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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.
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The Mysterious Sacroiliac Joint

2 Nov

Low back pain (LBP) can arise from a number of structures that comprise the lower back like the intervertebral disk, the facet joints, the muscles and/or tendon attachments, the ligaments that hold bone to bone, the hip, and the sacroiliac joint (SIJ). Though several of these can generate pain simultaneously, the focus of this month will center on the SIJ.

The role of the SIJ is quite unique, as it has a big job: it is the transition point between the flexible axial skeleton (our spine) and the pelvis, below which are the lower extremities or legs. The pelvis supports the weight of the torso, which usually accounts for about two-thirds of our body weight. The SIJ is shaped at an oblique angle that diverges or opens at the front and converges inwards at the back of the joint in order to support the weight on top of it. Because the sacrum/tailbone is “V” shaped, it fits like a wedge and is held together by very strong ligaments, making it an inflexible but sturdy joint.

Making a diagnosis of SIJ syndrome or identifying it as a pain generator can be a challenge. Your chiropractor may depend on several types of examinations in order to arrive at an SIJ syndrome diagnosis, such as palpation looking for pain directly over the SIJ; compression tests of the pelvis; front-to-back hip movements to stretch the joint; and imaging, such as x-ray, CT scans, and MRI.

Since the SIJ is NOT a flat and smooth oblique joint, an x-ray has many limitations. However, the pubic bone called the “symphysis pubis” (SP), which is located in the front of the pelvis, can be easily seen on x-ray. Because the pelvis is a ring-like structure, an SP that is out of alignment may indicate SIJ dysfunction.

In a recent study, two independent orthopedic surgeons analyzed the x-rays of 20 consecutive patients (17 women and 3 men) with proven SIJ dysfunction and LBP (confirmed by SIJ injection testing), which resulted in the findings of osteoarthritic degeneration and subluxation (misalignment) in 18 of the 20 subjects.

When they assessed the SP in 20 non-SIJ LBP control subjects (16 women and 4 men), 7 had abnormal SP findings (35%) versus 18 of 20 with SIJ-LBP mentioned above (90%). A review of the patients’ past radiology reports found that only three reports mentioned this in the SIJ-LBP group and none reported this in the control group. The authors concluded that SP findings are underreported by radiologists, and because SP is much easier to “read” or assess than the SIJ itself, it NEEDS to be looked at!

 

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.

Management Strategies for Chronic Low Back Pain

2 Oct

Chronic LBP (cLBP) is a BIG problem in our society, accounting for about 33% of work-related disability. So, what is the best management strategy for cLBP?

One study looked at the effectiveness of spinal manipulation therapy (SMT) using three groups of patients with cLBP. Each group received either: 1) “sham” spinal manipulation (twelve treatments of sham or “fake” SMT) over a one-month timeframe and then discontinued; 2) “real” SMT (high-velocity, low-amplitude thrust) twelve times during a one-month timeframe and then discontinued; and 3) the SAME as the second group but with additional SMT treatments every other week for nine additional months.

As expected, the first group saw no benefits from sham SMT with the second and third groups reporting similar benefits after one month of care. However, ONLY the third group reported continued benefits at the tenth month. The study concluded that in order to obtain long-term benefits for patients with cLBP, patients should receive maintenance care after an initial intensive care plan. It’s also worth noting that this 2011 study was not only published in the illustrious journal SPINE but it was authored by two medical doctors.

More recent studies have consistently validated that SMT is a safe, effective method of managing cLBP, especially when it is repeated on a maintenance basis.

Doctors of chiropractic also include exercise training for flexibility and core strengthening as standard recommendations in the management of LBP patients, in addition to advice to remain active and avoid prolonged bed rest. If you haven’t utilized chiropractic care for cLBP, you owe it to yourself to give it a chance – the evidence supports it!

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.

Pregnancy and Low Back Pain – Part 3

4 Sep

In Part 1 of this series, we discussed the many aspects of pregnancy that contribute to low back pain (LBP) including hormonal, chemical, biomechanical, and psychological changes that occur throughout pregnancy. In Part 2, we looked at the results of several studies showing that chiropractic care can help reduce low back pain (LBP) both during pregnancy as well as during labor and delivery. This month, let’s focus on what to expect when you visit a doctor of chiropractic.

The initial visit typically consists of an intake process: a history, examination, vital signs, and so on. Your doctor of chiropractic will discuss the treatment goals and procedures typically utilized during the three trimesters of pregnancy and will provide a treatment recommendation.

After the initial treatment, it is not uncommon for people, pregnant or not, to feel a “post-exercise soreness” type of discomfort. This makes sense as chiropractic adjustments and mobilization are indeed “exercising” your spinal joints with the goal of reducing joint stiffness and fixations, which some chiropractors may refer to as “spinal joint subluxations.”

