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Ten Persistent Myths About Low Back Pain in the Elderly

2 Feb

Low back pain (LBP) is one of the costliest and most disabling conditions affecting older adults. Not only
can pain and disability interfere with the ability to carry out activities of daily living, but proprioceptive deficits
associated with low back pain can impair balance, increasing the risk of serious falls and injuries that can
dramatically affect long-term health and independence. Despite clinical guidelines on effective management of low
back pain in the senior population, these ten prominent myths persist and continue to hinder recovery:

  • MYTH: Back pain is inevitable with aging. FACT: Back pain is common but not inevitable. Prevalence
    increases with age and then levels off after approximately age 60.
  • MYTH: Back pain usually indicates serious disease in older adults. FACT: Serious underlying conditions
    account for fewer than 5% of cases. Most low back pain is classified as “non-specific” and is not associated
    with serious pathology.
  • MYTH: Imaging is necessary in adults over age 50 with low back pain. FACT: Imaging in the absence of
    “red flags” (such as cancer, fracture, infection, or cauda equina syndrome) can lead to unnecessary
    interventions and can cause more harm than benefit.
  • MYTH: Pain should guide behavior—avoid lifting, twisting, and bending when experiencing low back
    pain. FACT: Physical activity promotes recovery, while prolonged avoidance and inactivity are associated
    with worse outcomes. Pain during activity does not usually indicate tissue damage.
  • MYTH: Bed rest is recommended for low back pain in older adults. FACT: Bed rest can cause more harm
    than good, particularly when prolonged, and may contribute to deconditioning and delayed recovery.
  • MYTH: Medication should be the first-line treatment for low back pain. FACT: Clinical guidelines support
    nonpharmacological treatments as first-line approaches, including manual therapies such as those provided
    by chiropractors.
  • MYTH: Surgery is effective for primary back-dominant low back pain. FACT: Surgery is not
    recommended for primary back-dominant pain and may result in worse outcomes or unnecessary
    complications.
  • MYTH: Chronic low back pain in older adults is always caused by structural damage. FACT: Structural
    changes seen on imaging correlate poorly with pain severity or disability. Psychosocial factors play a
    substantial role in persistent pain.
  • MYTH: Injections, ablation, and nerve blocks are highly effective treatments. FACT: For nonspecific low
    back pain, these interventions often provide no greater benefit than sham treatments and are associated with
    increased adverse events in older adults.
  • MYTH: Disk herniations commonly cause leg pain in older adults. FACT: Disk herniations are less
    common in this population; clinical findings are often more reliable than imaging alone.
    Unfortunately, this misinformation is frequently reinforced by family members, friends, social media,
    pharmaceutical companies, other industries, and even healthcare providers. These myths about back pain foster
    inaccurate attitudes, beliefs, and behaviors that can lead to inappropriate, costly, and sometimes harmful treatments.
    Additionally, such misconceptions can result in psychological consequences—including fear of movement, poor
    self-efficacy, low motivation, anxiety, stress, and depression—all of which contribute to greater disability and
    slower recovery. The good news is that, in most cases, chiropractic care serves as a conservative treatment option
    that can help reduce pain and disability, enabling older adults to more easily maintain independence and perform
    activities of daily living.
    Brent Binder, D.C. 4909 Louise Dr. Suite 102 Mechanicsburg, PA 17055 (717) 697-1888

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The Neck and Low Back Connection

15 Jan

When a patient seeks chiropractic care for a condition like neck pain or low back pain, it’s natural to assume the underlying cause is located in the region where the patient feels symptoms. But this isn’t always the case. Sometimes, the primary or contributing factor to the patient’s chief complaint can be elsewhere in the body. A July 2024 study involving patients with cervical myelopathy helps illustrate this point.

