Low Back Pain: What Can I Do for It?

Back-Pain-PNG-FileLow back pain (LBP) is the second most common reason for doctor visits in the United States and it is a condition that most of us will at some point in our lives. Last month, we reviewed the wide acceptance of spinal manipulation as the treatment of choice for both acute and chronic LBP. This month, let’s take a look at what you can do outside the doctor’s office to self-manage acute and chronic low back pain.

One of the best self-management protocols for LBP is exercise that targets the lower back. It appears that the optimal time to engage in exercises for the lower back is during the work day since doing so may help alleviate some of the overuse and repetitive strain contributing to one’s LBP. Let’s focus on exercises you can perform from either a sitting or standing position during short work breaks…

RULES: Perform slowly to a full/firm stretch without pain; take three slow deep breaths for each; only do exercises that “fit” your job and time limits—this might be only one every fifteen minutes; make it work!

SITTING EXERCISES: 1) Sitting Forward Bends – bend forward and reach for the floor (as far as reasonably tolerated). 2) Sitting trunk rotations – twist slowly left, then right. 3) Cross Leg Stretch – cross one leg over the other; grasp and pull the crossed leg knee to the opposite shoulder while arching the back to its maximum until a firm stretch is felt in the buttocks.

STANDING EXERCISES: 1) Hamstring Stretch – place one foot on an elevated surface (like a chair seat, foot stool, or guard rail); perform an anterior pelvic tilt by arching your low back until you feel a firm stretch in the hamstrings. Switch sides and repeat. 2) Groin Stretch – do exactly the same steps as the hamstring stretch but this time, rotate your trunk to the side of the standing leg (away from the stretched leg) until you feel the stretch in the inner thigh or groin muscles. 3) Backward Bends – place your fists behind your low back and slowly bend backwards to a maximum tolerated point.

These “portable” exercises can be performed frequently throughout the work day, whenever you can spare 30-60 seconds. The most important point is to do these exercises on a regular basis. It may help keep your LBP from worsening during your workday.

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Low Back Pain: Spinal Manipulation vs. NSAIDs

lbpLow back pain (LBP) is the single greatest cause of disability worldwide and the second most common reason for doctor visits. Overall, LBP costs society more than $100 billion annually when factoring in lost wages, reduced productivity, and legal and insurance overhead expenses.

Studies regarding the use of spinal manipulation(SM)—a form of treatment offered by doctors of chiropractic—for LBP are plentiful and have led to the strong recommendation that SM should be considered as a FIRST course of care for LBP. The American College of Physicians and the American Pain Society both recommend SM for patients with LBP who don’t improve with self-care.

In 2010, the Agency for Healthcare Research and Quality (AHRQ) reported that SM is an effective treatment option for LBP – EQUALLY effective as medication in reducing LBP and neck pain.

A 2013 study compared SM and non-steroidal anti-inflammatory drugs (NSAIDs) and found that SM was MORE effective than diclofenac, a commonly prescribed NSAID, for the treatment of LBP. Patients in the SM group also reported NO adverse side effects. More importantly, a 2015 study found that NSAID use can actually slow the healing process and even accelerate osteoarthritis and joint deterioration!

Doctors of chiropractic utilize SM on many conditions, including LBP— more than any other healthcare profession including osteopathy, physical therapy, medical doctors, and others. Chiropractors also combine other synergistic forms of care, such as patient-specific exercise training, to help patients learn how to self-manage their LBP, as recurrence is such a common issue.

How Do MDs View Chiropractic?

In the mid-1980s, a political event spurred a change regarding the medical community’s outward disrespect of chiropractors when the AMA (American Medical Association) was sued for anti-trust violations and the chiropractors won!

For the first time, the public, open anti-chiropractic slander that appeared on billboards, in magazine articles, and in TV/radio advertisements against the chiropractic profession was prohibited.

In fact, prior to this, it was against the AMA by-laws for a Medical Doctor (MD) to publicly socialize with a chiropractor! This all seems pretty extreme but was truly occurring prior to the mid-1980s… BUT NOT ANYMORE!

In 1994, the United Kingdom and the United States almost simultaneously published official guidelines for the treatment of acute low back pain.

BOTH DOCUMENTS REPORTED THE USE OF SPINAL MANIPULATION, A PRIMARY FORM OF CHIROPRACTIC TREATMENT, AS A FIRST CHOICE IN THE TREATMENT FOR ACUTE LOW BACK PAIN.

Now, for the first time, a non-chiropractic group had recommended chiropractic based on researched data that overwhelmingly supported spinal manipulation as an effective, safe, and less expensive form of care when compared to all the other treatment approaches that the healthcare consumer can choose from.

