Catch-a-Lumbago, GO! (Part 1)

Danh NgoLow Back Pain, Uncategorized

What Pokemon have you caught lately?  Lumbago?  Stenosis-kachu? Herniation? Sciaticasaurus?  If you have not noticed, these are not Pokemon creatures but low back pain (LBP) diagnosis but with a Pokemon twist to it.  You can say the company has been reVITALized by this classic game series.

I believe there are a few parallels between low back pain (LBP) care and the Pokemon empire.  Wait, hear me out!  I’m going to let you in on a secret about myself.  I used to play Pokemon a lot (please don’t hold that against me). Each creature is grouped into a certain element like water, fire, earth, etc.  The grouping by element allows the Pokemon to be more effective when fighting a weaker element.  Water Pokemon is better against fire Pokemon.  This concept sounds simple but when applied, allows the system to have an edge in managing back care.

Low back pain (LBP) is something that 1 out of 4 people will get within their lifetime. Even though we live in an advanced medical age with robots assisting surgeries and transplantation of cells to regenerate tissue, the medical system is ineffective in managing LBP.  Successful back surgery outcomes are equal to a flip of a coin, 50%.  This is not a good risk to reward ratio.  Old school medical practices look at LBP as a one-diagnosis-fits-all.  Clinician’s bias based on emotions and experiences prevent consistent, quality care.  The current trend with proven studies (though clinicians may not be using it) has shown that initial management should be based on grouping people into common patterns.  Just like a water Pokemon is a good choice when battling a fire Pokemon.

When grouping people with LBP, treatment based on the diagnosis ONLY has been shown to be a poor method of care.  It has gotten western medicine nowhere and resulted in mislabeled, frustrated patients.  The proven method is to group each LBP cohort by common characteristic patterns followed by MOVEMENT pattern.

Recent data shows that patients are getting effective care when treatment is based on common characteristics.  This is called Clinical Prediction Rules (CPR).  In “Knee Banger Part One” I talked about the knee Ottawa rule.  This helps doctors and therapists to know when someone needs a x-ray.  There are Clinical Prediction Rules to help physical therapists know who and when to perform a manipulation/adjustment, traction and when to focus on “core” exercises.  These guidelines have been a game changer that allows physical therapists confidence in knowing who needs what.  For example if you have LBP and have all five criteria, then the chances of you walking out of the clinic feeling good after a manipulation to your low back is 97%.  I would put money on that any day!  Water will always beat fire any day…(except when the fire is out of control and you don’t have enough water).

What will give you the next advantage when playing Pokemon?  Each creature has traits like speed, the ability to fly, and other fun fighting skills.  A faster Pokemon can outrun a slower stronger Pokemon.  Movement based classification is great in helping us know what treatment will be most effective.  There are two parts to this equation.  What position were you in when you hurt your back?  Which movement or position does your back respond the best to?  First question sounds like a simple concept but highly effective.  You focus treatment by emphasizing movement in the OPPOSITE direction of how it was hurt. If you felt a pull in your back when bending FORWARD to pick up pencil, then the go to option is to focus on bending BACKWARDS.  This a big reason why it hurts more to sit slouched, drive, put on shoes, and perform flexed based chores like mopping and vacuuming.  This is another reason why I am not in favor of stretching out “tight” back, hip or leg muscles even though it “feels good” in the moment.  We want progression of pain relief not momentary pain relief.

It is rare that you would bend forward to stretch out the pain, but this is what many typically do when they have back pain.  The common group of people that tends to need this are gymnasts, volleyball athletes, and overhead laborer like painters.  They tend to “live in” extension (bending back) so bending forward is their treatment.  If you had a compression injury then decompression is your first line defense.  Again this sounds simple, but it is hard to maintain this rule.  This method is highly effective in addressing sciatica LBP patterns, which I will talk about in a future post since that is another complex animal.

Catch-A-Sciaticasaurus, GO! (Part 2)” talks about managing Sciatica.

Email me at for five of my favorite exercises to manage “extension (backward bending)” based back care.  I will add the BONUS page in regards to criterions that will give you the 97% success when you get treated with a manipulation.