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Choose Chiropractic FIRST for Low Back Pain

10 Sep

When it comes to a condition like low back pain, does it matter what type of healthcare provider a patient initially visits for treatment? A study published in 2015 looked at this question and found that the type of healthcare provider a patient initially consulted had a dramatic effect on both their short-term and long-term prognosis.

In the study, researchers monitored 719 patients with low back pain, 403 of whom initially consulted with a medical physician and the rest first sought care from a doctor of chiropractic. The results showed that the patients in the chiropractic care group not only experienced a greater reduction in their low back pain, but they were also more satisfied with their experience. Additionally, the average cost of treatment for the chiropractic patients was $368 (US dollars) lower than the average cost of treatment in the group that received care from their medical doctor. The study clearly favored chiropractic care as the initial treatment choice for patients with low back pain.

In a 2019 study, researchers reviewed medical records from over 216,000 patients without a history of opioid use and who had new-onset back pain to see if initial provider choice influenced future prescription narcotic use. The data showed that 22% of patients received a prescription for an opioid in the short-term; however, patients who consulted with a doctor of chiropractic first were even less likely to require either a short-term or long-term prescription than those who visited a medical doctor initially. The authors of the study concluded, “Incentivizing use of conservative therapists may be a strategy to reduce risks of early and long-term opioid use.”

Another study followed a set of 2,870 acute and chronic low back pain patients for four years. The research team observed that chiropractic care provided more favorable short-term outcomes for patients with chronic back pain, while both acute and chronic low back pain patients reported better outcomes in the long term, especially in chronic patients with leg pain extending below the knee.

Seeing a chiropractor first can also reduce the chances a patient will require a surgical procedure to address their back pain. A 2013 study published in Spine looked at data from Washington state worker’s compensation cases and found that 43% of injured 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—a massive difference.

TAKE-HOME MESSAGE: Seek chiropractic care FIRST to receive the most satisfying, efficient, and cost-effective approach for managing acute or chronic low back pain!

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Spinal Stability and Low Back Pain

3 Aug

When it comes to managing a low back condition, the goal of chiropractic treatment is for the patient return to their normal daily activities as soon as possible. This not only means addressing low back pain but also low back disability, including impaired postural control and reduced spinal stability, which can manifest in reduce position sense, increased postural sway, and impaired balance.

Movement control and spinal stability are controlled the deep muscles, the superficial muscles, and the nervous system that sends information to and from the brain. Dysfunction in ANY of these can result in lumbar spine instability.

To complicate matters, when an injury is present, the body will alter its neuromotor patterns as a protective mechanism. However, this can lead to some muscles becoming overworked while others may become deconditioned. If unaddressed, additional musculoskeletal conditions may result in nearby parts of the body, which explains why patients will often present with multiple seemingly unrelated complaints.

In addition to manual therapies like manipulation and mobilization to restore proper joint movement, treatment for low back pain may also include core stabilization/strengthening exercises and balance exercises.

For abdominal strengthening, one exercise that works well is a spine-sparing sit-up. Place the hands behind the lower back to prevent flattening of the lumbar curve and lift the head and chest as a unit a few inches off the floor, hold for ten seconds, and repeat to tolerance (five to ten reps to start out with).

To strengthen your sides, try a side-bridge or side-plank (from feet or knees), holding for ten seconds and repeating as tolerated.

To strengthen the back, try the front plank. Rest on your forearms in a push-up position for ten seconds and repeat as tolerated. The bird dog is another good exercise. Kneel on your hands and knees and raise the opposite arm and leg without twisting the trunk and hold for ten seconds, repeat with the other arm/leg.

For improved balance, stand on one leg with your eyes open or closed (if able) as long as you can. This stimulates the neuromotor system.  Be safe, and do these in a corner to prevent falling!

Make these exercises a habit. Consistency will help improve low back function and you’ll reduce your risk for a future episode of low back pain!

