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Low Back Pain and Obesity.

10 Dec

Low back pain (LBP) is a VERY COMMON PROBLEM! Here are some facts about LBP: 1) At ANY given time, 31 million Americans experience LBP; 2) LBP is the single leading cause of disability worldwide; 3) 50% of ALL working Americans admit to having LBP symptoms each year; 4) LBP is the #1 reason for missed work and, the 2nd most common reason for doctor office visits (outnumbered ONLY by upper respiratory infections); 5) Most cases of LBP are “mechanical” and NOT caused by serious conditions like inflammatory arthritis (like rheumatoid), infection, cancer, or fracture; 6) At least $50 BILLION is spent annually by Americans on back pain (and that’s JUST the more easily identifiable costs); 7) At some point in life, experts estimate 80% of the population will experience LBP.

In prior Health Updates, we’ve discussed ways to prevent LBP like exercise, eating right, staying active (avoid prolonged inactivity or bed rest), not smoking, maintaining proper posture, wearing low heeled comfortable shoes (and possibly foot orthotics and/or heel lifts), sleeping on a medium-firm mattress, using proper bending and lifting methods, fixing work station problems (computer key board and monitor placement is important!), and more.

This month’s topic concerns obesity and LBP. How are these related, and does it really matter? Let’s look at some adult obesity facts: 1) Obesity is common, serious, and costly: 35.6% of US adults are obese; 2) Obesity related conditions include: heart disease, stroke, type 2 diabetes, certain types of cancer, and is the LEADING CAUSE of preventable death! 3) An estimated $147 BILLION was spent on obesity related medical costs and the average medical cost for an obese person was $1429 higher than for those of normal weight (Body Mass Index or BMI of 18.5-24.9). 4) Ethnic variations: Non-Hispanic blacks have the highest obesity rate at 49.5% vs. Mexican Americans (40.4%), all Hispanics (39.1%) and non-Hispanic whites (34.3%) [ref. JAMA, 2012; 307(5):491-97]. 5) There was a dramatic increase in obesity in the US from 1990 through 2010. No state in the U.S. met the nation’s “Healthy People 2010” goal to lower obesity prevalence to 15%. Instead, in 2010, there were 12 states with obesity prevalence >30% vs. in 2000, NO state had an obesity prevalence >30%! 6) More than 2 in 3 adults are overweight (BMI 25-29.9) and, 1 in 3 adults are obese (BMI >30). 7) In children 6-19 years old, about 33% are overweight or obese and 17% are obese.

Intuitively, common sense tells us that if we are overweight, it has to affect our low back in a negative way. Well, you are right! In the 1/15/13 journal Spine, an 11 year study from Norway, gathered data between 1995-1997 and again in 2006-2008 of an entire county in Norway which included 8733 men and 10,149 women, aged between 30-69 years old who DID NOT have chronic LBP (>3mo. within the past year) vs. 2669 men and 3899 women who DID have LBP. After 11 years, a significant increase in risk was reported between those with a BMI >30 (obese) vs. those <25 (BMI 18.5-24.9 = normal). They also found that the recurrence rate of LBP was also higher in those who were obese.

Weight management is a goal of LBP care, and we have many strategies that can help you fight this problem.

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Can Chiropractic Help the Post-Surgical Patient?

9 Dec

Low back pain (LBP) accounts for over 3 million emergency department visits per year in the United States alone. Worldwide, LBP affects approximately 84% of the general population, so eventually almost EVERYONE will have lower back pain that requires treatment! There is evidence dating back to the early Roman and Greek era that indicates back pain was also very prevalent, and that really hasn’t changed. Some feel it’s because we are bipedal (walk on two legs) rather than quadrupedal (walk on four limbs). When comparing the two, degenerative disk disease and spinal osteoarthritis are postponed in the four-legged species by approximately two (equivalent) decades. But regardless of the reason, back pain is “the rule,” NOT the exception when it comes to patient visits to chiropractors and medical doctors. Previously, we looked at the surgical rate of low back pain by comparing patients who initially went to spinal surgeons vs. to chiropractors, and we were amazed! Remember? Approximately 43% of workers who first saw a surgeon had surgery compared to ONLY 1.5% of those who first saw a chiropractor!  So, the questions this month are, how successful IS spinal surgery, and what about all those patients who have had surgery but still have problems – can chiropractic still help them?

A review of the literature published in the Journal of the American Academy of Orthopaedic Surgeons showed that in most cases of degenerative disk disease (DDD), non-surgical approaches are the most effective treatment choice (that includes chiropractic!). They report the success rate of spinal fusions for DDD has been only 50-60%. The advent of artificial disks, which originally proposed to be a “cure” for symptomatic disk disease, has fared no better with possible worse long-term problems that are not yet fully understood. They state, “Surgery should be the last option, but too often patients think of surgery as a cure-all and are eager to embark on it.” They go on to write, “Also, surgeons should pay close attention to the list of contraindications, and recommend surgery only for those patients who are truly likely to benefit from it.” Another study reported that, when followed for 10 years after artificial disk surgery, a similar 40% of the patients treated failed and had a second surgery within three years after the first! Similar findings are reported for post-surgical spinal stenosis as well as other spinal conditions.

So what about the success rate of chiropractic management for patients who have had low back surgery? In a 2012 article, three patients who had prior lumbar spinal fusions at least two years previous were treated with spinal manipulation (three treatments over three consecutive days) followed by rehabilitation for eight weeks. At the completion of care, all three (100%) had clinical improvement that were still maintained a year later. Another study reported 32 cases of post-surgical low back pain patients undergoing chiropractic care resulted in an average drop in pain from 6.4/10 to 2.3/10 (that means pain was reduced by 4.1 points out of 10 or, 64%). An even larger drop was reported when dividing up those who had a combination of spinal surgeries (diskectomy, fusion, and/or laminectomy) with a pain drop of 5.7 out of 10 points!

Typically, spinal surgery SHOULD be the last resort, but we now know that is not always practiced. IF a patient has had more than one surgery and still has pain, the term “failed back syndrome” is applied and carries many symptoms and disability. Again, to NOT utilize chiropractic post-surgically seems almost as foolish as not utilizing it pre-surgically!

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