Spinal Manipulative Therapy for Seniors with Low Back Pain

5 Sep

While low back pain can affect people of all ages, it’s particularly problematic for older adults and is one of the top three reasons they see a doctor. Despite this, low back pain among seniors often persists for longer than three months, and in the presence of multiple comorbidities (which is often the case with advancing age), low back pain may be under treated or mismanaged. While guidelines for the management of low back pain often emphasize conservative approaches first and foremost, older patients tend to be underrepresented in the studies used to formulate such recommendations. Let’s take a look at the current research on the utilization of spinal manipulative therapy—the primary form of treatment provided by doctors of chiropractic—for the management of low back pain in older adults.

A 2022 study scoured electronic databases for randomized controlled trials conducted during the previous two decades that examined the effects of spinal manipulative therapy in older adults with chronic low back pain. The research identified ten studies consisting of a total of 786 individuals over 55 years of age, of which 261 were between 65 and 91 years old. The types of spinal manipulation included in this study are high-velocity low-amplitude (HVLA) techniques and mobilization or low-velocity low-amplitude (LVLA) techniques.  In particular, the research team looked at how these manual therapies fared with respect to improvements in pain and function against other approaches, including standard medical care and exercise therapy, in the short-, medium-, and long-term. 

In their final analysis, the authors concluded there is moderate-quality evidence that spinal manipulative therapy results in similar outcomes (compared to usual medical care and exercise therapy) for pain and functional improvement, and it should be considered a non-pharmacological treatment option for this patient population. This is important as up to 80% of older adults already take multiple prescription medications, with nearly a third taking five drugs, to manage their current health concerns. The addition of one or more prescriptions to manage low back pain increases the risk for adverse events and harmful drug interactions.

The researchers add that while their analysis was unable to establish a safety profile as the studies used had heterogenous data on adverse events, spinal manipulation appears to be safe for older patients. They further note that their findings are consistent with other systematic reviews on the effectiveness of spinal manipulative therapy for all age groups. 

The findings from this analysis confirm that spinal manipulative therapy has a place in the management of low back pain affecting older patients. If you suffer from chronic low back pain, don’t put it off or assume you need to live with it. Schedule an appointment with your local doctor of chiropractic to see if a course of conservative chiropractic care can help reduce your pain and improve your mobility.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

(717) 697-1888

Member of Chiro-Trust.org 

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When Is Low Back Surgery Appropriate?

30 Jun

Low back pain is the most common musculoskeletal complaint, and it is the leading cause of activity limitation and absenteeism from work. There are many treatment options available to the low back pain patient, including surgical procedures. But when is surgery appropriate and in what cases should it be avoided? 

Generally, clinical guidelines don’t recommend surgery as an initial treatment, except in emergency or critical situations. For example, when a patient presents for chiropractic care, there are red flags that indicate the patient should be referred out to another healthcare provider, if not the emergency room. These include cancer, fracture with instability, infection, and cauda equina syndrome (includes loss of bowel and/or bladder control). In these cases, surgery may be the best available option for the patient to avoid a catastrophic outcome. 

In addition to these red flag scenarios, a literature review published in 2023 in the Medical Journal of Australia concluded that spinal surgery may have a role in the management of non-responsive nerve compression with radiating leg pain. That is, once conservative, non-surgical options have failed. However, outside of these situations, the review concluded, “Spinal surgery for all other forms of back pain is unsupported by clinical data, and the broader evidence base for spinal surgery in the management of LBP is poor and suggests it is ineffective.” Additionally, the authors note that spinal surgery for LBP “has substantially increased over recent decades, and disproportionately among privately insured patients, thus the contribution of industry and third-party payers to this increase, and their involvement in published research, requires careful consideration.”

Unfortunately, a 2022 study found that 41.7% of low back pain patients who underwent spinal surgery had minimal, if any, engagement with non-pharmacological, non-operative treatment in the six months before their procedure. A 2013 study that used data from Washington state worker’s compensation system found that 43% of workers with a back injury who initially consulted with a surgeon ended up having surgery while just 1.5% of those who first received chiropractic treatment eventually had a surgical procedure for their back pain. Not only are patients who visit a chiropractor first less likely to end up under the surgeon’s knife but they’re also less likely to be prescribed opioids within the following year, something that offers tremendous benefits to society in light of the opioid crisis.

