Tag Archives: MEchanicsburg chiropractor

Low Back Pain – Is it on the Rise?

11 Dec

As stated in previous articles, the prevalence of low back pain (LBP) is REALLY high! In fact, it’s the second most common cause of disability among adults in the United States (US) and a very common reason for lost days at work. The total cost of back pain in the US, including treatment and lost productivity, ranges between $100 billion to $200 billion a year! Is low back pain on the rise, staying the same, or lessening? Let’s take a look!

In the past two decades, the use of health care services for chronic LBP (that means LBP > 3 months) has substantially increased. When reviewing studies reporting insurance claims information, researchers note a significant increase in the use of spinal injections, surgery, and narcotic prescriptions. There has been an increase in the use of spinal manipulation by chiropractors as well, along with increased physical therapy services and primary care physician driven non-narcotic prescriptions. In general, LBP sufferers who are chronic (vs. acute) are the group using most of these services and incurring the majority of costs. The reported utilization of the above mentioned services was only 3.9% in 1992 compared to 10.2% in 2006, just 11 years later. The question now becomes, why is this? Possible reasons for this increase health care use in chronic LBP sufferers may be: 1) There are simply more people suffering from chronic LBP; 2) More chronic LBP patients are deciding to seek care or treatment where previously they “just accepted and lived with it” and didn’t pursue treatment; or, 3) A combination of these factors. Regardless of which of the above three is most accurate, the most important issue is, what can we do to help chronic back pain sufferers?

As we’ve discussed in the past, an anti-inflammatory diet, exercise within YOUR personal tolerance level, not smoking, getting enough sleep, and obtaining chiropractic adjustments every two weeks are well documented methods of “controlling” chronic LBP (as there really ISN’T a “cure” in many cases). You may be surprised to hear that maintenance care has good literature support for controlling chronic LBP. In the 8/15/11 issue of SPINE (Vol. 36, No. 18, pp1427-1437), two Medical Doctors (MDs) penned the article, “Does Maintained Spinal Manipulation Therapy for Chronic Nonspecific Low Back Pain Result in Better Long-Term Outcomes?” Here, they took 60 patients with chronic LBP (cLBP) and randomly assigned them into one of three groups: 1) 12 treatments of sham (fake) SMT (spinal manipulation) have over a one month period; 2) 12 treatments, over a one month period but no treatment for the following nine months; or 3) 12 treatments for one month AND then SMT every two weeks for the following nine months. To measure the differences between the three groups, they measured pain, disability, generic health status, and back-specific patient satisfaction at baseline, 1-, 4-, 7-, and 10-month time intervals. They found only the patients in the second and third groups experienced significantly lower pain and disability scores vs. the first group after the first month of treatments (at three times a week). BUT, only the third group showed more improvement at the 10-month evaluation. Also, by the tenth month, the pain and disability scores returned back to nearly the initial baseline/initial level in group two. The authors concluded that, “To obtain long-term benefit, this study suggests maintenance SM after the initial intensive manipulative therapy.” Other studies have reported fewer medical tests, lower costs, fewer doctor visits, less work absenteeism, and a higher quality of life when maintenance chiropractic visits are utilized. The question is, WHEN will insurance companies and general practitioners start RECOMMENDING chiropractic maintenance care for chronic LBP patients?

 

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Neck Pain – Where Is It Coming From?

10 Dec

Neck pain can arise from a number of different tissues in the neck. Quite often, pain is generated from the small joints in the back of the vertebra (called facets). Pain can also arise from disk related conditions where the liquid-like center part of the disk works its way out through cracks and tears in the thicker outer part of the disk and can press on nerves producing numbness and/or weakness in the arm. It is possible to “sprain” the neck in car accidents, sports injuries, or from slips and falls. This is where ligaments tear and lose their stability resulting in excessive sliding back and forth of the vertebrae during neck movements. When muscles or their tendon attachments to bone are injured, these injuries are called “strains” and pain can occur wherever the muscle is torn. There is also referred pain. Here, the injury is at a distance away from where the pain is felt. A classic referred pain pattern is shoulder blade pain when a disk in the neck herniates. Let’s take a closer look at two conditions we often diagnose and treat as chiropractors:

Spinal Stenosis: This occurs when the canals in the spine narrow to the point of pinching the spinal cord in the trefoil shaped central canal (called “central stenosis”) or when the nerve roots get pinched in the lateral recesses (called lateral recess stenosis). This can occur from arthritis in the facet joints, disk bulging or herniations, thickening of ligaments, shifting of one vertebra over another, aging, heredity (being born with a narrowed canal), and/or from tumors. Usually, combinations of several of the above occur simultaneously. When this is present in the neck, it can be more serious compared to stenosis in the low back as the spinal cord ends at the upper part of the low back (T12 level) so only the nerves get pinched. Stenosis in the neck however pinches the spinal cord itself. Symptoms can include pain in one or both arms, but it’s more dangerous when leg pain, numbness, or weakness occur (called myelopathy). Rarely, loss of bowel or bladder control can occur which is then considered a “medical emergency” and requires prompt surgery.

Cervical Disk Herniation: As previously stated, the liquid-like center of the disk can work its way through cracks and tears in the outer layer of the disk and press on a nerve resulting in numbness, pain, and/or weakness in the arm. The classic presentation is the patient finding relief by holding the arm over the head, as this puts slack in the nerve and it hurts less in this position. The position of the head also makes a difference as looking up usually hurts more and can increase the arm pain/numbness while looking down reduces the symptoms. We will carefully test your upper extremity neurological functions (reflexes, muscle strength, and sensation as each nerve performs a different function in the arm), and we can tell you which nerve is pinched after a careful examination. This condition can lead to surgery so please take this seriously.

The good news is that chiropractic care can manage both spinal stenosis and cervical disk herniations BEFORE they reach the point of requiring surgery. So make chiropractic your FIRST choice when neck pain occurs!