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Walking Backward for Chronic Low Back Pain

1 Jul

Kinesiophobia, the fear of movement, is a common occurrence for patients with chronic low back pain (cLBP). Unfortunately, self-restricting one’s daily physical activity can result in muscle weakness and atrophy. This can lead to further inactivity and more muscle weakness, and subsequently, poor tolerance of normal activities of daily living, work absenteeism, and depression. When the muscles around the low back or lumbar spine become atrophied and weak, the risk for acute flair-ups of low back pain (LBP) increases, leading to more dysfunction and distress.

Studies have reported that when comparing the muscles in the front of the lumbar spine (the “flexors”) to those behind the spine (the “extensors”) in individuals with cLBP, greater amounts of atrophy and weakness occur to the extensors. The lumbar multifidus (MF) muscles are crucial for maintaining stability of the lumbar spine, while the erector spinae (ES) superficial extensor muscles are known as “global stabilizers”, which are designed to produce gross movements and to counterbalance when lifting external loads.

When treating patients with cLBP, doctors of chiropractic commonly prescribe rehabilitation/exercise programs to improve motor control, muscle strengthening, stretching, and aerobic capacity. One such exercise that may be recommended is walking backward. Compared with walking forward, studies have shown that walking backward can lead to better results with respect to cardiovascular fitness and MF muscle activation (which as noted previously, are often weaker in cLBP patients).

Additionally, walking backward works the lower limb muscles to a greater degree while reducing stress on the patellofemoral joint (the kneecap). This is important, as knee pain can commonly co-occur with low back pain, especially in patients who are overweight/obese. Walking backward also stretches the hamstrings, which are often short/tight in cLBP patients.

So not only can walking backward benefit patients who already have back pain, but adding this activity to your exercise regimen may also reduce the risk for low back pain in the first place!

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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Chiropractic Care During Pregnancy for Back and Pelvic Pain

3 Jun

Low back pain (LBP) and posterior pelvic pain (PPP) are very common complaints during pregnancy. In fact, current estimates show that two-thirds of expectant mothers will experience back pain during pregnancy and one in five will report pelvic pain. These afflictions can have a significant impact on a woman’s quality of life and her ability to carry out everyday tasks. So, where does chiropractic care fit into this picture?

While some pain conditions associated with pregnancy may be related to changes in certain hormones, there is evidence that the growing fetus shifts the center of gravity forward in a woman’s body. This shift can greatly affect the biomechanics of the body and place added strain on the lumbar and sacroiliac joints, giving rise to pain in those areas.

A landmark 2014 study looked at the effect of chiropractic treatment on 115 pregnant women with LBP/PPP. In a nutshell, 52% improved with respect to pain and disability after just one week of care, 70% after one month, 85% after three months, and 90% after six months.

Interestingly, the patients who had LBP/PPP prior to pregnancy tended to have higher pain scores at the conclusion of the study than those without a previous history of LBP/PPP. This finding supports the theory that women who have a history of LBP prior to pregnancy are particularly good candidates for chiropractic care early in their pregnancy. Also, due to a common link between persistent LBP after pregnancy and pre-pregnancy LBP, chiropractic care post-partum may be equally important.

This study included many chiropractors in various locations, and treatment was not standardized to any one specific method or technique. That being said, high-velocity, low-amplitude spinal manipulative therapy was the most common approach utilized and is the “standard of care” utilized by most chiropractors around the world. As further research is conducted, it seems clear that the use of SMT during pregnancy will become “the norm.”

 

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.

Can the Outcome of Back Pain Be Predicted?

2 May

When patients present with low back pain (LBP), they are frequently nervous and worried about whether they’re going to respond to the treatment—especially when it comes to getting out of pain and returning to their normal activities. A variety of studies have shown chiropractic care to be an effective option for the LBP patient, and though there is no “crystal ball”, there are some tests that doctors of chiropractic can perform during an examination that can help predict outcomes!

In fact, a meta-analysis of data from 43 studies published since 2012 suggests that centralization and directional preference, which may be present in 60-70% of LBP cases, offers important prognostic clues. Directional preference means that it’s possible to move the body in a manner that feels better to the patient. Centralization implies that it’s possible to move in a way that reduces the range of the pain to a specific region.

Here’s an example… Let’s say an LBP patient presents with radiating leg pain from their lower back with numbness and tingling in the leg and foot. The focus is to find a movement that REDUCES the leg pain/numbness, so their doctor of chiropractic asks the patient to bend forward, backward, and sideways, and to rotate their torso, looking for which direction is preferred, i.e., directional preference. When pain decreases AND centralizes (the leg pain disappears), then extension is the directional preference.

When centralization occurs, this is a favorable prognostic sign indicating that improvement can be expected. Likewise, when all positions or directions increase leg pain, this is a poor prognostic sign, meaning this is likely a more challenging case.

This helps doctors better advise patients about their condition and what to expect from care in both the short and long term so the patient can make REALISTIC goals and timely plans. Over or under reassuring patients is simply not appropriate! Directional preference also allows providers a means of determining what type of treatment to emphasize. For example, if the patient feels better bending backward and leg pain disappears, the provider will approach treatment and exercise recommendations from that direction.

Patient education is an important part of treatment, and educating patients on how this process can predict treatment outcome instills trust and places realistic goals in perspective so patients know what to expect. This improves compliance with care and confidence for both the healthcare provider and the patient.

 

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.

How Does Chiropractic Stack Up for Low Back Pain?