If you experience an episode of low back pain, consider chiropractic care as your first treatment choice. If your condition doesn’t respond to a multimodal treatment approach, your chiropractor can refer you to an allied healthcare provider for additional care. 

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

(717) 697-1888

Member of Chiro-Trust.org 

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Correct Behaviors that Cause Upper-Cross Syndrome

25 Jun

Upper-cross syndrome (UCS) patients often demonstrate postural defects such as forward head posture, forward or rounded shoulders, and thoracic kyphosis. These postures are becoming more common as computers and device use assumes an even greater part of our lives and can lead to weakness in the muscles in the mid-back and front of the neck along with tightness of the chest muscles and the muscles in the rear of the neck. Viewing the body from the side, if you connected the groups of tight muscles with a line and did the same for the weak muscles, it would form a cross or X. 

A 2019 survey conducted by Common Sense Media revealed that 20% of eight-year-old children own a cell phone. By age eleven, more than half of kids have a phone and by their high school years, 84% own phones. As they age, kids spend more and more time on their phones, clocking in five hours a day as preteens and increasing use to more than seven hours a day during late adolescence. A 2023 study that included 45 teenagers found that 17 exhibited upper-cross syndrome with nearly half having forward head posture and four-in-five having rounded shoulders. 

Adults who spend their working day in front of the computer screen and their evenings watching TV or using electronic devices like tablets and smartphones are even more likely to have upper-cross syndrome and the musculoskeletal issues that can accompany it. In another 2023 study that included 99 office workers with neck and shoulder pain, researchers observed that 100% had rounded shoulders, 43.4% had forward head posture, and 54.3% had thoracic hyperkyphosis with muscle tightness in the pectoralis minor (100%), levator scapulae (93.0%), and upper trapezius (98.3%) muscles—all hallmarks of upper-cross syndrome. A 2014 study found that about half of office workers have neck and shoulder pain at any given time and nearly a third report persistent neck and shoulder pain. 

The good news is that upper-cross syndrome can be addressed with a combination of chiropractic care, at-home exercises/therapies, and lifestyle/work modifications. Your doctor of chiropractic may employ a variety of manual therapies to restore normal movement to the joints in the neck, upper back, and shoulders. Between visits, you may be asked to perform exercises to help restore good posture, which may include strengthening weakened muscles, like the deep neck flexors. As they will be more familiar with your unique situation, your doctor of chiropractic will be able to offer more specific advice with the aim of reducing your current pain/disability and lowering the chances for a future episode.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

(717) 697-1888

Member of Chiro-Trust.org 

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Can Hip Osteoarthritis Be Prevented?

20 Jun

Hyaline cartilage is the slick, translucent tissue that lines joint surfaces and allows for the smooth movement of joints in the body, including the hip. If the structure or health of this cartilage is compromised, it can gradually wear away, leading to joint pain, stiffness, and disability. Eventually, the hip osteoarthritis patient may have no choice but to accept a dramatically reduced lifestyle or undergo total hip arthroplasty. Is it possible to prevent osteoarthritis of the hip or at least slow its progression?

Unfortunately, the answer isn’t a firm yes or no. There appears to be a genetic component to osteoarthritis risk, so you may be destined for the condition. However, it does appear that if you manage to avoid major trauma to the hip and stay physically active and otherwise live a healthy lifestyle, then it may be possible to significantly reduce the risk for developing the condition and requiring surgical intervention. 

Between 2014 and 2017, researchers in Germany conducted a study in which nearly 24,000 patients with either hip or knee osteoarthritis received usual care or participated in a structured program focused on guidelines-recommended therapies and patient empowerment, including lifestyle changes and exercise interventions. Patients in the experimental group were 33.6% less likely to be hospitalized or undergo joint replacements related to their knee/hip. 

 Chiropractic care offers a unique opportunity for patients as the initial history typically includes a comprehensive review of systems including all aspects of health, both past and present. This approach often extends care well past the primary presenting complaint (hip pain, in this case) to include patient education regarding diet/nutrition, stress management, sleep quality enhancement, and more. Additionally, a doctor of chiropractic will assess related areas of the body to identify problems that can affect normal movement patterns (the foot, ankle, knee, pelvis, low back) as addressing these issues may be critical to help the patient achieve a satisfactory outcome.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

(717) 697-1888

Member of Chiro-Trust.org 

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Complementary and Alternative Approaches to Multiple Sclerosis

