What's New and What's Missing in the 2017 ACP Clinical Guidelines for Back Pain Treatment

March, 2017

The American College of Physicians (ACP) has just issued new Clinical Guidelines for the non-invasive treatment of non-radicular lower back pain (pain that does not radiate from and is not caused by damage to the spinal nerve root).

Since the last guidelines were issued in 2007, the ACP has dramatically revised the medical solutions commonly offered for back pain. Many interventions that were once routinely administered to back pain patients, having proven to be ineffective or counterproductive for back pain, are no longer part of the guidelines for doctors. Surgery, cortisone and nerve blocking injections, X-rays, and MRIs are all discouraged in back pain cases where they used to be a part of standard care.


A lot of the what used to be standard of care for back pain is no longer recommended.

The new guidelines issued last month also discourage the use of pain medications as a treatment for back pain. The recommendation is based on extensive data showing that pain meds (whether over-the-counter, prescription NSAIDs, or opioids) are ineffective in back pain treatment. Strong painkillers may help to mask symptoms, but do little to actually treat the cause of pain. As painkiller addiction has become a serious large scale problem, it is commendable that the ACP has taken this bold move to discourage the overuse of a common but ineffective and potentially harmful intervention.


The new ACP guidelines discourage the use of pain medication to treat back pain.

What is sadly missing in the guidelines is an enthusiastic endorsement of any intervention. Physicians and patients are advised to try non-drug therapies, but this is followed by the lukewarm statement “physicians should select therapies that have the fewest harms and costs, since there were no clear comparative advantages for most treatments compared to one another.”

In 2017 mainstream medical practice, there is still no satisfactory understanding of the root causes of back pain, nor robust treatment to eliminate it. I dream of a future when randomized controlled trials (RTCs) validate what Gokhale Method students and teachers experience, and what our recently collected data and the data on healthoutcome.org suggest. Imagine if the Gokhale Method became part of standard protocol for back pain! Here are some key ways that would play out:

1. The ACP guidelines correctly recommend that people resume “normal everyday activities” as early as possible. This would take on a whole new meaning! Often, people develop their aches and pains from the ways they slump-sit, round-bend, jerk-walk and so forth. How could sending such a person back to their “normal” everyday activities constitute a sensible measure? The Gokhale Method would help these people transform their slump-sitting and arch-sitting into stretchsitting and stacksitting. They would learn to hiphinge not round-bend, and glidewalk not jerk-walk. Previously injurious everyday movements become comfortable and therapeutic. Now life becomes a gym and a playground, and the recommendation to do "normal" activity makes eminent sense to the back pain sufferer.


Bending is a healthy everyday activity if and only if one has good form.

The recommendation to do exercise, yoga, and other augmented activity would become a more robust recommendation. With Gokhale Method principles integrated into exercise and yoga, there’s less risk of injury and more leveraged benefits to be had.


Yoga done wth good form bestows many benefits; yoga done with poor form can result in injury.

2. Some medical interventions, that went through cycles of being over-used and then booted out, may well have a new role and relevance when used to supplement a robust postural re-education program. Medical science will continue to improve in determining which interventions work in which circumstances. Pain meds, spinal injections, and even surgery have more of a place as palliative or auxiliary measures if they facilitate new learning which gets to the root cause of the problem. They provide a window of opportunity to learn new posture ways without acute pain and symptoms getting in the way of being able to concentrate and function.


Coupled with posture training, a lot of medical interventions for back pain acquire a new role and relevance.

For example, if someone gets spinal surgery but then goes back to their old habits, their pain is likely to come back, and the surgery may be deemed ineffective. But if instead they use the temporary pain relief from surgery to learn new habits from the Gokhale Method, their pain is less likely to return. In that case, the surgery will have been part of a more integrated and ultimately successful approach.

Similarly a more circumspect use of pain meds could facilitate learning new posture ways, getting to the root of pain, and, in turn, eliminating the need for pain meds.

The Gokhale Method doesn’t just combine well with wise medicine, exercise or therapeutic interventions, it can redefine them. For that reason we’re looking forward to being adopted into standard care guidelines one day—wouldn’t that be lovely?

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Comments

Dear Esther,

I would be very grateful if you could help me with my questions.

What is your opinion on an aid like Posture Medic? (Of course as an addition to the Gokhale method. Or is  a product like this the opposite of what the Gokhale method stands for?)

http://www.apemedical.com.au/shop/detail/posture-medic/

http://www.apemedical.com.au/content/page/posture-stretch.html

 

Background info, in case it is useful/necessary to answer my questions:

I´m in a process of rebuilding my body, so to speak, after almost 40 years of Atlas subluxation (dislocated neck), resulting in a very imbalanced body with tension and pain almost from head to toe, and especially in the neck, front of neck, jaw, upper back, shoulders, hips etc.

In addition to treatments, I do yoga and Scott Sonnons Intuflow and stretching and veeeery careful strenghtening. However it is a complicated process. It is like the muscles have to be re-taught how to behave and work, because I automatically use the muscles wrong, the wrong muscles do the job, since others were left paralysed because of tension.

Today I was recommended this Posture medic by one of my therapists. At first I was sceptical, but after reading about it, it seems to me that this might just the sort of help I need in learning how to feel what a correct posture is, how to move again and re-teaching the muscles.

So I´me very curious about your take on a product like this?

 

And also, about yoga: Are the poses Halasana (plow pose) and Karnapidasana (knee-to-ear-pose) ok to do? Or do they cause damage to the spine?

 

I hope my questions aren´t to exhaustive.

Thank you so much on beforehand.

Best regards,

H.

I am not familiar with this particular product, but there are many shoulder braes on the market that can be helpful if they are comfortable. This one looks like it could dig into your flesh a bit much. There are others that are better padded, but as with clothing, it would be ideal to try them on for fit. 

Halasana without a pile of blankets can put a lot of load on the neck. You have to be careful not to round the spine either. It's challenging to do and the benefits of the pose (being upside down, for example) can be dervied in safer ways. This is even more true for Karnapidasana.

I see that you requested our course in Norway, where you live. I hope we get enough requests to be able to send a teacher to you!

 

Thank you so much for your kind help.

Yes, I really would like to go on a course, I think it is much needed for me. :)

I see that you also have online courses, but I´m a bit confused about how well this works compared to a "hands on" course. How much of my (wrong) posture and (wrong) movements will a teacher be able to see through (me moving in front of) a screen?

Thanks again.