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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.

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.