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

A Link Between Back Pain and Urinary Incontinence

14 Jul

While under chiropractic treatment, it’s not uncommon for a patient to report improvement for an issue that seems unrelated to their chief complaint. For example, a patient with a temporomandibular disorder may experience an improvement in their jaw symptoms following treatment to the neck or upper back. Or treatment to improve hip function may also benefit the ankle or knee. In this article, we’re going to look at how treatment for low back pain may help a patient who also has urinary incontinence (UI) issues.

There are many potential causes for UI, but one contributing factor is weak pelvic floor muscles. Thus, it makes sense that treatment to address impaired pelvic function may benefit some UI patients. A 2018 Cochrane systemic review concluded that pelvic floor muscle training (PFMT) is more effective than either a sham treatment (placebo) or no treatment for some individuals with UI.

This is where back pain comes into play. It’s estimated that back pain will affect more than 80% of us during our lifetime. We often adjust how we perform everyday activities to avoid pain, both consciously and unconsciously. These abnormal movements can place added stress on other parts of the body. In the case of the lower back, altered function in the hips and pelvis is common.

A November 2019 study published in the Journal of Craniovertebral Junction & Spine concluded that individuals with lumbar degenerative disk disease, spondylolisthesis, and failed back surgery syndrome are more likely to exhibit abnormal spino-pelvic alignment. Overtime, these individuals can develop secondary conditions in the hip or pelvis, which can impair the function of soft tissues, including muscles, in the region. Or likewise, injury to the hips/pelvis can lead to dysfunction in the lower back, which may be why the patient sought care in the first place.

Doctors of chiropractic are trained to review a patient’s case history and conduct a thorough examination on the whole patient in order to identify contributing factors for the patient’s chief complaint. Hence the importance of noting all symptoms, even those that seem unrelated or may be embarrassing. If a low back pain patient’s history notes UI and the examination identifies abnormal pelvic posture, then treatment will likely address improving function in both the pelvis and low back to achieve a successful outcome.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Low Back Pain and Directional Preference for Exercises

10 Feb

Several studies have found that a treatment approach that combines specific exercises with spinal manipulation, mobilization, and nutrition is often ideal for reducing pain and improving function in patients with low back pain. But how does your doctor of chiropractic know which low back exercises to recommend and which to avoid? The answer: it depends.

Because each patient is unique (age, health status, fitness), it’s clear that exercise prescriptions need to be individually tailored to be safe and to avoid injury. Perhaps one of the most important tools your doctor will take into consideration is the concept of directional preference. That is, which position helps your back feel good or bad? From a sitting position, first slump and slouch and then ask yourself, “Does this feel good, bad, or no different?”

Next, sit up straight and arch your lower back and ask the same question. Do you prefer one over the other? If so, the position in which you feel BEST is YOUR directional preference.

Using that concept, let’s say you feel best slumped and slouched, which is quite common. What are the “BEST” exercises for this flexion directional preference (FDP)?

  • While laying down and facing upward, pull one knee to the chest followed by the other, repeating five to ten times each (staying within reasonable pain boundaries).
  • While laying down and facing upward, flatten and “push” the arch of your lower back into the floor by rocking your pelvis forward and hold three to five seconds, repeating five to ten times.
  • While sitting, bend forward and try to touch your toes. Repeat multiple times a day as needed.

If you feel best in the arched sitting posture, then the ideal exercises for you may be those that utilize the extension directional preference (EDP):

  • While sitting or standing, place your hands behind your back, and arch your back over your hands (as far as comfortably allowed). Hold for three to five seconds, repeat five to ten times.
  • Sit up as arched as your can and try to hold that position as long as possible when doing sitting tasks (computing, driving, etc.).
  • Do a “saggy push-up” (also called a “Cobra,” or prone press-up) by keeping your hips on the floor while doing a push-up, arching the low back.

