How Does Chiropractic Stack Up for Low Back Pain?

Doctors of chiropractic offer a non-surgical, treatment protocol for both acute and chronic low back pain (LBP), as do several other healthcare delivery systems. However, due to patient preference and a rising concern for potentially harmful side-effects, many LBP patients seek management strategies that offer a natural, non-pharmaceutical approach, of which chiropractic is the most commonly sought after practitioner-type. So what evidence is there regarding the benefits of chiropractic vs. other forms of care in managing LBP and its associated pain-related functional loss? 

A 2018 study published in the online Journal of the American Medical Association focused directly on this question by comparing patient outcomes of those receiving usual medical care to a second group of patients that also received chiropractic care.

Data was collected at three sites—two large military medical centers and one smaller hospital at a military training site—over the 3.5-year time period. Eligible participants included active duty United States service members between 18 and 50 years in age who were diagnosed with mechanical low back pain. 

Patients in each group received usual medical care for six weeks that included self-care, medications, physical therapy, and pain clinic referral. Participants in one group also received chiropractic care that included spinal manipulative therapy in the low back and adjacent regions and additional therapeutic procedures such as rehabilitative exercise, cryotherapy, superficial heat, and other manual therapies. 

Up to six weeks after the conclusion of care, the researchers reported that patients in the  chiropractic group scored higher with respect to LBP intensity, disability, perceived improvement, satisfaction, and medication use. The researchers concluded that this trial clearly shows the need for chiropractic care for those suffering from LBP—reminding the reader that current LBP guidelines have embraced chiropractic care as a FIRST line of treatment for LBP.

This is not the first study to show the benefits of chiropractic care, as prior high-quality studies have reported higher patient satisfaction levels, less medication use, higher quality of life scores, and less LBP-related disability and recurrence rates for patients receiving chiropractic treatment vs. usual medical care. This article was published in a highly regarded medical journal (JAMA) and CLEARLY supports the need for chiropractic care in the management of LBP.

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Can the Cervical Spine Cause Shoulder Pain?

Subacromial impingement (SAI) is a common injury in sporting activities that require overhead motions, especially among pitchers, quarterbacks, and swimmers. Not everyone responds to treatment to the same degree, and a new study that reviewed two specific cases may offer a possible reason: the neck.

One of the two cases involved a high school football quarterback and the other a collegiate swimmer. Both participants presented with signs and symptoms of subacromial impingement with minimal neck complaints and few clinical signs that initially supported neck involvement.

Of interest, both patients had poor posture that included forward head carriage and rounded forward shoulders. During the initial examination, both had shoulder pain and weakness while raising their arm up from the side, a “classic” sign of rotator cuff muscle injury and subacromial bursitis. However, neither case did well when treatment addressed only the shoulder, prompting their doctors to test whether or not the patients’ poor posture had a role in their shoulder discomfort.

Once the patients performed chin retraction exercises followed by chin retraction plus extension exercises (three sets of ten repetitions) to improve their posture, they experienced a complete improvement in shoulder impingement and muscle weakness. 

The author suspects that both patients experienced intermittent irritation of the C5 nerve root in the neck, which innervates the rotator cuff muscles, leading to their shoulder pain and weakness. In both cases, the two athletes performed home-based exercises and returned to their sports and did not have further problems during the rest of the season. 

These two cases are GREAT examples of why doctors of chiropractic evaluate the whole patient to identify any and all factors that may contribute to a patient’s chief complaint. It is very common to find cervical spine joint dysfunction in patients with shoulder pain, and success in treatment favors treating both areas, of which (as noted in these case studies) the neck may be the most important focus.

Can Chiropractic Adjustments Help Headaches?

Experts report that 157 million work days are lost each year in the United States due to headaches at a cost of about $50 billion in work absenteeism and medical expenses. According to current estimates, about 18% of chronic headache patients are believed to have cervicogenic headaches (CGH), or headaches that originate from dysfunction in the neck. 

Many CGH sufferers utilize complementary and integrative health treatment approaches for neck pain and headaches, of which spinal manipulative therapy (SMT) is the most common. While past studies have demonstrated SMT to be a superior form of treatment for CGH, no one has investigated how many treatments are needed to achieve the maximum clinical benefit for CGH patients – at least not until recently!

In order to determine what dose of SMT may best benefit patients with headaches originating from the neck, researchers randomized 256 CGH patients into four treatment groups that received 0, 6, 12, or 18 SMT treatments over the course of six weeks. The researchers found a dose-dependent relationship between SMT and days without CGH over the following year with patients in the 18 visit group experiencing 16 fewer days with CGH over the next twelve months than those in the zero treatment group.