15 Jun

Multiple sclerosis (MS) is a chronic neurological autoimmune disease that affects an estimated 2.5 million people globally and accounts for about $85 billion a year in both direct and indirect healthcare costs in the United States alone. Typical MS symptoms and clinical presentations can include sensory loss affecting sight (optic nerve), weakness (motor nerves/brain), facial muscle weakness (facial cranial nerve), ataxia (cerebellum, motor cortex, spinal cord), vertigo (inner ear, vestibular branch of the cranial nerve), pain, fatigue, bladder/bowel control, and psychological disorders. Because the condition is not fully understood and has been linked to both genetic and environmental causes, there’s no one-size-fits-all treatment available to MS patients. Conventional pharmaceutical approaches may have a limited effect, and these immunomodulating or immunosuppressing drugs can lead to adverse allergic reactions that affect the skin and other organs. This has led many patients and researchers to explore alternative and complementary treatment approaches to help slow the progression of the disease and improve a patient’s quality of life.

An October 2022 systematic review looked at ten previously published randomized-control trials to investigate the effects of manual therapies in reducing symptoms in MS patients. The authors concluded that Swedish massage, acupressure, and reflexology interventions lasting 10-30 treatments spread over 4-10 weeks were effective for improving fatigue, pain, spasticity, psychological state, and physical function. 

In addition to hands-on treatment, there have been several studies exploring the role of diet and specific nutrients in MS management. Dietary approaches such as the Mediterranean diet, ketogenic diet, and the dietary approaches to stop hypertension (DASH) diet have been linked to better cognitive health and greater preservation of the thalamus (an area of the brain that relays motor and sensory data to the cerebral cortex). In particular, omega-3 fatty acid supplementation may reduce the severity of some MS symptoms and oleic acid—a fatty acid found in cooking oils, meats, cheese, nuts, seeds, eggs, pasta, milk, avocados, and olives—may stimulate the production of the regulatory T cells that help keep the immune system from attacking the central nervous system.

Staying active may also benefit MS patients. One study found that using an activity tracker helped lower the risk for relapsing-remitting MS symptoms and improved the participants’ ability to maintain normal activities, including working. There’s also research to suggest the obesity, depression, and poor sleep can have a detrimental effect on MS patients, so maintaining a healthy weight and good mental health and sleep hygiene are also important. 

As with many health conditions, early detection and treatment is second only to prevention. In the case of MS, a review of medical records of more than 85,000 adults revealed that those who would eventually develop MS were more likely to make doctor visits for issues such as urinary problems, visual disturbances, abnormal skin sensations, impaired movement, and dizziness in the time preceding their diagnosis. Recognizing these clusters of symptoms can help doctors identify patients who may be at increased risk for MS earlier in the course of the disease when treatment may be more effective.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

(717) 697-1888

Member of Chiro-Trust.org 

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Exercise Can Hasten Whiplash Recovery

10 Jun

Whiplash-associated disorders (WAD) can be a challenging condition to manage, and the current data suggests that up to half of WAD patients may continue to experience pain and disability for up to a year following their car accident, slip and fall, or sports collision. Exercise therapy has long been considered a meaningful treatment option for many musculoskeletal conditions, but what does the current research reflect with respect to the role of exercise therapy for the WAD patient?

In 2021, researchers conducted a systematic review and meta-analysis that included 27 studies in order to gauge the effect of exercise therapy compared with other treatments, placebo interventions, or no treatment. They found that exercise therapy had short-term effects on neck pain and medium-term effects on neck-related disability, but they concluded that “the current evidence is weak” with respect to exercise as a sole treatment for WAD.

However, when used in combination with other treatments, exercise therapy can be quite beneficial to the WAD patient. In addition to the advice to stay active or even start exercising in some capacity (even if that means taking a short walk each evening to begin with), WAD patients may be prescribed more specific, neck/shoulder/upper back exercises to restore posture and strengthen the deep muscles that often become deconditioned in patients with the condition.

In addition to exercise recommendations, your doctor of chiropractic may employ a multimodal approach that includes manual therapies (massage, manipulation, mobilization, active release technique, trigger point therapy, and more); physical therapy modalities (electric stim, ultrasound, class IIIb and IV lasers, pulsed electromagnetic field, traction); patient education (including emphasizing the importance to resume normal activity as soon as possible); and ergonomic assessments (to minimize work stress and strain). When psychosocial barriers to recovery exist, your chiropractor may team with allied healthcare providers that offer cognitive behavioral therapy and other needed services.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

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