I see a lot of patients with back and neck pain who are frustrated with their condition. They’ve tried yoga, Pilates, lifting weights, core training — nothing seems to help. Sometimes exercise even makes it worse. They are at a loss about their pain and are ready to give up, assuming they have a “bad back.”

This isn’t usually the case; they are just coming at it from the wrong angle. They assume their pain comes from muscles that are too tight or weak, so the answer must be to exercise them, strengthen the core, stretch the tight hamstrings, etc. When that doesn’t work, well, the problem must be structural — arthritis, ruptured disk, torn tendons, etc. — so there really isn’t much to be done.

The reason for this dilemma is most patients — and doctors, for that matter — do not consider the joints when they think of back and neck pain. This makes sense; most doctors are not trained to evaluate spinal joints. But they are a major cause of pain, and if they are not treated, the patient will not recover completely.

For years, doctors of chiropractic have compared joint alignment with car tire alignment. The comparison is oversimplified but can be used for our purposes. If your tires are out of alignment, it only makes sense that the harder and faster you drive the car, the more stress there will be on the tires and all their supporting structures. The same is true for our bodies. If a joint is not working properly and you increase the demand on it by exercising, the result is more inflammation and pain. This also affects the nearby structures. Conditions such as tendonitis, bursitis and even arthritis — the “itis” at the end of the word means inflammation — often are caused by secondary stress from a joint that is dysfunctional.

However, once the joint alignment is restored, exercise is vital to maintaining it. When treating a patient with chronic problems, we were trained to start them on gentle stretches, progress to more aggressive ones as the patient improves and only when they are doing well do we introduce core training or other strengthening exercises.

“Deconditioning” is a common problem with patients who have chronic pain. This is the result of the downward spiral people are caught up in. They have chronic pain that is worse with activity, so naturally they start to limit what they do. That helps in the short run, but in the long run — because the underlying joint issue is not being addressed — it only allows the problem to worsen, until even minor activities cause pain. Unfortunately, many of these people are given the well-meaning advice to “work through the pain.” This is not always a good idea. While it does work for some people, I have seen too many cases where it makes things worse.

How do you break up this vicious cycle? Start by fixing the joint alignment. Faulty joints are the underlying cause for much chronic inflammation and pain. These mechanical problems cannot be “worked out” by exercise; the strongest muscle cannot stabilize a misaligned joint. They respond best to manipulation, a quick thrust into the joint. So if your pain and inflammation don’t respond to exercise, the problem probably isn’t in the muscles; you may want to consider manipulation. But once the treatment starts working and the joint is moving well again, then exercise becomes a necessity to keep it well.

The goal is not just to ease the patient’s pain, though that is a good start. The longer term goal is to allow the patient to resume as much activity as they can. Joint manipulation, combined with exercise, is a very powerful tool in managing chronic spinal pain and reversing the deconditioning that plagues a lot of our seniors. It also has the added benefit of reducing dependence on pain and anti-inflammatory drugs, which have serious side effects, especially with long-term use.

Dr. Michael Noonan practices chiropractic, chiropractic acupuncture and other wellness therapies in Old Town. He can be reached at noonanchiropractic@gmail.com.