Tag Archives: back pain

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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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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Two Things You Should Do If You Don’t Want Back Pain.

12 Mar

It’s funny how the more we learn about ourselves and the world around us, the more established “facts” turn out to be completely wrong and the opposite of what is “true.” For example, new research concludes that people with low back pain will achieve greater benefits by exercising more, not less.

In a study done by the University of Alberta on 240 men and women with chronic lower back pain showed, those who exercised 4 days a week had a better quality of life, 28 percent less pain, and 36 percent less disability. Those who hit the gym only 2 or 3 days a week did not show the same level of change.

“While it could be assumed that someone with back pain should not be exercising frequently, our findings show that working with weights 4 days a week provides the greatest amount of pain relief and quality of life,” said Robert Kell, lead author of the study and an Assistant Professor of Exercise and Physiology at the University of Alberta, Augustana Campus.

Here is something really important from the study… The participants were split into four groups of 60. One group exercised with weights 2 days a week, another 3 days a week, and a third group 4 days a week. The fourth group did not exercise with weights.

All groups were tracked for 16 weeks. At the end of the 16 weeks, the level of pain reportedly decreased by 28% in the 4-day a week group, by 18% in the 3- day a week group, and by 14% in the 2-day a week group.

So What Does This Mean To You?

It depends. Every case of back pain is individual and you should not just run out today and start lifting weights. That could be a disaster.

If you have back pain, your first move should be to get a complete examination by a qualified doctor who treats back pain every day.

Chiropractors are specially trained to diagnose and treat low back pain and can tell you what the probable cause of your back pain is and the best treatment methods for your individual case.

But clearly, for many low back sufferers, exercise is a very good thing.

Now for something else that can possibly help your back pain…

As If Lung Cancer Wasn’t Bad Enough…

For quite some time, researchers have known that smoking is a risk factor for chronic pain disorders. More specifically, smoking has been linked to increased risk for low back pain, spinal disk problems, and poor outcome after surgery.

Now, a new study published in the December 2012 issue of The Journal of Bone and Joint Surgery found that smokers suffering from spinal disorders and related back pain reported greater discomfort than spinal disorder patients who stopped smoking during an eight-month treatment period.

The study analyzed the pain reported by more than 5,300 patients with back pain and related conditions.

The results as reported in Science Daily: “At the time of entry into care, patients who had never smoked and prior smokers reported significantly less back pain than current smokers and those who had quit smoking during the study period. Current smokers reported significantly greater pain in all visual analog scale (VAS) pain ratings — worst, current and average weekly pain — when compared with patients who had never smoked.”

It was also noted that patients who quit smoking reported greater improvement than those who continued to smoke and the group that continued to smoke had no reported improvement in pain.

The leading author of the study said that nicotine increases pain. According to the study, if you quit smoking, your condition should improve. If you continue to smoke, you may see no improvement, regardless of what treatment you receive. If you smoke, you are dramatically decreasing your chances of getting better from any treatment, including surgery.

Here is the conclusion of the study: “Given a strong association between improved patient-reported pain and smoking cessation, this study supports the need for smoking cessation programs for patients with a painful spinal disorder.”

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Low Back Pain and Balance Specific Exercises.

24 Dec

Low back pain (LBP) and its relationship to balance has been the topic for the past two Health Updates, and an initial discussion regarding specific balance exercises was introduced last month. This month’s Health Update will complete the discussion about what you can do to preserve your current balance skills, or better yet, improve them! Remember, wear your foot orthotics and don’t forget to move them between your different shoes. Similarly, if you have leg length imbalance, move your heel lift to other shoes or simply purchase additional lifts and keep the heel lift in several pairs of shoes. Also, test your balance skills now before starting a balance exercise program and re-test every 2-4 weeks to measure improvement (see the January 2013 Health Update for the testing protocol).

The initial exercise we discussed was standing with your feet together and holding that position for progressively longer times (eyes open and closed). Once you can hold this position with your eyes closed for ≥ 30 seconds, start increasing the balance challenge by:

Move your heel of the left foot next to the big toe of the right foot and repeat the exercise with the eyes open and closed. Repeat on the other side! When successful for ≥30 sec., do it with eyes closed…..

Place your left foot in front of the right foot/toes (like standing on a balance beam) and repeat the exercise with the eyes open and closed. Repeat on the other side! When successful for ≥30 sec., do it with eyes closed…..

Repeat #1 and #2 standing on a thin pillow and/or a wobble cushion or rocker board, making sure you are “safe” by standing in the corner of a room or in an entrance to a room where you can grab the door frame when needed. DO NOT RISK falling!

Rocker board exercise options:

Rock forwards/backwards (FW/BW) looking straight ahead (don’t look down at your feet). Make sure the board you are using is “safe” (where you can safely step off forwards and backwards). Don’t use a board that is too high off the ground (about 3” is maximum). Repeat the FW/BW rocking slowly for 10 minutes periodically opening and closing your eyes.

Repeat “A” but stand at a 45° angle to the front/back direction so you are rocking at an angle using the same methods and time frame.

Repeat “A” but stand at a 90° angle to the front/back direction so you are rocking at an angle using a similar method and time frame.

You can then “make up” exercises standing on the rocker board or cushion like simulating a golf swing, tennis stroke, or other favorite sport, yoga move, etc. Be creative and make it fun!!!

We realize you have a choice in who you choose to provide your healthcare services.  If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

 

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