1. Muscle, nervous system, joint or biochemical? Where is the pain coming from?
**2. Healing and the power of time. **
3. Empirical practice, scientific knowledge and application. Don’t refer to google as a guide to healing low back pain.
What started with a knee injury from squatting turned into a low back issue for powerlifter Dr. Ken Kinaken. It was two weeks before the Canadian Powerlifting Championships when he heard his knee make a sound like bed sheets ripping. Kinanken recalls how he could still run and climb stairs, but he would still feel pain when squatting over 400 pounds. It was another nine months before he was told it wasn’t his knee, rather his low back and SI joint that was the root cause.
Kinaken speaks to DTS Fitness Education Director of Education Ben McDonald about his journey into healing and how he works now to educate and help others with back pain.
#1) Muscle, nervous system, joint or biochemical? Where is the pain coming from?
According to Kinaken, the most critical step in addressing back pain is to get a proper assessment and to differentiate between a muscle problem, a nerve problem, a joint problem or a biochemical problem.
The challenge for all health practitioners whether it is chiropractors, massage therapists or physiotherapists, is to address all the possibilities and not just one isolated area.
“You really need to figure out if you’re dealing with a muscle problem, joint problem, or nervous system problem,” he says. “The nervous system issue has been changing the last two to three years in which it’s really focusing heavily on the brain. What we’re starting to see if that if you have pain in the low back long enough it changes the brain. All of a sudden your ability to contract or perception of pain alters.”
Kinaken’s experience working with medical doctors in a pain clinic for five years clarified for him how chronic pain affected people’s brain and their perception of pain.
“We’re seeing an emergence of treatments for the low back by doing brain protocols. Are you dealing with inflammatory issues, because if you’re constantly inflamed, that’s also going to give you pain,” he adds.
Another area of assessment is diagnostic imaging, which includes X-rays, ultrasounds and Magnetic Resonance Imaging (MRIs). The problem, however, is if a disc herniation is shown on an X-ray people would say this is where the pain is originating from, Kinaken says.
“Ultimately, the assessment and protocols should be based off a functional standpoint. Does the person have good strength, do they have a good range of motion, can you increase the pain by doing different orthopedic tests, then you correlate that with what you see off an xray or MRI,” says Kinaken. “You never diagnose off an X-ray or MRI because a lot of times you can have two X-rays where one looks like it has complete disc degeneration and the other one looks perfectly normal. When asking people who has pain, the obvious choice is the one with disc degeneration but it’s actually the other one. It backs up your actual differential diagnosis then you build up your protocol with a combination of treatment and rehabilitation exercises and any other protocols you may need.”
People need to remember that each problem results in a different protocol, and one can have more than one problem at the same time.
**#2) Healing and the power of time. **
The body wants to heal itself.
“Time is really, really important in terms of what’s given to heal an injury,” explains Kinaken. “If you don’t give it enough time to allow the bone heal, it will turn from a micro fracture to a macro fracture and that’s how you end up with end plate sclerosis and fractures and everything else.”
Micro fractures in vertebral bodies, for example, are good for powerlifters as it helps build up resistance and strengthens the bone for heavy lifting. When these micro fractures aren’t given enough time to recover, it becomes a bigger issue. Similarly, this also applies to discs.
Though Kinaken preaches the benefits of strength training and lifting heavy, heavy volume training isn’t necessary all the time.
“There was a study at the University of Saskatchewan where a guy came in with classic disc herniation signs. If you’re lying on your back (called straight leg raise test) he could only get it to 70 degrees and he was feeling pain all the way down his foot,” he recalls.
The study’s participant lost his knee reflexes in the one leg; he couldn’t maintain his foot drop so his anterior tibialis would slap on the floor; and he was getting atrophy on his right leg. An MRI was completed and because it was at a university hospital they did conservative therapy, exercises, chiropractic application, soft tissue therapy, and traction.
After 12 weeks, he recovered everything and physically it looked like he was healed. They redid the MRI and the disc herniation was identical to when he first did the scan.
“That’s what we’re starting to see, whenever there is a disc herniation that inflammatory products around that area was creating the symptoms. Overtime, the inflammatory products would get reabsorbed and strengthened up even though the disc herniation was the same,” explains Kinaken. “We’re starting to see this more and more where people say they have a disc herniation and say they can’t do anything. You just have to be intelligent about it. (Dr. Stu) McGill says it best when he says take time off, it’s not going to be days or weeks to recovery - we’re talking months. And do the exercises that will help it.”
Time, and the correct assessment and application of protocol, is the best medicine for low back pain.
#3) Empirical practice, scientific knowledge and application. Don’t refer to google as a guide to healing low back pain.
“The biggest thing is whenever you get back pain, your friends and family will give you well-intentioned bad advice,” chuckles Kinaken. “You’re a mechanic and all of a sudden you’re giving rehabilitative exercises and ideas that worked for you. And that’s fine because it may have worked for you when you saw your chiro, physio or doctor, but it has nothing to do with their pain.”
Pain is an individual listing and there may be a number of different reasons why you’re experiencing - it could be as something as simple as the way you sit or it could be your car seat. Google is not the reference point to solving low back pain.
“A clue is when people say, ‘It always bothers me when I drive.’” he says, adding when you eliminate daily activities, what does that reveal? “The evidence will always be based on what you are able to actually find and test it. A lot of the time through different testing we’re finding out a whole bunch of different things.”
Following one stream evidence and not changing when the evidence changes is part of the problem of constantly updated information as technology improves.
“I’m a huge believer in finding out all the research. I’ve got thousands of books and papers and I attend seminars all over the world, and I take a look at what works empirically,” says Kinaken. “That’s the bottom line - does it actually work? I’ve seen whacky shit work and I’m like, I have no idea what you just did but it’s working really, really well. I’m not going to discount it because there’s no model around it or we don’t know why it works.”
In the early 1700s, an Englishman came to North American and noticed all the Native Americans eating white willow bark whenever they were in pain. The Englishman took samples back to England, analyzed it and when people took it, whatever pain they were feeling would go away.
“What they found in white willow bark is salicylic acid. The guy’s name was John Baylor, the maker of aspirin,” explains Kinaken. “That is what aspirin is made of, salicylic acid, which is white willow bark. They didn’t know until 1971 how aspirin worked, yet they were using it empirically.”
Don’t throw out the empirical but keep looking for science, keep doing all the investigations and that’s the emergence of seeing what works and what the evidence says, concludes Kinaken.
Resources and References from the Podcast
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