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Low Back Pain and The Importance of Sleep

27 Feb

Monthly Health Update: Whole Body

Low back pain is the leading cause of disability worldwide, and it’s estimated 619 million people suffer an episode each year. By 2050, it’s expected this total will jump to 843 million! In addition to the direct and indirect effects low back pain can have on the individual patient, the overall healthcare costs and productivity losses associated with this musculoskeletal disorder add up to more than $230 billion dollars each year in just the United States! This in mind, identifying and mitigating risk factors for low back pain by even a small amount can result in large societal gains. One risk factor for low back pain that isn’t typically imagined is sleep.

Sleep is considered essential for survival. Many vital functions occur during slumber including tissue growth and repair, cytokines production to bolster the immune system, heart rate and blood pressure regulation, memory consolidation, and brain detoxification, just to name a few. If an individual suffers from insomnia, obstructive sleep apnea, circadian rhythm sleep-wake disorders, or sleep bruxism, these critical processes are impeded, which can make the body more susceptible to developing musculoskeletal pain, including low back pain.

In one study, researchers looked at health data concerning 6,285 older adults and found that an individual’s risk for low back pain increases by 13.6% for each hour less than seven hours of sleep he or she averages a night. However, any additional sleep beyond seven hours does not confer additional low back pain reduction benefits. Interestingly, this finding held true even after adjusting for age, gender, income level, education level, and occupation.

Not only can poor sleep increase the risk for low back pain, but it can stimulate changes in how pain is perceived, leading to greater pain sensitivity, which in turn results in increased disability and avoidance behaviors. One study, published in December 2020, found that older adults with moderate-to-severe sleep disturbances will likely accumulate chronic neuropsychiatric and musculoskeletal conditions at a faster rate than seniors with good sleep hygiene. To complicate matters, the American Academy of Sleep Medicine reports that 80% of American adults experience daytime sleepiness, meaning they either aren’t sleeping enough each night or the quality of their sleep is poor. So what can be done to improve sleep hygiene?

The Centers for Disease Control and Prevention (CDC) offers the following tips for better sleep: be consistent with bed times; make sure your bedroom is quiet, dark, relaxing, and kept at a comfortable temperature; remove electronic devices from the bedroom; avoid large meals, caffeine, and alcohol before going to bed; and get some exercise during the day. If low back pain is keeping you up at night, be sure to let your doctor of chiropractic know. They may be able to recommend additional strategies to improve your sleep and if necessary, co-manage your case with an allied healthcare provider.

If you are struggling with sleep, come on in for a visit!

Watching your back,

Dr. B

Pain Relief Chiropractic

4909 Louise Drive, Suite 102

Mechanicsburg, PA 17055

 717-697-1888

Painreliefcare.net

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.

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Aquatic Exercise for Low Back Pain

7 Sep

Deconditioned and tight muscles are often observed in patients with chronic low back pain and must be addressed for the patient to achieve a satisfactory outcome. Research on physical activity to manage chronic low back pain typically involves land-based exercises— like brisk walks or cycling, for example—but what about aquatic exercises? Do water-based exercises have a place in chronic back pain management?

In January 2024, researchers conducted a systematic review and meta-analysis that included data concerning 524 chronic low back pain patients from 15 studies who participated in either water- or land-based exercise intervention, or they had been assigned to a waiting list to serve as a non-active control group. Their analysis revealed that participants in both exercise groups experienced significant improvements in pain intensity when compared with the non-active patients. Those in the water- and land-based groups also reported similar improvements with respect to low back pain-related disability and flexibility that were not evident in the control group. Ultimately, the authors concluded that aquatic exercise is as effective as land-based options for managing chronic low back pain.

For those who find land-based exercises challenging—especially if weight-bearing exercises are too stressful on the joints—aquatic exercise may be a viable option. However, water-based exercise is not just a synonym for swimming laps. There are several forms of water-based exercise available, such as water aerobics, aqua jogging, water walking, aqua Zumba, water yoga, water polo, aqua cycling, pool volleyball, resistance band training, and water tai chi. These various workouts take advantage of buoyancy so there’s less impact on joints, the natural resistance of water for strength training, and the cool-down effect of water on the skin. For individuals who get more enjoyment from group workouts, these exercises are an excellent choice!

In addition to helping manage chronic low back pain, meeting physical fitness guidelines of 150 minutes of moderate- or 75 minutes of vigorous-intensity exercise each week may also reduce the risk for developing chronic low back pain in the first place. Furthermore, patients who recover from chronic low back pain and stay physically active are also less likely to experience a recurring episode. So if traditional exercise like jogging or cycling doesn’t appeal to you and you’d rather spend time in the pool, consider an aquatic exercise routine!

