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Low Back and Dysmenorrhea – Are They Related?

3 May

Dysmenorrhea, also known as painful periods, is a common gynecological condition that affects up to 70% of menstruating women. About 15% of individuals with the condition report that it significantly interferes with their activities of daily living (ADLs) and in some cases, results in absence from school and/or work. Studies have found that dysmenorrhea is related to early menarche (the onset of menstruation), nulliparity (not having children), and stress. But is it possible there’s an anatomical component to the condition?

The lumbar spine, or low back, consists of five vertebrae that rest on top of the sacrum, or tail bone, which is wedged between the “wings” of the pelvis (the ilia) making up the sacroiliac joints (SIJs). This close anatomical relationship with the pelvic organs suggests that the musculoskeletal dysfunction may play some role in dysmenorrhea. But is this truly an important relationship and if so, can spinal manipulation to the low back and pelvis/SIJs help reduce the pain associated with dysmenorrhea?

One study looked at the relationship between pelvic alignment and dysmenorrhea in 102 females divided into groups of those with and those without the condition. The researchers observed there were differences in pelvic alignment between members of both groups.

Another group studied the lumbo-pelvic alignment and abdominal muscle thickness in 28 women with primary dysmenorrhea and 22 women without the condition and found greater misalignment and smaller diameter abdominal muscles in the dysmenorrhea group.

To determine if there is a change in pain perception after pelvis manipulation in women with primary dysmenorrhea, a randomized controlled trial of 40 women (20 in two different groups) received a “global pelvic manipulation” (GPM) while the other group received a sham or placebo intervention. The participants in the GPM treatment group reported significant improvements in overall pain and sensitivity when compared with the sham treatment group, supporting manipulation as an effective tool in the management of dysmenorrhea.

Though further research is warranted, this study shows there is scientific support for the use of spinal adjustments in women suffering from dysmenorrhea. Therefore, chiropractic may offer an effective, safe, and often fast remedy for those who choose to not risk the side effects of various medications commonly used to treat dysmenorrhea.

 

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.
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What Causes Low Back Pain?

9 Apr

Low back pain (LBP) is VERY common condition, and research shows that up to 50% of the adult population in the United States will experience LBP in any three-month time frame over the course of a year. Worse, low back pain can persist for months, years, and even longer, significantly reducing one’s ability to work, play, and enjoy life. So, let’s take a look at where LBP can come from…

ANATOMY: There are five lumbar vertebrae located just below the last rib and extending down to the sacrum. The FRONT of the vertebral column is made up of large box-shaped “vertebral bodies” that are strong and made to bear heavy weight. Between the vertebral bodies are shock-absorbing “intervertebral disks” that have a tough outer layer that surrounds a liquid-like center, giving it the ability to absorb vertical loaded pressure.

The spinal cord runs through the MIDDLE of the vertebra through the spinal canal. Nerves also exit the spine at each spinal level.

The BACK of the vertebra is made to protect the spinal cord. There are two gliding joints on the either side (called facet joints) of the vertebrae, which allow us to bend sideways, backwards, forward, or a combination of movements.

Below the lumbar spine sits the sacrum. The sacrum is wedged between the left and right wings of the pelvis, the ilia, forming the sacroiliac joint (SIJ). For many years, anatomists didn’t believe the SIJ could move and thus, could not be a pain generator. More recent research has concluded that not only is there movement in the SIJ but it may be the primary pain generator in up to 30% of lower back pain cases.

CASE STUDIES: Each of the above anatomical structures can be potential causes of LBP, and the presenting patient’s symptoms and clinical signs can help a doctor of chiropractic figure out what’s going on. For example, when a patient states, “My back kills me and the pain shoots down my leg when I bend over and feels better when I bend backwards and leg pain disappears,” this is most often caused by a herniated disk pinching a nerve in the low back.

In the above case, it’s important to examine the nerves that run down the leg, as the nerve can become damaged if too much pressure is exerted on the nerve for too long. Here, your doctor will ask you to walk on your toes and heels, check your reflexes at your knee and heel, and test your ability to feel sensations on the skin. If any of these tests reveal loss of function, the first goal of care will be to remove the pinch on the nerve to restore leg feeling and strength.

On the other hand, when a patient feels better bending over and worse bending backwards, the facet joints and/or the SIJ may be the culprit.

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.

Chiropractic & Foot Orthotics: A Great Combination for Back Pain!

8 Mar

When treating patients with low back pain (LBP), doctors of chiropractic have three common goals: 1) pain management; 2) posture alignment or correction; and 3) prevention. When warranted, the use of corrective prescription foot orthotics can help achieve all three goals.

In a 2017 study, researchers recruited 225 adult subjects with chronic low back pain (cLBP) and randomly assigned them to one of three treatment groups: 1) shoe orthotics only; 2) chiropractic care (included spinal manipulation, hot or cold packs, and manual soft tissue massage) with shoe orthotics; or 3) a non-treatment group.

The primary outcome measures used to track change over time included a numerical pain rating scale and a functional rating questionnaire (Oswestry Disability Index – ODI) at baseline and after six weeks of treatment, with follow-up three, six, and twelve months later.

After six weeks, only the first two groups experienced improvements in both average back pain intensity and function, with the orthotic plus chiropractic group reporting even greater functional improvement.

