Understanding the Differentials of Low Back Pain

Understanding the Differentials of Low Back Pain

Featured Speaker: Anna Folckomer, L. Ac, DAOM

For many clinics, back pain can be something that we see the most, but is often understood the least. Or perhaps we treat all of them with the same local points and just hope for the best. It’s true, back pain does have ambiguity and lots of overlap, but that is never a reason to forfeit our diagnostic principles and inherently thorough assessment skills.

Take Francis, for example. He’s fit, athletic, and the last repetition of his deadlift “tweaked" his back one week ago, and it’s not improving the way previous back episodes have. Next comes in Cara, who bent over to pick something up in her office, felt a sudden twinge, and had to leave work early and lie on a heating pad for the rest of the day. Both of these cases are just different enough from Kelly, who occasionally experiences a feeling of having a tight strip across her lower back, but flared recently after a prolonged period of standing on concrete floors for a real estate showing. Amy’s pain has a sudden onset and is dull, diffuse, and difficult to locate but seemed to really get worse last night, and Jen’s pain flared up after the heel broke off her boot, but she needed to keep working through a hectic day and didn’t notice until 20,000 steps later. It’s only 11 am and all of these people, all with back pain, have pointed to the exact same area of discomfort.

What tests do you run? How do you explain their pain to them? There are elements of Qi and blood stagnation in all of them, but some of them have very real contraindications for local needling and deep tissue work.

Would your assessment tell you that Francis has a disc herniation, Cara strained posterior oblique fibers, Kelly has arthritis, Amy is having uterine referral, and Jen doesn’t have a back problem at all, it’s actually her sacroiliac joint? While we continue to support the kidneys, move qi and blood, and clear the channel, we can also entertain a more specific structural assessment. After all, arthritis is treated differently to a strain, and good luck getting your patient back if you needle a dermatomal patch with neuritis. All of these are cases of back pain in the same area, all different mechanisms, all different treatment principles.

This is the information that will be organized in my upcoming course presented at the annual FSOMA conference,                                “Understanding            the Differentials of Back Pain.” No one should ever have to worry about their treatment accidentally flaring up their patient or making their pain worse the next day. There should be no crossing of fingers and hoping for the best as we send our patients off. We can standardize our approach in a way that is harmonious with our Eastern medicine diagnostics. Each one of these patients has a different provocation and different alleviation, and that tells a unique story in all of them. It’s our job to understand that story and relay that information to educate our patient.

Orthopedic tests are not just for insurance documentation. Even if you practice in a state that prohibits “diagnosing”, it’s still crucial to know what you’re dealing with and why someone presents the way that they do.

Pain, whether it’s an acute onset or a flare- up of an old injury, scatters the Qi. It is a perceived threat to their sympathetic nervous system, which then creates a systemic effect.

Never underestimate the therapeutic value of simply having answers, educating your patient, and giving them fair and managed expectations going forward. We have the privilege of often spending the most time with them and using the widest clinical lens, so if we’re not offering this, who will?

In this class, we’ll learn how to make your treatment and aftercare advice specific to their pattern, so that you feel more confident and your patient has a clear direction. Learn how and when to refer out, but also how to pinpoint extremity problems that are actually coming from the back. We will explore how to understand the anatomy of assessment and mechanism of injury. We’ll even discuss a few conditions that can throw you a curve ball from time to time so they’re on your radar.

With a good assessment, you’ll never have to wonder and your patient will thank you and leave your office always feeling better than when they walked in. I hope to see you this summer!

Anna Folckomer headshotDr. Anna Folckomer is an acupuncturist, herbalist, and clinical anatomist. She maintains a private practice in Manhattan and is a faculty member at Seton Hall University's School of Health and Medical Sciences, where she teaches Gross Dissection, Exercise Physiology, and Pharmacology. She is the Co-Founder of the internationally known seminar series, Immaculate Dissection and also teaches Anatomy and Injury Prevention at Joffrey Ballet School. She has lectured on functional anatomy topics in the US, UK, Canada, and across Asia, which combines assessment and rehabilitative strategies for clinicians.

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