Brent Binder, D.C. 4909 Louise Dr. Suite 102 Mechanicsburg, PA 17055 (717) 697-1888

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 Treatment for Lumbar Disk Herniation

10 Dec

The annulus of the intervertebral disk is comprised of tough, dense, and strong cartilaginous fibers that protect the nucleus within, which facilitates the movement of the spine. If the structure of the annulus is compromised, the nucleus can leak into or beyond the annulus, a condition that may be classified as a disk herniation, protrusion, extrusion, or sequestration. In the event a disk herniation in the lumbar spine places pressure on a lumbar nerve root, an individual may feel pain down into the leg, which is called lumbosacral radiculopathy or sciatica. Absence a red flag—infection, fracture, cancer, and cauda equina syndrome (loss of bowel and/or bladder control)—that may necessitate immediate emergency and/or surgical intervention, what treatment approach may best serve a patient with a newly diagnosed lumbar disk herniation?

In 2022, researchers conducted a retrospective cohort study that looked at outcomes of more than 11,000 patients under age 49 with a newly diagnosed lumbar disk herniation, half of whom received initial treatment from a doctor of chiropractic. While the authors of the study note that additional studies are needed, their analysis revealed that lumbar disk herniation patients whose first choice of treatment is chiropractic care are significantly (up to two-times) less likely to undergo lumbar diskectomy in the following two years than disk patients who initially seek out a different healthcare provider.

It should be noted that treatment guidelines generally advise conservative treatment approaches, which include chiropractic care, before consulting with a surgeon. However, another study published in 2022 found that, among a group of 144 patients who underwent back surgery, 60 (41.7%) did not receive any conservative treatment in the six months before their procedure. A 2021 study that looked at questionnaires completed by 3,724 adults revealed that the majority of respondents believe that surgery is always needed for a disk herniation, which is inaccurate.

For the management of a lumbar disk herniation, doctors of chiropractic will typically employ a multimodal approach that includes spinal manipulative therapy, mobilization therapy, soft tissue therapy, and exercise training. Chiropractors may also offer additional services such as traction or non-surgical decompression that can benefit such patients. If the patient does not experience improvement in their pain and disability or their condition worsens, they may be referred to an allied healthcare provider to explore other treatment options.

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The Thoracolumbar Fascia and Chronic Low Back Pain 

5 Oct

The thoracolumbar fascia is a structure in the lower back that is comprised of layers of densely packed collagen and elastic fibers separated by loose connective tissue that allow the deep stabilizing muscles in the lower back to move independently of the superficial muscles used for twisting and bending forward and backward. When adhesions form in the fascia, movement can become restricted, which can lead to pain and disability in the lower back and nearby parts of the body. A January 2023 study that included 131 adults—68 with low back pain—revealed a 25-30% reduction in thoracolumbar fascia elasticity among those with low back pain. This suggests that improving the function of the thoracolumbar fascia is essential in the management of low back pain. So, what can your doctor of chiropractor do to improve the elasticity of these important tissues?

The most common technique used to address adhesions in the thoracolumbar fascia is a manual therapy technique called myofascial therapy or myofascial release. Myofascial release is a hands-on treatment in which a doctor of chiropractic applies pressure with their hands, elbow, or a tool to stretch the muscles to knead out trigger points or adhesions that may inhibit the ability of the muscles to slide against one another during normal movements. In the last thirty years, various forms of myofascial therapy have been developed and disseminated to healthcare professionals who apply hands-on care, which includes doctors of chiropractic. In addition to care provided in the office, patients may also be instructed on self-myofascial release, which may include the use of a foam roller, for example.

In 2021, two systematic reviews—studies that pool data from previously published studies—concluded that myofascial therapy is effective for reducing disability and pain in patients with low back pain. More recently, a 2023 study that included 48 patients with low back pain found that those treated with a single session of myofascial therapy experienced a significant decrease in pain and thickness of the thoracolumbar fascia, in addition to a reduction in stiffness in the erector spinae muscles and thoracolumbar fascia. Follow-up examinations after the treatment showed the benefits persisted two and seven days later. 

In many cases, there are many contributing factors to a patient’s low back pain that must all be addressed to achieve a satisfactory result. This starts with a thorough examination to understand the patient’s unique situation and extends to a multimodal approach that incorporates several treatment methods to reduce pain and improve mobility in the lower back, which can include myofascial treatment to break down adhesions in the thoracolumbar fascia to allow for proper movement. In fact, an October 2022 study found that a multimodal chiropractic treatment plan that included spinal manipulation, education, exercise, self-management advice, and myofascial therapies led to improvements in pain, disability, and thoracolumbar fascia mobility in women with chronic low back pain. 