Cervical myelopathy is a condition in which the spinal canal narrows due to a variety of potential causes—age-related degeneration, cervical spinal stenosis, herniated disks, trauma, rheumatoid arthritis, ossification of the posterior longitudinal ligament, or even tumors, infections, or congenital narrowing—and compresses the spinal cord. While neck pain is common, irritation of the spinal cord can produce downstream effects in the areas those nerve fibers reach. In this study, which involved 786 individuals with cervical myelopathy, two-thirds also reported low back pain.

Following treatment for cervical myelopathy, about half of those with concurrent low back pain experienced meaningful improvement in both lower back pain and function, and some even reported complete resolution. This suggests that for roughly half of these patients, the issue in their neck was a major contributing factor to their low back symptoms.

Beyond cervical myelopathy itself, several soft-tissue systems span the entire spine—including fascia, long spinal muscles, and ligamentous structures—making it possible for restrictions or dysfunction in the upper spine to influence symptoms in the lower spine. The reverse is also true: issues affecting the feet, ankles, knees, hips, or low back can lead to compensatory postural changes that place additional strain on the neck as the body works to keep the eyes level.

This helps underscore the importance of evaluating the whole patient rather than narrowing attention to the immediate area of complaint—something doctors of chiropractic are trained to do. The good news is that the hands-on care chiropractors provide can often help resolve these contributing issues, and when necessary, your doctor of chiropractic will coordinate with allied healthcare providers to support the best possible outcome.

Pain Relief Chiropractic

4909 Louise Drive Suite 102

Mechanicsburg, PA 17055

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The Evidence Map of Low Back Pain Treatment Options

5 Jan

Low back pain is extremely common and remains one of the leading causes of disability worldwide, resulting in substantial healthcare utilization and cost. Because of this broad impact, identifying and implementing effective, safe, and cost-efficient strategies to diagnose, manage, and prevent low back pain is essential to improve patient outcomes and reduce overall healthcare burden. In 2022, researchers conducted a comprehensive analysis of the available evidence for ten commonly recommended treatments for low back pain—five medication-based and five non-medication-based—drawn from multiple clinical practice guidelines:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) work by blocking the COX-1 and COX-2 enzymes responsible for producing prostaglandins, which influence pain sensitivity, inflammation, fever, and tissue blood flow. Evidence supports short-term improvements in pain and disability, but use is limited by potential side effects such as stomach irritation, increased bleeding risk, kidney strain, and caution in patients with certain heart conditions.
  • Acetaminophen (paracetamol) also blocks prostaglandin production, but its effects are largely restricted to the central nervous system. Importantly, available evidence shows little to no meaningful benefit for pain, function, or quality of life in patients with low back pain.
  • Opioids blunt incoming pain signals and alter how the brain interprets pain. Due to risks of misuse, dependence, and overdose, guidelines recommend restricting their use to severe acute pain or postoperative situations and strongly discourage long-term use.
  • Muscle relaxants can reduce muscle spasm through several central mechanisms. Evidence supports short-term symptom relief, but high-quality evidence is limited, and side effects—including drowsiness, dizziness, cognitive slowing, dry mouth, low blood pressure, nausea, drug interactions, and dependence—must be carefully considered.
  • Antibiotics are intended to treat infection. Evidence supporting their role in low back pain management is weak, inconsistent, and not broadly applicable.
  • Psychological or behavioral therapies can be especially valuable for patients with persistent or recurrent low back pain, as psychological factors strongly influence whether patients engage in behaviors that support or hinder recovery.
  • Staying active and avoiding bed rest are strongly recommended. Activity helps maintain function, reduce disability, and speed recovery.
  • Reassurance—emphasizing that low back pain is common, manageable, and rarely dangerous—reduces fear and catastrophizing and lowers the risk of progression to chronic pain.
  • Exercise, including both general physical activity and targeted movement strategies, provides modest but meaningful improvements in pain and disability. Exercise also reduces recurrence risk.
  • Manual therapy, which includes manipulation and mobilization, helps restore normal movement to the spine and associated tissues, reducing pain and disability. Practitioners often combine different manual techniques based on examination findings, patient preference, and clinical training and experience.