Research has continued to pour in and recently, similar recommendations were made in the treatment of chronic low back pain. Also, when reviewing the research pool, continued support of the 1994 guidelines for acute low back pain was again found to be valid with little change required.back-pain-lg[1]

According to the published guidelines, ALL patients with acute AND chronic low back pain should see chiropractors FIRST.

If this guideline was followed by everyone, there would be such a shortage of chiropractors, it would become one of the most desirable professions to seek vocationally.

Unfortunately, many MDs do not know enough about chiropractic to strongly recommend it to their inquiring patients. That is why our office goes out of its way to educate MDs in our community about the benefits of Chiropractic care.

Also, some programs at medical schools are now including “alternative medicine” courses in the curriculum of the undergraduate MD programs and, rotations in alternative or complimentary health services currently offered at some university / hospital settings as a post-graduate option.

This is reflected by an increasing population of MDs who actively seek out chiropractors to work with when their patients present with conditions like acute or chronic low back pain, neck pain, and/or headaches.

The MD/DC relationship is truly improving as noted by the inclusion of chiropractic into hospital programs, integration into the military bases and VA hospitals, routine coverage by most insurance companies, etc.

So rest assured, you’ve made a smart decision to choose Chiropractic care.

What Type of Doctor Should You See For Acute or Chronic Back Pain?

Have you ever considered which type of doctor is best suited to treat back pain?

Since there are so many treatment options available today, it is quite challenging to make this decision without a little help.

To facilitate, a study looking at this very question compared the effectiveness between medical and chiropractic intervention.

 

Over a four-year time frame, researchers followed 2,780 low back pain patients who were treated using conventional approaches by both MDs (Medical Doctors) and DCs (Doctors of Chiropractic).

Chiropractic treatments included spinal manipulation, physical therapy, an exercise plan, and self-care education.

Medical therapies included prescription drugs, an exercise plan, self-care advice, and about 25% of the patients received physical therapy.

The study focused on present pain severity and functional disability (activity interference) measured by questionnaires mailed to the patients.

The authors of the study reported that chiropractic was favored over medical treatment in the following areas:

  • pain relief in the first 12 months (more evident in the chronic patients);
  • when LBP pain radiated below the knee (more evident in the chronic patients);
  • chronic LBP patients with no leg pain (during the first 3 months)

Similar trends favoring chiropractic were observed in regards to disability but they were of smaller magnitude.

All patient groups saw significant improvement in both pain and disability over the four-year study period.

Acute patients saw the greatest degree of improvement with many achieving symptom relief after three months of care.

This study also found early intervention reduced chronic pain and, at year three, those acute LBP patients who received early intervention reported fewer days of LBP than those who waited longer for treatment.

While both MD and DC treatment approaches helped, it’s quite clear from the information reported that chiropractic should be utilized first.

These findings support the importance of early intervention by chiropractic physicians and make the most sense for those of you struggling with the question of who to see for your LBP.

The Healthy Way to Wear a Backpack

It’s back to school time for all the young scholars and with it comes the daily ritual of lugging school supplies around in a backpack. You may not realize it but ill fitting backpacks can put a significant amount of stress on your child’s body.
The long-term stress of wearing a poorly designed and/or excessively heavy backpack can lead to a back aches, neck stiffness, burning shoulders, headaches, tingling in the arms/hands, fatigued muscles and a stooped posture. These aches and pains can be a major distraction to your child’s focus in the school room, hamper their enjoyment of everyday childhood activities and increase the likelihood of future back problems later in life.

Loading a Backpack

  • Your child’s backpack should not exceed 15% of their body weight.
  • back pack2Load the heaviest items closest to your child’s back. Pack the bumpy or sharp edged items furthest away from the back. Arrange the school gear so it won’t shift and slide as they walk.
  • Many parents are shocked to discover just how heavy their child’s backpack truly is. To calculate how much the pack weighs have your child stand on a weigh scale with and without the pack on and subtract the difference.
  • On heavy backpack load days have your child hand carry a heavy book or item.
  • Pack up the bag on a table or ledge that is waist high as opposed to leaning forward over a pack on the floor.

Wearing the Backpack

  • Always use the two straps to spread out the weight evenly. Carrying a heavy load with one strap can lead to unwanted curvatures and abnormali
  • ties in the developing spine and musculature.
  • Make sure the straps are well padded (2 inches wide) to protect the blood vessels and nerves in the neck and shoulder region. Prolonged pressure in these areas can lead to pain and tingling in the neck, arms and hands.
  • Adjust the straps so that pack fits snugly against your child’s back. You should be able to slide one hand between the pack and your child’s back. Loose packs can pull your child back causing muscle strains.
  • The back of the pack should never rest more than 4 inches below the waist line.
  • Wearing a waist strap can take as much as 50 – 70% of the weight off the shoulders and spine helping to distribute the weight more evenly.
  • Teach your child to put on their backpack properly. Place the pack on a table and do up both straps before moving as opposed to twisting and reaching back or swinging the pack around the shoulder.Backpack21

It is important to be aware of your child’s daily burden because it could be detracting from their school experience. If they complain of back pain, headaches, numbness or weakness in their arms seek help to ease their discomfort and prevent future problems.

