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Greater Access to Chiropractic Reduces Low Back Pain Costs

31 May

Not only is low back pain a musculoskeletal condition that will affect nearly everyone at least once in their lifetime, but it also accounts for a significant portion of all healthcare expenditures. When an individual experiences low back pain, they have a variety of treatment options, including chiropractic care. While there is an abundance of literature available on the safety and effectiveness of chiropractic treatment for the low back pain patient, perhaps just as interesting is the cost and societal benefits associated with chiropractic management of low back pain.

Past research has shown that greater access to chiropractic care is linked to a lower reliance on primary care services for treatment for a condition like low back pain, which is handy as experts predict a severe shortage of primary care physicians in the near future.  But is the inverse true, does reduced access to chiropractic lead to greater utilization of primary care?

In a 2019 study, researchers examined Medicare claim data concerning nearly 40,000 older adult chiropractic patients who moved to an area with less access to chiropractic care. The research team observed that following their move, the seniors were more likely to visit their primary care physician for spine conditions, which can lead to potentially harmful opioid prescriptions, unwarranted testing, and invasive procedures, including surgery. This equated to an additional cost of nearly $115,000 per 1,000 beneficiaries on medical services or $391 million nationally. 

In another study, researchers looked at the healthcare costs and utilization of 2.5 million adults with low back pain and leg pain. They found that 1.2% received surgery and these patients accounted for 29.3% of all healthcare costs among the study population. The data also show that many of the patients who received non-surgical care underwent advanced imaged within 30 days of diagnosis and/or without an initial trial of hands-on care (like chiropractic care), which is contrary to treatment guidelines. A 2022 study that looked at low back pain patient experiences found that 41.7% who underwent back surgery had minimal non-pharmaceutical, non-operative treatment in the six months before their operation. 

BOTTOM LINE: The current research suggests that greater access to chiropractic care not only provides large cost savings to the public and private insurance agencies, but patients who utilize chiropractic care for low back pain are less likely to receive treatment that may be less effective and may carry greater risks for adverse side effects.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org 

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Low Back Pain and the Sacroiliac Joint

20 Apr

The sacroiliac joints (SIJ) sit between the sacrum (tailbone) and ilium (pelvis), which serve to connect the spine and pelvis and facilitate load transfer from the low back to the lower extremities. Generally, when we consider the cause of a patient’s low back pain, the first place investigated is the lumbar spine. But as it turns out, the culprit can often be the SIJ.

Studies in recent years estimate that the SIJ may be the primary or contributing cause of 15-30% of low back pain cases. Not only can sacroiliac joint dysfunction be experienced by the patient as low back pain but it can also cause pain in the groin, and according to a 2017 study, up to 60% of SIJ patients report pain that radiates into the leg! 

The mechanism of SIJ injury is often a combination of axial loading (downward/jamming pressure) and abrupt rotation (twisting). While this can be caused by a sudden fall or collision, repeated strain can also injure these joints.  A 2018 study that included 271 recreational golfers found that 23% had sacroiliac joint dysfunction, presumably from repeatedly swinging a golf club, and nearly all of them (96%!) also had lower back pain. Another study, also published in 2018, found that among a group of 1,500 pregnant women, 80% had sacroiliac dysfunction. The researchers suspect the combination of weight gain and a loosening of ligaments that occurs during pregnancy is the likely cause. 

Researchers have also found that leg length discrepancy (LLD) can place uneven loads on the sacroiliac joints, which can increase the risk for injury. Other causes of SIJ injury can include prior lumbar fusion, joint infection, malignancy, spondyloarthropathies, inflammatory bowel disease, gait abnormalities, scoliosis, and excessive exercise. 

The good news is that doctors of chiropractic are well equipped to not only determine if the SIJ can be a factor in a patient’s low back pain (or leg or groin pain) but also to manage SIJ dysfunction. Studies have shown that a combination of manual therapies (including spinal manipulative therapy) and stabilization exercises is effective for reducing pain and improving function in the SIJ, more so than corticosteroid injections or physiotherapy. While patients may experience immediate improvement after a single treatment, it may take several treatments to achieve a satisfactory and lasting result.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717) 697-1888

Member of Chiro-Trust.org

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Exercises to Prevent Sports-Related Back Pain

16 Mar

According to a systematic review that included 201 studies, low back pain may affect between 10-67% of athletes at any given moment, with anywhere from 17-94% experiencing sports-related back pain each year. This broad range is due to the age, level of competition, and the specific sports included in each study. For example, the data show the risk for low back pain is higher in gymnastics, diving, weightlifting, golfing, football, and rowing. That said, what can be done to lower the risk for sports-related back pain?