You can improvise and make up your own exercises using this concept, but while some discomfort is to be expected, avoid sharp lancinating pain. If you don’t have a directional preference and feel good in both positions, do ALL of the above! Your doctor of chiropractic can help monitor and train you in these and many more exercises as part of your treatment plan to reduce back pain and improve back function.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Spinal Stenosis and Non-Surgical Care

2 Jan

It’s common to see older adults with a slumped posture, and though there are many possible reasons for this, perhaps the most common cause is a condition called spinal stenosis.

The Mayo Clinic notes that spinal stenosis can result from wear-and-tear that narrows the spinal disks. This narrowing can place pressure on the nerve roots as they exit the spine prior to traveling down into the legs. The symptoms—which can include pain, numbness/tingling, and weakness—typically come on gradually and may worsen over time. The spinal stenosis patient may feel more comfortable by leaning or bending forward as this posture opens the holes in the spine (the foramen), taking pressure off the nerves.

Because spinal stenosis is a condition caused by wear-and-tear, some individuals may be at more risk than others, especially those with a history of spinal/disk injury, heavy labor, poor nutrition, or obesity.

The good news is that patients with spinal stenosis can benefit from non-surgical approaches!

In a 2019 randomized trial involving 259 seniors with spinal stenosis, researchers compared the effectiveness of three approaches: medical care (including epidural steroid injections), group-based exercise, or manual therapy (spinal mobilization performed by a doctor of chiropractic) with individualized exercise (stretches and strength training).

While participants in the medical care and exercise-only groups reported some benefits, the research team noted that the patients in the manual therapy plus individualized exercise group experienced greater improvements with respect to pain, function, and walking ability.

The “take-home” message here is that in all three measured outcomes—pain, function and walking ability—the chiropractic approach did the BEST!  If you suffer from spinal stenosis and its associated symptoms and walking limitations, PLEASE consider chiropractic not only as an option but perhaps as this study points out, the BEST option!

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Traction for Low Back Pain?

16 Dec

In the past, we’ve written about the use of mechanical traction for patients with neck pain. But what about the low back pain (LBP) patient? Can traction help reduce pain and improve function for this group? Let’s see what the scientific literature has to say about traction for the lower back and whether it has merit.

In a 2018 systematic review, researchers analyzed data from previous studies regarding the use of traction on the lumbar spine. They identified 37 randomized clinical trials that reported on five different types of traction: mechanical, auto-traction, manual, gravitational, and aquatic. Not only did the research team observe great variability in the types of traction used, but they also saw differences with respect to the amount of force, rhythm, session duration, and treatment frequency. To add yet more variables, patient characteristics often included a mixture of acute, subacute, and chronic LBP patients, with or without sciatica and without consistency in the clinical diagnoses.

With so many varieties of low back traction being used on patients with a large mix of diagnoses in the acute, sub-acute, and chronic stages of their condition, the review was unable to make an overall determination about the effectiveness of traction. However, some of the studies that included well-defined patient populations did show promise.

For example, the authors discussed a small pilot study that utilized inversion traction. This form of traction is unique because it is designed to be done at home, making it far more cost-effective and practical. The participants in this study all had a single herniated disk in their lower back with sciatica (pain radiating down the leg following the course of the pinched nerve). The methods of the study were straightforward. A group of patients awaiting surgery for their herniated disk were randomly assigned to one of two groups: physical therapy (PT) ONLY or PT plus inversion traction (IT). While the research team tracked improvement using a variety of criteria, their ultimate definition of success was defined as cancellation of the surgery.

The results CLEARLY showed that the group receiving PT alone did worse than PT + IT group, as 22.2% vs. 76.9% of each group avoided surgery, respectively. The authors concluded that inversion traction is a form of traction that resulted in a significant reduction in the need for surgery, and they recommended a larger study be carried out to further validate their results.

For some patients, traction may be useful in the management of low back pain, depending on their unique case. Doctors of chiropractic often treat patients with low back pain using a combination of spinal manipulation, mobilization, nutritional advice, exercise recommendations, and more—including in-office or at-home traction, if warranted.

 

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.