and no, I do not cost the government money for useless x-rays because when the patient at that age has never had an x-ray done before, you never know of signification other findings. To her disbelief, the scoliosis reading was 4 degrees, not anywhere close to 20-40 range that has any clinical significance. Sadly, this isn’t the only case I had like that. Several parents of children complain and fear that their child has scoliosis and start taking the child to all these different kind of physiotherapy clinics without even ever getting an x-ray done to determine the degree of the curvature. The problem is that in most of these cases, the child has less than 10 degree curvature and absolutely no clinical significance. Also, what they don’t understand is that scoliosis is a lifelong structural abnormality. You can help to manage the condition through bracing, manual therapy and sometimes surgery when warranted however you cannot bring the curvature back to 0 degrees.

It can therefore take an enormous amount of de-programming to convince people that their backs aren’t actually as fragile as they think. Mental habits are incredibly strong and our mind is an extremely powerful tool. This is of even greater significance when we are under stressful situations. When we are in pain, we are likely to revert to the most familiar thought patterns. The emphasis on the mind cannot be eliminated nor forgotten when it comes to low back treatment especially. To say that your back pain is all in your head isn’t true. There is undoubtedly pain in your back however it is very much affected by your psyche.

There are some important factors for discussion. The difference between patient “A” whose low back reacts to most minor perturbations and patient “B” who only reacts to more serious cases lies primarily in the psyche. Yes there are certain physiological aspects to consider such as physiology of the muscles involved, how well their T-L fascia functions, musculotendinous junctions, stability factors to name a few. However, how can you explain that someone can also recover faster from a more serious injury rather than someone who develops chronic low back pain from a minor strain. The confidence of the victim and understanding of what’s actually going on are important factors to consider. They have to understand that they aren’t as fragile as they think they are, there is nothing serious about their condition and that most people go through this injury and come out just fine. One example I often use when someone mentions to me that they had this serious knee injury a long time ago and that is their reason behind why they don’t run anymore. After doing more health history, it turns out they had a meniscal tear or ACL grade 2 sprain for example. The patient will state for example that knee injury has never healed. I look at the timeline: it’s been 10 years. How can Rafael Nadal come back to the level of human movement after a much more serious knee injury virtually every year or someone else can’t come back to general running after a meniscal tear? This lies primarily as mentioned, in the psyche and how we perceive pain. Communicating this to the patient should be one of the most important factors and challenges to any health care practitioner. Nadal is no different than you. He is also a human being and his system functions much the same way. He is also just an example I use but this happens to many of us and if we can only understand our bodies a bit better as well as being re-assured from our health care professionals, we can raise the bar when it comes to pain perception for our future generations. If gene transcription and translation has taught us anything, it’s that pain perception is one of the most complicated measurable traits because it is an aggregate of several phenotypes associated with peripheral and central nervous system dynamics, stress responsiveness and inflammatory state.

Diatchenko, L. et al.Idiopathic pain disorders–pathways of vulnerability. Pain. 2006; 123: 226–230