In 2022, researchers recruited 70 high school volleyball players—another sport with a high prevalence of low back pain—and assigned them to one of two groups: a control group that continued their normal activities and an intervention group that performed their usual activities in addition to four weeks of stretching and exercises focused on dynamic thoracic mobility and trunk stabilization. This program, which took about ten minutes to complete, included the jack-knife stretch (to loosen the hamstrings to improve forward bending), gastrocnemius stretch (to loosen the calf muscles to enhance ankle dorsiflexion), iliopsoas stretch (to loosen the hip flexors and reduce lumbar lordosis), and trunk stabilization (front plank to strengthen the low back and gluteal muscles).

During the study, 33% of the players in the control group reported low back pain, compared with just 8.8% in the intervention group. This means the participants who worked on improving strength and flexibility were nearly four times less likely to experience low back pain. Additionally, the players in the intervention group demonstrated improved physical function with respect to back endurance; spine/back flexibility; shoulder and trunk range of motion; ankle mobility; and iliopsoas, quadriceps, and hamstring flexibility. 

The study highlights the importance of a strong and flexible core for reducing the incidence of low back pain, something that also applies to non-athletes. Doctors of chiropractic often observe deficiencies in core strength and flexibility in patients with low back pain and advise such patients to perform at-home exercises to not only aid in the rehabilitation process but also reduce the risk for a future episode of low back pain.

Pain Relief Chiropractic

4909 Louise Dr

Mechanicsburg, PA 17055

 (717)697-1888

Member of Chiro-Trust.org 

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Poor Seated Posture and Low Back Pain

6 Jul

We’ve all been told—especially as children—to stop slouching and to stand or sit up straight. As it happens, this is great advice to keep the spine healthy and reduce the risk for a painful low back condition.

 A landmark 1981 study calculated the amount of pressure placed on the intervertebral disks in the lower back in various positions. A neutral standing position places about 100 pounds per square inch (lbs/in2) of pressure on the disk in the low back and laying supine (facing up) cuts the pressure dramatically to 25 lbs/in2. On the other hand, when subjects stood leaning forward or sat slouching forward, the pressure placed on the lower back disks jumped as high as 275 lbs/in2. All this added pressure can place the disks at increased risk for injury, which can have a dramatic effect on a patient’s ability to carry out their daily work and life activities.

To maintain and improve one’s posture (either standing or sitting), Harvard Medical School recommendations the following:

  1. Visualize: Think of a straight line that passes evenly through the ears, shoulders, hips, knees, and ankles (when standing). Then imagine a strong cord attached to the top of the head pulling you upwards, making you taller (i.e., “stand tall”).
  2. Shoulder blade squeeze: Sit up straight in a chair, relax the arms with the shoulders down (no shrugging), breathe deeply, and draw the shoulders back and squeeze the scapulae together keeping the chin tucked in. Repeat three to four times.
  3. Chest stretch: Stand facing a corner and place your forearms and palms on each of the two walls and straddle your feet one in front of the other. Lean forward until there’s a strong stretch in the chest muscles. Hold for 20-30 seconds and take deep breaths.
  4. Arm-across-chest stretch: Raise the right arm forward to shoulder height and bend at the elbow. Grasp the right elbow with the left hand and gently pull it across your chest until you feel a strong stretch in the right shoulder and arm. Hold for 20 seconds and repeat on the opposite side and repeat three times.

What about individuals who already have injured or degenerated lumbar spinal disks? What can they do to sit as pain-free as possible? In a 2018 study, researchers evaluated lumbar disk patients as they sat in various types of chairs and found that a kneeling chair is best for keeping the spine in a neutral posture, reducing the pressure on the disks. Additionally, a study published in 2021 showed that trunk muscle activity increases when patients with chronic back pain slouch forward, which means poor posture isn’t even relaxing.

In addition to providing advice and exercises for improving posture, your doctor of chiropractic can provide treatment to restore normal movement to the lumbar spine to reduce low back pain and disability.