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

Member of Chiro-Trust.org 

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Spinal Manipulative Therapy for Seniors with Low Back Pain

5 Sep

While low back pain can affect people of all ages, it’s particularly problematic for older adults and is one of the top three reasons they see a doctor. Despite this, low back pain among seniors often persists for longer than three months, and in the presence of multiple comorbidities (which is often the case with advancing age), low back pain may be under treated or mismanaged. While guidelines for the management of low back pain often emphasize conservative approaches first and foremost, older patients tend to be underrepresented in the studies used to formulate such recommendations. Let’s take a look at the current research on the utilization of spinal manipulative therapy—the primary form of treatment provided by doctors of chiropractic—for the management of low back pain in older adults.

A 2022 study scoured electronic databases for randomized controlled trials conducted during the previous two decades that examined the effects of spinal manipulative therapy in older adults with chronic low back pain. The research identified ten studies consisting of a total of 786 individuals over 55 years of age, of which 261 were between 65 and 91 years old. The types of spinal manipulation included in this study are high-velocity low-amplitude (HVLA) techniques and mobilization or low-velocity low-amplitude (LVLA) techniques.  In particular, the research team looked at how these manual therapies fared with respect to improvements in pain and function against other approaches, including standard medical care and exercise therapy, in the short-, medium-, and long-term. 

In their final analysis, the authors concluded there is moderate-quality evidence that spinal manipulative therapy results in similar outcomes (compared to usual medical care and exercise therapy) for pain and functional improvement, and it should be considered a non-pharmacological treatment option for this patient population. This is important as up to 80% of older adults already take multiple prescription medications, with nearly a third taking five drugs, to manage their current health concerns. The addition of one or more prescriptions to manage low back pain increases the risk for adverse events and harmful drug interactions.

The researchers add that while their analysis was unable to establish a safety profile as the studies used had heterogenous data on adverse events, spinal manipulation appears to be safe for older patients. They further note that their findings are consistent with other systematic reviews on the effectiveness of spinal manipulative therapy for all age groups. 

The findings from this analysis confirm that spinal manipulative therapy has a place in the management of low back pain affecting older patients. If you suffer from chronic low back pain, don’t put it off or assume you need to live with it. Schedule an appointment with your local doctor of chiropractic to see if a course of conservative chiropractic care can help reduce your pain and improve your mobility.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

(717) 697-1888

Member of Chiro-Trust.org 

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When Is Low Back Surgery Appropriate?

30 Jun

Low back pain is the most common musculoskeletal complaint, and it is the leading cause of activity limitation and absenteeism from work. There are many treatment options available to the low back pain patient, including surgical procedures. But when is surgery appropriate and in what cases should it be avoided? 

Generally, clinical guidelines don’t recommend surgery as an initial treatment, except in emergency or critical situations. For example, when a patient presents for chiropractic care, there are red flags that indicate the patient should be referred out to another healthcare provider, if not the emergency room. These include cancer, fracture with instability, infection, and cauda equina syndrome (includes loss of bowel and/or bladder control). In these cases, surgery may be the best available option for the patient to avoid a catastrophic outcome. 

In addition to these red flag scenarios, a literature review published in 2023 in the Medical Journal of Australia concluded that spinal surgery may have a role in the management of non-responsive nerve compression with radiating leg pain. That is, once conservative, non-surgical options have failed. However, outside of these situations, the review concluded, “Spinal surgery for all other forms of back pain is unsupported by clinical data, and the broader evidence base for spinal surgery in the management of LBP is poor and suggests it is ineffective.” Additionally, the authors note that spinal surgery for LBP “has substantially increased over recent decades, and disproportionately among privately insured patients, thus the contribution of industry and third-party payers to this increase, and their involvement in published research, requires careful consideration.”

Unfortunately, a 2022 study found that 41.7% of low back pain patients who underwent spinal surgery had minimal, if any, engagement with non-pharmacological, non-operative treatment in the six months before their procedure. A 2013 study that used data from Washington state worker’s compensation system found that 43% of 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. Not only are patients who visit a chiropractor first less likely to end up under the surgeon’s knife but they’re also less likely to be prescribed opioids within the following year, something that offers tremendous benefits to society in light of the opioid crisis.

If you experience an episode of low back pain, consider chiropractic care as your first treatment choice. If your condition doesn’t respond to a multimodal treatment approach, your chiropractor can refer you to an allied healthcare provider for additional care. 

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

(717) 697-1888

Member of Chiro-Trust.org 

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