While podiatrists have long suggested the use of foot orthotics for some cases of LBP because of the effect foot function has on the “kinetic chain,” it was not until the last decade that researchers in other fields have reported the effects the feet have on knee, hip/pelvic, and back function.

Studies have now demonstrated the adverse effects of hyperpronation (rolling in) of the foot on pain, function, and alignment of the pelvis. These studies point out the importance of not overlooking foot dysfunction as a potential (and important) contributing factor when managing patients with LBP.

 

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.

The Elderly & Back Pain – Is Chiropractic Effective?

1 Feb

Around the world, low back pain (LBP) is a leading cause of disability and ranks sixth in terms of “overall disease burden.” Chronic low back pain (cLBP) has a profound socioeconomic impact on individuals, families, and communities—so much so that the World Health Organization has identified LBP as a major disabling condition.

Older people tend to have greater physical disability caused by LBP compared with younger individuals, and old age is often associated with non-recovery and poor outcomes. One study found that more than a quarter of older people in the United States had cLBP upon entering retirement and that baby-boomers (those born between 1946 and 1964) account for 51% of all costs (over $10 billion) associated with cLBP.

So the question of the month is: how safe and effective is chiropractic care for older patients with cLBP? To help answer this question, researchers searched multiple sources for studies that included patients over 55 years of age with cLBP (more than three months of LBP), that utilized some form of manual therapy, that included tools that measured pain and disability, and that utilized a randomized control trial design. Researchers excluded data from experiments in which subjects had prior back surgeries, had pelvis-only pain (e.g. tail bone pain), or had received only a single treatment without follow-up.

Though only four studies met these stringent criteria, the authors did conclude that manual therapies, which include spinal manipulation delivered by doctors of chiropractic, can improve pain and function in older patients with chronic low back pain with very few adverse side effects.

This study supports the benefits of chiropractic care for the aging population and emphasizes the need for effective treatment options for cLBP with a low risk for serious adverse effects. With the size of the senior population expected to double over the next several decades, Chiropractic care will surely continue to play an important role in improving the quality of life of the elderly.

A Simple Remedy for Chronic Low Back Pain?

4 Jan

Low back pain (LBP) affects about 80% of adults at some point in their life, and its impact on work, recreation, and overall quality of life can be devastating if it transitions into chronic LBP (low back pain that persists for more than three months).

So, is there really a simple remedy for chronic LBP (cLBP)? Since back pain is often multifactorial in its causation, the simple answer is “probably not”. BUT, a 2017 study reports that simply taking vitamin D can offer significant benefits for the cLBP patient.

In the study, researchers provided participants (68 patients with a history of cLBP and low vitamin D levels) with an oral dose of 60,000 IU of vitamin D3 every week for eight weeks. The research team measured pain intensity and disability using common outcome assessments at baseline and at two, three, and six months post treatment. They also collected blood samples to measure vitamin D serum levels.

The data show that not only did the patients’ vitamin D levels improve from 12.8 ng/mL (+/- 5.73) at baseline to 36.07 (+/- 12.51) at eight months with 45 (66%) of the patients attaining a normal level of >29 ng/mL, but the participants also report significant improvements in pain and disability throughout the course of the study.

The authors conclude that vitamin D supplements can improve pain and function in cLBP patients with vitamin D deficiency. Hence, this is a VERY SIMPLE remedy!

It is well known that vitamin D deficiency is a very common problem, with up to 75% of teens and adults having suboptimal levels. Past research has demonstrated vitamin D deficiency may be a risk factor for many disorders including cancer, heart disease, diabetes, and depression. It appears that we can now add cLBP to the long list of conditions that vitamin D supplementation may benefit.

Chiropractic services frequently include nutritional counseling, diet management, and other wellness-related services in the quest of optimizing patient health, well-being, and quality of life.

What to Do for Chronic Low Back Pain

4 Dec

Low back pain (LBP) is a very common problem that many, if not most of us, have had at some point in life. In fact, about 80% of adults experience LBP in their lifetime, and it’s the leading cause of job-related disability and missed work days. According to the National Institutes of Health, more than 25% of adults have had a recent episode of LBP.

Men and women are equally affected by LBP, which can occur abruptly following a specific incident (such as over lifting), or it can develop slowly over time due to wear and tear. Studies show a sedentary lifestyle during the week can set the stage for developing LBP, especially when it’s followed by strenuous weekend workouts.

Although about 80% of acute LBP (lasting a few days to weeks) resolves with self-care or short-term management, about 20% of those with acute LBP will still have persistent symptoms after a year. So what can be done to manage chronic LBP and prevent disability?

One study looked specifically at maintenance spinal manipulative therapy (SMT) to determine its effectiveness in managing chronic LBP, which they defined as LBP that persists for more than six months. Researchers randomly assigned sixty patients to receive either 1) 12 treatments of sham SMT for one month; 2) 12 treatments of SMT for one month but no treatment thereafter; or 3) 12 treatments for one month followed by SMT twice a month for the following nine months.

The research team found that groups two and three experienced significantly lower pain and disability scores than the sham treatment group at the end of the first month. However, only the third group experienced more improvement in regards to pain and disability at the ten-month evaluation. In the absence of continued SMT, the second group’s pain and disability scores returned back to near pre-treatment scores. The authors concluded that SMT is effective for chronic nonspecific LBP, but to obtain long-term benefit, patients should continue to receive care on an ongoing basis.

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.