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 Pelvic Floor & Low Back Pain

3 Jun

The pelvic floor is the muscular “hammock” that carries the weight of the viscera located in the pelvis. If these muscles become too loose or too tight, an individual may experience urinary (or fecal) urgency or incontinence, sexual dysfunction, pelvic organ prolapse, as well as pain in the pelvic region and even in the lower back.

This condition, known as pelvic floor dysfunction (PFD), most commonly affects women (95% of PFD patients are female) with advancing age and a history of multiple childbirths. Many women have PFD but often do not complain about it due to embarrassment or “just accepting it as part of having babies” or “just part of aging.” However, the condition can be addressed so that its effect on quality of life is reduced, and a doctor of chiropractic may play a role in managing the condition.

Patients with weak pelvic floor muscles (hypotonic PFD) often benefit from Kegel-type exercises where the patient “pulls-up” (or “draws inwards”) the perineum, as if to stop or prevent urination and/or defecation. Unlike classic Kegel exercises with a short hold time (more rapid frequency), PFD exercises should be done with 10 second holds and gradually increase the number of reps to 30 to obtain muscle fatigue. Although some doctors recommend doing these exercises virtually anywhere and anytime, the KEY is to do them very consciously (using visualization)!

It is important to AVOID abdominal bracing (tightening up the abdominal muscles) because this INCREASES the pressure against the pelvic floor. Keep the stomach, buttocks, and inner leg muscles relaxed, and don’t hold your breath. Try exhaling as you do the exercise. When you sense a sneeze or cough coming, squeeze the pelvic floor to support the bladder.

For patients with tight (hypertonic) pelvic floor muscles, studies recommend manual therapy, scar tissue manipulation, modalities (ultrasound or e-stim), massage, breathing re-training, cognitive behavioral therapy, and meditation.

Both hypotonic and hypertonic PFD may be co-managed with an OB/GYN or the patient’s medical physician with supporting care provided by their doctor of chiropractic. A doctor of chiropractic can address musculoskeletal issues in the pelvic region and lower back with manual therapies (including manipulation and mobilization) to reduce pain and relieve pressure on the pelvic floor. The good news for individuals with PFD is that the condition is manageable, and you don’t have to accept it as a normal consequence of life!

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.

A Vascular Cause of Low Back Pain

6 May

For the older adult, pain that radiates into the leg is a common complaint. This process, called neurogenic claudication, occurs when the spinal cord and/or nerve roots are pinched as they exit the arthritic spine (a condition called spinal stenosis). However, there is another degenerative condition that can cause pain in the legs called peripheral vascular disease, and it can be quite challenging to differentiate between vascular and neurogenic claudication.

Peripheral vascular disease (PVD) is a slow, progressive narrowing, blockage, or spasm in a blood vessel that can affect any blood vessel outside of the heart including arteries, veins, or lymphatic vessels. This hardening of the arteries most often affects the legs and feet, although it can affect any organ, including the brain. The most common cause is atherosclerosis, which is the buildup of plaque inside the vessel wall that narrows the blood vessels in one or both legs. This depletes blood flow, and as a result, oxygen and nutrients can’t easily reach their intended destination. Other causes can include injury to the affected part, irregular anatomy of the muscles and ligaments, and infection.

The first symptom of PVD is typically painful leg cramping during exercise that is relieved with rest. This usually occurs after a certain length of walking time, which gets shorter as the disease progresses. This experience is similar to symptoms reported by patients with spinal stenosis, and as such, individuals with PVD may find themselves consulting with a doctor of chiropractic about what they suspect is a musculoskeletal condition. So how does a doctor of chiropractic differentiate leg pain from PVD from leg pain from spinal stenosis associated with dysfunction in the lumbar spine?

One study that administered questions to patients with either neurogenic claudication (NC) or vascular claudication (VC) found that specific symptoms could help in the diagnostic process. For example, if standing still does not trigger pain, NC could be ruled out. On the other hand, NC is likely if standing triggers or increases pain, bending or leaning forward relieves pain when symptoms are above the knees, and sitting provides relief. Patients with VC are more likely to experience leg pain down to the calf that is relieved by standing still. For a definitive diagnosis, a referral for more advanced diagnostics may be required.

Doctors of chiropractic frequently treat patients with spinal stenosis with neurogenic claudication and will refer a patient to a vascular specialist or their medical physician if PVD is suspected so the patient can be provided with appropriate care.  

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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