Ineffective treatments for low back pain might actually make the pain (and treatment) worse

Everyone who served in the military knows someone they served with who suffers from low back pain. Researchers have tracked 1,981 records dating back to 2005, and found that low back pain is the most common complaint in the military, affecting troops and readiness. It’s no wonder, considering all the literal and figurative heavy lifting we do for the country.

For the individual service member, once low back pain develops, it becomes the biggest risk factor for permanent disability.

It’s important to know what kind of low back pain we experience, because a misdiagnosis of the real problem can lead to ineffective treatments, costly care and a lifetime of real chronic low back pain—all of which are highly prevalent in military members, regardless of their occupational specialty.

There are four kinds of low back pain: acute, subacute, recurrent, and chronic. The most prevalent and costly of these (and the type most associated with military members) is chronic. Generally speaking, acute pain is caused by a sudden injury to the muscles of the low back, subacute is pain that lasts from 4-12 weeks, and recurrent is a pain that keeps coming back. All of them can lead to chronic low back pain.

Clinicians focus on keeping the other kinds of pain from transitioning to chronic low back pain, but if it’s unreported or underreported (and in the military, it often is) or misdiagnosed, it will only get worse over time, which can lead to depression, reduced mobility, or permanent disability. A misdiagnosis, can lead to ineffective treatments, which will usually be palliative, addressing only the symptoms and not the underlying cause.

Any kind of lower back injury, be it a small strain during PT, pulling a muscle while loading a pallet, or a larger one, like hitting the side of an aircraft during a jump, can lead to chronic low back pain. The multifidus muscle group next to the spine stabilizes the spine and the vertebrae. Normally, it functions almost subconsciously, getting signals from the brain to provide support for everything we do all day.

When the multifidus is injured or disabled, the brain can stop sending signals to the muscle, causing it to stop working, atrophy and degenerate to the point where some areas will be overtaken with fat. It’s the largest stabilizing muscle in the back, so the loss of support will shift the load to your spinal joints and discs, causing chronic mechanical low back pain. It’s a disorder called multifidus dysfunction and it’s the most overlooked cause of pain.

Medical care for low back pain is costly, can be time-consuming and can put some at risk of opioid addiction. There are some who even suggest mindfulness and meditation as a treatment. While that might help general quality of life for some people, it’s not going to help low back pain suddenly get better. In fact, prolonged periods of sitting can make chronic low back pain worse.

There are some drugs that can temporarily help with chronic low back pain, but none of them are intended for long-term use. Analgesic creams and anti-inflammatories are a band-aid for a much larger problem. Opioids run the user a risk of addiction, and would only be prescribed if all other avenues have failed.

Pain clinics offer injections that will also help lessen pain in the short term. Steroids, ablations and nerve blocks are a few types of palliative pain treatments. Steroids carry the problem of weakening the immune system and can cause anxiety and even increase the pain. Nerve blocks and ablations simply block or deaden the nerve to prevent them from sending pain signals to the brain, but only temporarily before the pain returns and a repeat procedure with less effectiveness over time is often required.

Physical therapy is a common-prescribed treatment for chronic low back pain. It requires a definite diagnosis, and has to be deployed in the acute or subacute phase of back pain to try and re-establish this muscle function. Even with a physical therapist who is trained to help multifidus dysfunction, multiple visits and the continuation of exercises at home and well into the future, cannot rehabilitate a chronic back pain condition caused by multifidus dysfunction. Even if the patient is willing to continue the exercises, the relief from physical therapy may be limited because of how deep multifidus muscles are and because they are involuntarily controlled. Patients can’t “flex their multifidus muscle” like a bicep or quadricep. The brain controls this muscle involuntarily through a process called proprioception. 

For those suffering from multifidus dysfunction, it's not just the chronic pain they need to worry about. The pain is caused by the increased workload on the spine and discs, which can cause long-term damage and permanent disability. This is particularly troublesome for military members, who are not only prone to chronic low back pain, but that pain is almost guaranteed to return if left untreated.

Most of the treatments described above will only treat the symptoms of the pain. While that may be nice in the short term, it’s important for patients to consider that there is something seriously wrong with their back muscles and time really is a factor. Not only are those treatments expensive, they are not treating the cause of the pain. As time goes on, the pain will be harder to address.

There is currently only one long-term treatment that is clinically proven to help with multifidus dysfunction and provide significant pain relief. Mainstay Medical has created a device called ReActiv8, an implant that can be inserted under the skin in an outpatient procedure to reestablish its connection to the brain.

ReActiv8 uses electric leads to activate the multifidus muscles, restoring the brain’s command and control to the entire group, so it can resume its support to the spine and other back muscles. Using the ReActiv8 system consists of two 30-minute stimulation sessions per day, which can feellike a deep-tissue massage and over a period of time, provides notable improvements in pain relief and quality of life.

If you are suffering from low back pain, pain that keeps returning or have recently injured your back and still feel ongoing pain, see a medical professional and ask if you may be suffering from multifidus dysfunction. Pain that gets worse with simple every tasks and sometimes with no movement at all is a sign of multifidus dysfunction. Your doctor will need to run imaging tests, perform physical assessments, and review your medical history to determine what the root of the problem is, but there is only one restorative treatment for chronic low back pain caused by multifidus dysfunction. Talk to your doctor about ReActiv8.