The chiropractic spinal manipulative therapy treatment used in the study consisted of high-velocity, low-amplitude thrust manipulation in the neck and upper back regions (specifically, occiput to T3) aimed at sites with detected joint dysfunction (fixation or pain), which is typically the method most chiropractors determine where to apply spinal manipulation.

This study is VERY important for a few reasons: 1) it proves SMT helps patients with CGH; 2) it provides doctors of chiropractic with an idea of how many visits it may take to obtain optimum results; and 3) it can be used as a guideline when managing CGH patients, stressing the important point that EACH patient is UNIQUE and modifications may be appropriate depending on each case.

A Weak Core May Contribute to Hip Pain

When people think of hip pain, they generally turn to hip-specific exercises as a self–help strategy.  However, recent evidence shows there’s a correlation between poor core stability of the trunk and injury to the lower extremities, which includes the hips.  In March 2018, Belgian researchers reviewed data from nine previously published studies with a focus on the importance of core stability and its relationship to lower extremity musculoskeletal injuries in a healthy athletic population. The investigators reported that core strength, core proprioception (balance), and neuromuscular control (coordination) of the core are directly linked to the likelihood of lower extremity injuries.  

Let’s take a closer look at three specific core strengthening exercises that can be done relatively fast and are highly effective (you can view several demonstration videos on YouTube if you search for “stuart mcgill’s big-3 core exercises”).

1) The Curl-Up (abdominal strength): STEP 1 — Lie on your back, straighten your left leg, and bend your right leg, placing the right foot next to the left knee.  STEP 2 — Tuck your hands under your low back to prop up the lumbar curve (so it does not flatten out).  STEP 3 — Curl up by lifting your head, neck, and shoulders only a few inches off the floor (keep your chin tucked).  STEP 4 — Hold for 7–8 seconds (or work up to this).  STEP 5 — Slowly lower your trunk back to the ground.  Repeat five times with the right leg bent and five times with the left leg bent, while keeping the opposite leg straight.  This exercise helps reduce low back disk compression, which is significant when performing a conventional sit-up exercise.

 2) The Bird-Dog (core, back, and gluts):  STEP 1 — Kneel on all-fours (hands and knees).  STEP 2 — Keeping your back flat, lift and straighten out the LEFT arm and RIGHT leg parallel to the floor. STEP 3 — To further activate the core muscles, draw a square with the arm and leg while bracing the abdominal muscles (firm up your abs, as if to brace for being punched in the stomach). STEP 4 — Return to the starting position and repeat on the opposite side (repeat STEP 3 again). 

3) The Side-Bridge (obliques): STEP 1 — Lie on your side, elbow directly under your shoulder and bend your knees 90°. To increase the difficulty, keep the legs/knees straight. STEP 2 — Lift your hips off the ground so you are holding your weight with your elbow and knees (or feet). STEP 3 — Hold the “Up” position for as long as possible. STEP 4 — Repeat steps 1-3 on the opposite side. 

Doctors of chiropractic are trained to evaluate the entire person from the feet up to the head to identify issues elsewhere in the body that may contribute to or even cause the patient’s chief complaint. For many patients, managing hip-related conditions may involve treatment to address issues in the core (as described in this post), the lower back, and even the feet or knees!

Chiropractic Care for Headache Relief?

Woman Suffering From A HeadacheHeadaches have a significant impact on quality of life in both adults and children. Approximately 13% of patients who sought chiropractic care over the last decade did so for headache relief. Several studies have found that manual therapies, such as spinal manipulation and mobilization, can provide significant benefits for patients with both tension-type and migraine headaches—even better than standard medical care, in some cases.

In 2011, Canadian researchers reviewed data from 21 published studies to develop specific recommendations for chiropractic management of headaches. For episodic or chronic migraine and cervicogenic headaches (those caused by specific neck problems), they recommended spinal manipulation and other manual interventions, such as massage. Additionally, researchers noted that joint mobilization and strengthening exercises for the deep neck flexor muscles may also improve symptoms associated with cervicogenic headaches.

For episodic tension-type headache, the investigators did not find enough published evidence to support the use of spinal manipulation. They stated that, at the current time, “a recommendation cannot be made for or against the use of spinal manipulation for patients with chronic tension-type headache” (CTTH). However, they did report that low-load craniocervical mobilization “may be beneficial for longer term management of patients with episodic or chronic tension-type headaches.”

In contrast, following a randomized clinical trial of 80 patients with chronic tension-type headaches, Dutch researchers reported that “Manual therapy is more effective than usual [general practitioner] care in the short- and longer term in reducing symptoms of CTTH.”