Chiropractic Care… Safe and Cost Effective

“Ever since I was in my early teens, I’ve had muscle and joint problems that would come and go but never put me down where I couldn’t function. I was very active and played basketball, tennis, and ran in track but over the last 10 years I’ve avoided a lot of activity due to my problems. Now, after having a couple of children and gaining some weight, I notice more frequent and intense back problems and I’m getting quite concerned over the changes that have been taking place and afraid to do things. I talked about this with my family and friends and some have recommended chiropractic, some recommend physical therapy, others suggest medication and one even suggested shots! Quite frankly, I’m totally confused as to what to do!”

This scenario may sound familiar to many people.

lower-back-pain-s1-factsThe choice of health care provision is a personal one, often influenced by those around you – family, friends, teachers, and more!

It seems like everyone is an “expert” with different opinions and their advice, often conflicting, can lead to confusion about what is best for you.

There are many ways to approach back trouble, regardless of the diagnosis or condition.

First, all health care providers are biased in that they naturally focus on their specialty. If you choose to consult with a surgeon, s/he will look at your condition from a surgical perspective. Various surgical options may be discussed, tests are usually recommended and the process begins.

When consulting with a family physician, the typical approach is pharmaceutical or drugs such as anti-inflammatory medications (Advil, Nuprin, Ibuprofen, Aspirin, Aleve, Tylenol, etc.), heat or ice, activity modifications (possibly rest or mild/moderate activity), and possibly referral for chiropractic or physical therapy.

In reviewing the various guidelines, it is recommended to start with the least invasive, safest, most cost effective approaches first.

Unless “red flags” like cancer, fracture, infection or progressive severe neurological losses are present, surgery is not a logical initial approach.

Chiropractic has been recommended as a first or initial choice as it has been found to be safe, highly satisfying, non-invasive, and cost effective.

The typical approach includes a thorough history, an examination that includes an analysis of posture, motion, function and includes the whole body.

For example, if one leg is short, the pelvis will tilt and spine is often crooked. That needs to be corrected for both long and short term results.

If the feet pronate and the arches are flat, the effects on gait/walking on the ankle, knee, hip and back can lead to trouble or perpetuate current problems.

Deconditioning or, being out of shape is an important aspect included in the chiropractic management process.

If these methods fail to bring about satisfying results, referral for more invasive approaches will be considered.

“Bad weather plus your child’s back pack… equal neck, back or shoulder pains in our little ones!”

How big of a problem is Back Pack pain in our little ones? Well, get this. Your child’s backpack might be causing harm. The potential dangers of heavy backpacks used by children are greater than most parents realize.

According to national guidelines, students should carry backpacks that weigh… no More than 10-15% of their body weight. Yet did you know that…

“55% of students are carrying backpacks that weigh much more than the recommended weight?” (Simmons College, April, 2001)

Why is this such an “invisible” health concern? Hey, I realize we’re starting to sound like overprotective parents here, but consider this. Over the years the average weight associated with a children’s backpack has increased 120% since the 1970’s! Today in addition to school books, kids are also cramming their karate outfits in their backpacks… along with iPods, Game Boys, extra gym clothes for their after school sports leagues, baseball gloves, lunch pails, etc. Children today are “overscheduled” and thus carry much more “weight” into their backpacks to accommodate their extra-busy lifestyles.

Carrying too much weight really can cause permanent damage to a child’s back and spine. This is a serious health concern, that I can assure you. As a chiropractor, I am seeing more and more children complaining about back pain and it is often because of the weight they’re carrying on their backs to and from school every day.

A survey conducted by AIRPACKS in 2000 revealed that 66% of school nurses reported seeing students with pain or injury caused by backpacks. Here are a few quick tips:

1. Wear backpack straps on both shoulders, not just one

2. Put heavier books closest to the back, which can reduce the awkward strain

3. Teach your child to bend at the knees while lifting backpacks

4. Try to reduce the load! Only carry what is necessary each day.

If you would like to have your child examined or have concerns about their health, please give me a call. We’re here to help!

Interested in learning more how chiropractic can help your little ones? Call (309) 692-6800 today, because last year millions discovered chiropractic!