8 Apr

Doctors of chiropractic offer a non-surgical, treatment protocol for both acute and chronic low back pain (LBP), as do several other healthcare delivery systems. However, due to patient preference and a rising concern for potentially harmful side-effects, many LBP patients seek management strategies that offer a natural, non-pharmaceutical approach, of which chiropractic is the most commonly sought after practitioner-type. So what evidence is there regarding the benefits of chiropractic vs. other forms of care in managing LBP and its associated pain-related functional loss?

A 2018 study published in the online Journal of the American Medical Association focused directly on this question by comparing patient outcomes of those receiving usual medical care to a second group of patients that also received chiropractic care.

Data was collected at three sites—two large military medical centers and one smaller hospital at a military training site—over the 3.5-year time period. Eligible participants included active duty United States service members between 18 and 50 years in age who were diagnosed with mechanical low back pain.

Patients in each group received usual medical care for six weeks that included self-care, medications, physical therapy, and pain clinic referral. Participants in one group also received chiropractic care that included spinal manipulative therapy in the low back and adjacent regions and additional therapeutic procedures such as rehabilitative exercise, cryotherapy, superficial heat, and other manual therapies.

Up to six weeks after the conclusion of care, the researchers reported that patients in the  chiropractic group scored higher with respect to LBP intensity, disability, perceived improvement, satisfaction, and medication use. The researchers concluded that this trial clearly shows the need for chiropractic care for those suffering from LBP—reminding the reader that current LBP guidelines have embraced chiropractic care as a FIRST line of treatment for LBP.

This is not the first study to show the benefits of chiropractic care, as prior high-quality studies have reported higher patient satisfaction levels, less medication use, higher quality of life scores, and less LBP-related disability and recurrence rates for patients receiving chiropractic treatment vs. usual medical care. This article was published in a highly regarded medical journal (JAMA) and CLEARLY supports the need for chiropractic care in the management of 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.

Can Chiropractic Help Dysmenorrhea?

7 Mar

Primary dysmenorrhea (PD) is a very common gynecological disorder affecting 84.1% of women during childbearing age. The most common symptoms of PD include lower abdominal pain that can radiate to both thighs and/or to the low back. Other symptoms include tiredness, headache, nausea, constipation, and diarrhea. The condition precedes menstruation (in the absence of any organic pathology) and lasts approximately 48-72 hours. Primary dysmenorrhea is the most common reason for absenteeism from work or school, thus interfering with quality of daily life, which is associated with many direct and indirect costs.

There have been MANY proposed interventions for PD reported in the scientific literature. Most common are non-steroidal anti-inflammatory drugs (NSAIDs) and oral contraceptives, as both work similarly—they affect the cause of pelvic pain, which is reportedly mediated by the hormone-like fatty acid called prostaglandin factor 2x. However, both approaches carry negative side effects such as bleeding in the gut and hormone issues such as bloating and edema, respectively. Thus, the demand for new and alternative approaches with less associated risks has increased.

Spinal manipulative (SM) techniques for PD has been previously studied and proven to have positive benefits on pain perception and menstrual cramps, as well as affecting plasma (blood) levels of some chemical pain mediators. However, there appears to be a lack of agreement on where spinal manipulation should be applied. One study recommended that SM should be applied to the lumbosacral region (L5-S1) for symptom reduction in dysmenorrhea.

A more recent study found that “global pelvic manipulation” (GPM) performed on both sides of the pelvis to mobilize the sacroiliac joint (SIJ) and L5-S1 facet joint resulted in improvements related to low back pain and pressure pain thresholds in the SIJ, with a significant increase in serotonin.

Doctors of chiropractic specialize in the use of spinal manipulation therapy and are trained in many different techniques of lumbo-pelvic manipulation. For those struggling with PD, including a chiropractor as a member in your healthcare “team” makes perfect sense!

 

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.

What is the Best Treatment for Chronic Low Back Pain?

7 Feb

When it comes to treating patients with chronic low back pain (cLBP), doctors of chiropractic commonly use a multi-modal approach that involves manual therapies, like spinal manipulation and mobilization, combined with supervised and/or home-based exercises. Why is that?

In many cases, the superficial paraspinal muscles of patients with back pain will tighten as a reflex in an effort to restrict movement and protect the area from further injury. Unfortunately, such a restriction can result in altered movement patterns that raise the risk for further injury (and pain) elsewhere in the lower back (or even in other areas of the body). On top of that, because the superficial back muscles have abnormally assumed the job of maintaining posture, the deep muscles in the back can become deconditioned and weak, which only raises the risk for further back issues.

So, when it comes to chronic back pain, the job of a chiropractor is two-fold: restore proper joint motion to “turn off” this abnormal reflex muscle spasm and to strengthen the deep muscles so the superficial muscles can return to their normal function.

In a 2011 study, researchers randomly assigned 301 cLBP patients (adults over 65 years old with a five or more year history of chronic low back pain) to one of three treatment groups: supervised exercise therapy (SET); spinal manipulative therapy (SMT), or home exercise and advice (HEA).

Researchers monitored each participant’s progress for over a year and found that members of each group achieved similar short- and long-term improvements with respect to pain, disability, global improvement, general health status, and medication use. Though the patients in the SET group experienced greater gains with respect to trunk muscle strength, endurance, and range of motion in comparison with the home-based exercise group, the difference in results is understandable as the SET protocol was much more intensive.

Though this study did not specifically look at the effect of combining exercise and spinal manipulation for the treatment of cLBP, several guidelines that have looked at the available evidence recommend using such a multi-pronged approach for this group of patients. For example, in 2018, the Canadian Chiropractic Guideline Initiative wrote, “A multimodal approach including SMT, other commonly used active interventions, self-management advice, and exercise is an effective treatment strategy for acute and chronic back pain, with or without leg 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.