The great news is that doctors of chiropractic frequently employ a multimodal treatment approach that includes manual therapy, exercise, reassurance, and activity recommendations—among the most strongly supported options in this evidence map!

Pain Relief Chiropractic

4909 Louise Drive Suite 102

Mechanicsburg, PA 17055

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Risk Factors for Postpartum Low Back Pain

1 Dec

It’s estimated that as many as 50–70% of new mothers experience low back pain and
related disability, which can hinder their ability to carry out daily activities such as household
chores, self-care, and meeting the physical demands of infant care—including feeding, lifting,
and carrying. When severe enough, these physical limitations can contribute to stress, anxiety,
and postpartum depression, further interfering with the mother’s ability to bond with her
newborn and diminishing her overall quality of life. What are the underlying causes of
postpartum low back pain?
Interestingly, some risk factors may be present even before conception. Research
suggests that being overweight or obese, physically inactive, or exposed to occupational risk
factors such as whole-body vibration, poor ergonomics, and frequent lifting can set the stage for
low back pain both during pregnancy and after delivery. Women with a prior history of low back
pain are also at elevated risk for symptoms during and following pregnancy.
As the baby grows, the center of mass shifts forward in the body. To compensate, the
pelvis tilts anteriorly and the lumbar spine increases in lordosis, placing added stress on the
lumbar intervertebral disks and facet joints. The stretching of the abdominal muscles can reduce
spinal stability, while hormonal changes that prepare the pelvis for childbirth can increase joint
laxity, further affecting stability in the lower spine and pelvic region. To compound these effects,
expectant mothers may experience fluid retention, deconditioning from reduced activity, sleep
positions that strain the lower back, and psychosocial factors such as stress and anxiety that
heighten pain perception.
Childbirth itself can also contribute to postpartum low back pain. The physical effort of
pushing during delivery can strain the lower back, and the hormonal changes that allow for
ligamentous laxity during pregnancy may persist afterward, leaving the spine more susceptible to
mechanical stress. In cases of cesarean delivery, factors such as spinal anesthesia, post-surgical
immobilization, and prolonged bedrest can further delay recovery and exacerbate pain.
Unfortunately, it’s a common misconception that postpartum low back pain will simply
resolve on its own. In reality, studies suggest that up to 1 in 5 new mothers with low back pain
will develop chronic symptoms lasting a year or longer. While some risk factors for postpartum
low back pain are beyond a woman’s control, others—such as maintaining an active lifestyle,
avoiding prolonged inactivity, and seeking chiropractic care to help restore proper joint motion
and function in the lumbar spine during and after pregnancy—can play a key role in prevention
and recovery.
Brent Binder, D.C.

4909 Louise Dr. Suite 102 Mechanicsburg, PA 17055 (717) 697-1888

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Treatment for Vertebral Compression Fracture

3 Nov

While there are many potential causes of low back pain in older adults, one of the most common—especially among women—is vertebral compression fracture (VCF). By age 80, up to 30% of women and 20% of men will have sustained at least one VCF. Interestingly, only about one-third of cases produce acute, noticeable pain. The remainder are either asymptomatic or go undiagnosed due to lack of imaging or because other pain-generating conditions such as osteoarthritis or spinal stenosis may mask the fracture. The type of treatment to address the injury depends largely on whether the fracture is stable or unstable.

A vertebral compression fracture occurs when the bony structure of the vertebra collapses, often due to osteoporosis and weakened bone health. If the fracture extends beyond the anterior portion of the vertebra, radically alters spinal alignment, or places pressure on neural structures, it is considered unstable. These cases usually require surgical intervention, such as vertebroplasty or kyphoplasty (injecting a cement-like material into the vertebra) or spinal fusion to stabilize the spine. Fortunately, only 10–15% of vertebral compression fractures are unstable.

