Tag Archives: back pain

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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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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