There are many types of manual therapies available, and finding the method that matches your choice and needs is important. One type of manipulation often associated with chiropractic includes the use of a “high-velocity, low-amplitude” (HVLA) thrust, which is frequently referred to as “an adjustment.” Joint cavitation or the “cracking” sound that commonly occurs with adjustments is created by the formation of a gas cavity within the spinal joint space during the maneuver. The spinal joints often become looser during pregnancy due to the increase in circulating progesterone, estrogen, and relaxin, especially in the third trimester. Typically, very little force is needed to successfully cavitate a spinal joint when utilizing HVLA adjustments. For some patients, the cracking sound can provoke anxiety and in those cases, low-velocity, low-amplitude techniques may be preferred, as this does not typically result in joint cavitation.

Exercise throughout pregnancy is important, as studies show it improves energy, reduces mood swings, facilitates in stress management, and results in more restful sleep. Other benefits include less weight gain during pregnancy (by approximately 21%); shorter and easier labor (decreased by an average of two hours); fewer medical interventions experienced (24% fewer cesarean deliveries and 14% reduction of forceps use); less fetal distress; and faster recovery times.

Nutritional counseling is also appreciated and very important during pregnancy, and chiropractors are well-trained in this form of management.

Doctors of Chiropractic can work with OB/GYN doctors, primary care physicians, and/or midwives to coordinate care throughout the pregnancy with the common goal of making this the best experience of your life!

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055
Member of Chiro-Trust.org

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.

Pregnancy and Low Back Pain – Part 2

3 Aug

Back pain can become both more frequent and more intense as a pregnancy enters into the second and (especially) the third trimester. This is because the biomechanical changes that accompany pregnancy occur too fast for the body to properly adapt.

Besides the usual suggestions of bed rest, taking frequent breaks, using cold packs, and the like, there are many benefits derived from manual therapies such as manipulation, mobilization, massage, and exercise.

Chiropractors frequently offer these services, and one or a combination of these therapies can result in significant relief of back pain during pregnancy. One study reported that 94% of pregnant women receiving chiropractic treatment demonstrated clinically important improvement with substantial relief for several days following their initial treatment, with no adverse effects.

In a survey of 950 pregnant women and 87 medical providers, 31% responded that effective alternative therapies used during pregnancy included chiropractic care, massage, and yoga exercises. In a review of 400 pregnant female medical charts after delivery, 84% reported relief of back pain during the pregnancy with chiropractic care.

Studies have also shown that women with back pain during pregnancy have an elevated risk for a longer labor and delivery. Additionally, first-time pregnant women (primigravida) who received chiropractic care throughout their pregnancy averaged a 25% shorter labor time, while women who were pregnant after already having a child (multiparous) reported a 31% average shorter labor time.

Co-management and referrals between medical providers and chiropractors are becoming more common due to the growing amount of evidence published regarding the benefits of spinal manipulation during pregnancy.

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org

Pregnancy and Low Back Pain – Part 1

3 Jul

Did you know that between 50% of all pregnant women suffer from back pain and 50-75% experience back pain during labor?

There are MANY reasons why back pain becomes an issue for women during their pregnancy. The first and most obvious reason is the displaced weight gain of 25-35 pounds (on average) resulting in pain in both the upper quarter (often from the increase in breast volume and weight) and lower quarter (from the growing baby). As the baby develops, an expectant mother’s center of gravity moves forward causing her to sway back, which can overload the lower region of the spine. The women most at risk for pregnancy-related back pain include those who are overweight prior to their pregnancy, those who perform physically strenuous work, and those with a history of back pain.

Another factor that can increase a woman’s risk for back pain during pregnancy is water retention. Not only does retaining water increase the load the body must carry, placing added stress on the musculoskeletal system, but water retention has also been associated with stiffer joints throughout the body, which can increase the risk for musculoskeletal pain—including back pain.

The body requires more fluid during pregnancy to maintain the health of a growing baby, and drinking water is one of the best ways to hydrate. The American Pregnancy Association (APA) reports that the body produces 50% more body fluids during pregnancy.

Fluid retention is a common complaint during pregnancy. By the third month of pregnancy, approximately 50% of women notice swelling in their hands and feet and most have significant swelling by the third trimester. Sudden and new swelling in the face, hands, and eyes accompanied by blurred vision, severe headache, painful urination, and/or the inability to urinate with abdominal pain and hypertension (>140/90) may represent a medical emergency called pre-eclampsia. This occurs later in the pregnancy, usually after the twentieth week. If this is suspected, don’t delay in obtaining emergent medical care!

To combat fluid retention, avoid constrictive clothing around the wrists and ankles, rest with the feet elevated (especially when temperatures exceed 75-85º F / 25-30º C), use ice packs, wear comfortable shoes, and try support tights or stockings. Dietary options for reducing fluid retention include the use of certain herbs and vitamins, and foods such as celery, onions, eggplant, garlic, parsley, mint, bananas, coconut, dandelion, melons, salmon (omega-3 fatty acids), cucumber, and more.

FOR A FREE NO-OBLIGATION CONSULTATION CALL 717-697-1888

Dr. Brent Binder
4909 Louise Drive, Suite 102
Mechanicsburg Pa, 17055

Member of Chiro-Trust.org