Low back pain 1

Most of the entries I post in this blog have to do with metabolic issues (diabetes, obesity, inflammation etc.).  One of the underlying themes you may have gleaned by now is the integration of body systems.  Just when we think some component of our body works in isolation, science will demonstrate an intimate connection with other components of our physiology.  For example, in the series on heart disease, we saw how things like the gut, hormones, nutritional intake, and immune system influence the health of the heart.  For the next series, I want to tackle something just as prevalent; low back pain.

When you think of low back exercises, you may think of abdominal work.  If you find a more thoughtful therapist, he may recommend exercising the gluteal muscles (variety of squats or lunges) and stretching hamstrings.  An even more highly skilled therapist will integrate respiratory exercises and activation of muscles of the pelvic floor. Perhaps your therapist also examines the broader "kinetic chain" and examines your foot, ankle, knees and hips.  We often mistake this as a very sophisticated approach toward low back pain. I will admit that this is light years ahead of where low back rehab was just a decade ago, but we still have a long way to go.  

This paper changed my life forever.  In summary; 83% of patients who had chronic low back pain were found to have low levels of vitamin D.  They were treated with vitamin D and 95% of those treated had significant improvement in their symptoms!  The authors concluded, 

"Vitamin D deficiency is a major contributor to chronic low back pain in areas where vitamin D deficiency is endemic. Screening for vitamin D deficiency and treatment with supplements should be mandatory in this setting."

This paper was published in 2003 when I was in the middle of my residency.  In those years, I spent the vast majority of my clinical time performing physical rehabilitation on patients with musculoskeletal pain.  It irked me that the hours of physical exercise that my patients were performing may have been undermined by low vitamin D.  As more research uncovered the roles of vitamin D, it became clear that even something low back pain, more than likely, involved a intimate integration of physiological systems.

We'll take a closer look in the coming weeks.