Most VCFs are stable and can be managed conservatively, which may include chiropractic care. Treatment guidelines recommend activity modification during the early healing phase—avoiding heavy lifting, twisting, or prolonged sitting or standing. However, patients are encouraged to remain active within pain tolerance, as inactivity can lead to deconditioning and slower recovery. Bracing may be considered on a case-by-case basis, though evidence for its effectiveness is mixed. Spinal manipulation is generally contraindicated, but chiropractors can employ low-force manual therapies, modalities for pain and muscle spasm (such as ultrasound, TENS, or cold laser), and prescribe posture and core stabilization exercises. Co-management with a medical physician may include short-term medications to control acute pain.

Ultimately, the most effective treatment is prevention. Osteoporosis—the most common underlying cause of VCFs—is often silent until a fracture occurs. Guidelines recommend that all women over age 65 undergo a bone density (DEXA) scan, with earlier screening for those with family history or risk factors. While there is no consensus for men, approximately 1 in 6 will develop osteoporosis in old age. Just as important is adopting a healthy lifestyle that includes a nutrient-dense diet, weight-bearing exercise, maintaining adequate vitamin D levels, not smoking, and avoiding excessive alcohol consumption.

Pain Relief Chiropractic

4909 Louise Drive Suite 102

Mechanicsburg, PA 17055

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Understanding Lumbar Disk Injuries

2 Oct

Low back pain can arise from a variety of structures in the lower back. When symptoms include pain, tingling, numbness, and/or burning that radiates into the buttock, thigh, calf, or foot, a potential cause may be injury to one or more intervertebral disks. These disks function to stabilize the lumbar spine, absorb forces, and facilitate its range of motion.

The lower back is comprised of five lumbar vertebrae separated by intervertebral disks positioned in the anterior portion of the spinal column. The nucleus pulposus is a gel-like structure in the center of the disk that provides much of the strength and flexibility of the spine. In young, healthy disks, the nucleus pulposus is composed of 66–86% water, with the remainder consisting mostly of type II collagen and proteoglycans. The annulus fibrosis, surrounding this core, is made up of concentric layers (lamellae) of fibrous connective tissue, each oriented at about 60 degrees to the adjacent layer. This crisscross radial-ply design provides significant strength and helps prevent leakage of the nucleus pulposus, much like the reinforcement of a radial car tire. Finally, each disk is anchored to the vertebrae above and below by cartilaginous endplates.

Common disk injuries include disk bulge (the annulus remains intact but the disk extends beyond its normal boundaries), disk herniation (the nucleus pulposus pushes through the annulus), disk tear (the annulus itself tears), disk endplate injury (the nucleus pulposus intrudes into the vertebral endplate), disk degeneration (progressive breakdown leading to loss of disk height). Less common conditions include infection or neoplastic (tumor) invasion of the disk space. Importantly, disk injuries are not always symptomatic, which is why guidelines often recommend against advanced imaging for uncomplicated low back pain, as an observed disk herniation may not necessarily explain the patient’s symptoms.

Several studies have shown that it is nearly impossible to herniate a truly healthy disk. Rather, when an apparent injury follows a perceived trauma such as lifting with poor posture, it usually represents the culmination of a longer degenerative process in which the disk ultimately places pressure on a nerve root. Long-term risk factors for disk degeneration include obesity, family history of disk disease, and physically demanding occupations or leisure activities.

The good news is that many disk injuries can be managed non-surgically in a chiropractic setting using a multimodal approach. This may include spinal manipulation and other manual therapies, therapeutic exercise, physiotherapy modalities, and adjunctive anti-inflammatory strategies such as cryotherapy, dietary modification, and supplementation. In the short term, treatment focuses on restoring normal motion around the disk and reducing nerve root irritation. Over the longer term, the goal is to stabilize the spine and correct biomechanical issues that may place excess stress on the disk. If symptoms do not respond adequately, referral to a specialist for more invasive interventions, including surgical options, may be warranted.

Pain Relief Chiropractic

4909 Louise Drive Suite 102

Mechanicsburg, PA 17055

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