Chiropractors utilize many types of manual therapies as a primary form of care for several complaints and conditions, including headaches.

Great Exercises for Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is caused when the median nerve is compressed as it passes through the tight bony carpal tunnel at the wrist. The condition can result in pain, numbness, tingling, and weakness in the hand, and it can affect one’s ability to carry out everyday life and work tasks. Here are a few GREAT exercises for CTS that require no equipment and can be done anytime and anywhere:

Calm slim model standing in tree pose in bright room

PRAYER: Place your hands in a “prayer” position. Touch the palm-side finger pads together and slowly push the palms into one another while keeping the elbows up as much as possible as you feel a strong stretch in the hands, fingers, and palm-side of the forearms.

SHAKE: Shake your hands for 10-15 seconds as if you just washed them and you’re trying to air dry them off.

WRIST FLEXION STRETCH: Hold your arm out in front of you with the elbow straight, palm facing down. With the opposite hand, bend the wrist as far downward as possible so the fingers point to the ground. This will produce a strong stretch in the muscles located in the back or top of the forearm. Repeat five to ten ties holding each stretch for 15–20 seconds (as tolerated).

These exercises can be repeated multiple times a day, as often as once per hour. It is often very helpful to set a timer on your cell phone to remind you to take a stretch break. A “good pain” (stretch) is considered safe while sharp or radiating pain may be potentially harmful. However, if you experience sharp, lancinating, or radiating pain, then stop or modify the exercise.

Frequently, CTS involves more than just the wrist, and exercises that target the neck, shoulder, and elbow can often hasten recovery. This is especially true when there is “double crush syndrome” where the median nerve is entrapped in more than one location such as the neck, shoulder, elbow, or forearm (as well as the wrist).

Chiropractic management of CTS can include manipulation and mobilization of the hand, wrist, forearm, elbow, shoulder, and neck. Muscle release techniques are often employed as well as the use of physical therapy modalities such as laser, electric stimulation, ultrasound, and others. The use of night splints to keep the wrist straight when sleeping is a “standard” used by most healthcare providers. Co-management with primary care may be appropriate if diabetes, inflammatory arthritis, or other complicating conditions are present

Can Exercise Prevent Low Back Pain?

While it’s not possible to totally prevent low back pain (LBP), individuals who regularly exercise appear to have a reduced risk for LBP. Additionally, fit adults who develop back pain may experience it less often, at a reduced intensity, and for a shorter duration than those who lead a more sedentary lifestyle.low backWhich type of exercise is the best? A general rule is to keep trying different activities, starting with those MOST appealing to you. After all, you should enjoy exercise, so start with your favorites: walking (one of the best), walk/run combinations, running/jogging, bicycling, swimming/water aerobics, yoga, Pilates, core strengthening, balance exercises, tennis, basketball, golfing, etc.

Specific exercises for the low back can be individualized by determining your “position preference”, or the position that feels best to your low back. For example, bend forward as if to touch your toes. How does that feel? Do you feel a good stretch or pain? Does it shoot pain down your leg? If it feels good, then that might be your preferred position and the one to emphasize with exercise. Examples of exercises that fit this scenario include (but are not limited to): posterior pelvic tilts (flatten your low back by rocking your pelvis forward); single and double knee to chest; and bending forward from a chair (as if to touch the floor).

If bending backward feels good (better than flexion and especially if the presence of leg pain lessens or disappears), then “extension-biased” exercises fit that scenario. Examples include standing back extensions (place your hands behind the low back and bend backward); prone “press-ups” (lift the chest off the floor while keeping the pelvis down); and laying back-first over a Bosu- or Gym-ball.

Pelvic dysfunction and core weakness can also increase the risk for LBP. Try these exercises: abdominal crunches (bend one knee, place your hands behind your low back, and raise the breast bone toward the ceiling only a few inches and hold); front and side planks (start from the knees if necessary); supine bridges (supine, knees bent, lift the buttocks off the floor); “bird-dog” (kneel on all fours and raise the opposite leg and arm, keep good form, and alternate); and the “dead-bug” (on your back, bend the hips and knees at 90 degrees with your arms reaching toward the ceiling; slowly lower your right arm and left leg and return them to their starting position; repeat with the other arm/leg).

When lifting, bend the knees and hips but NOT your low back; keep weights close to you and lift with your legs. Don’t attempt lifts that you know are too heavy.

If you have a history of low back pain, research shows that receiving maintenance chiropractic care can help reduce the number of days in which low back pain may hinder your activities.