What’s This Tingling in My Leg?

              When you think of low back pain, you may visualize a person half-bent over with their hand on the sore spot of their back. Since many of us have experienced low back pain during our lifetime, we can usually relate to a personal experience and recall how limited we were during the acute phase of our last LBP episode. However, when the symptoms associated with LBP are different, such as tingling or a shooting pain down one leg, it can be both confusing and worrisome – hence the content of this month’s article!

            Let’s look at the anatomy of the low back to better understand where these symptoms originate. In the front of the spine (or the part more inside of the body), we have the big vertebral bodies and shock absorbing disks that support about 80% of our weight. At the back of each vertebrae you'll find the spinous and transverse processes that connect to the muscles and ligaments in the back to the spine. Between the vertebral body and these processes are the tiny boney pieces called the pedicles. The length of the pedicle partially determines the size of the holes where the nerves exit the spine.

            When the pedicles are short (commonly a genetic cause), the exiting nerves can be compressed due to the narrowed opening. This is called foraminal spinal stenosis. This compression usually occurs later in life when osteoarthritis and/or degenerative disk disease further crowds these “foramen” where the nerves exit the spine. Similarly, short pedicles can narrow the “central canal” where the spinal cord travels up and down the spine from the brain. Later in life, the combined effects of the narrow canal plus disk bulging, osteoarthritic spurs, and/or thickening or calcification of ligaments can add up to “central spinal stenosis.” The symptoms associated with spinal stenosis (whether it’s foraminal or central) include difficulty walking due to a gradual increase in tingling, heavy, crampy, achy and/or sore feeling in one or both legs.  The tingling in the legs associated with spinal stenosis is called “neurogenic claudication” and must be differentiated from “vascular claudication”, which feels similar but is

caused from lack of blood flow to the leg(s) as opposed to nerve flow.

            At a younger age, tingling in the legs can be caused by either a bulging or herniated lumbar disk or it can be referred pain from a joint – usually a facet or sacroiliac joint. The main difference in symptoms between nerve vs. joint leg tingling symptoms is that nerve pinching from a deranged disk is located in a specific area in the leg such as the inside or outside of the foot. In other words, the tingling can be traced fairly specifically in the leg. Tingling from a joint is often described as a deep, “inside the leg,” generalized achy-tingling that can affect the whole leg and/or foot or it may stop at the knee, but it’s more difficult to describe by the patient as it’s less geographic or specific in its location. Chiropractic management of all these conditions offers a non-invasive, effective form of non-surgical, non-drug care and is the recommended in LBP guidelines as an option when treating these conditions.  

Low Back Pain – When is it DANGEROUS to Wait?

             Low back pain (LBP) typically results from relatively “benign” causes, meaning it’s usually safe to wait and try conservative / non-emergency care first. However, there are a handful of times when prompt medical emergency management is appropriate, and it’s important that everyone is aware of these uncommon but dangerous and sometimes deadly causes of LBP, hence the purpose of this article. 

            “Red flags” trace back to the 1980s and 1990s, so this is not a “new” topic. In fact, guidelines for the care of LBP that have been published around the world ALL commonly state the anyone exhibiting these “red flags” needs to be promptly diagnosed and referred for emergent care. The common conditions cited in these guidelines include (but are not limited to): 1) Cancer, 2) Cauda equine syndrome, 3) Infection,  4) Fracture. The patient's history can sometimes uncover suspicion of these four conditions BETTER than a routine physical examination, though a definitive diagnosis is usually made only after special diagnostic tests have been completed including (but not limited to) imaging (x-ray, MRI, CT, PET scans), blood tests, bone scans, and more.

1) Cancer: a) Past history of cancer. b) Unexplained weight loss (>10 kg within 6 months). c) Age over 50 or under age 18. d) Failure to respond to usual care (therapy). e) Pain that persists for four to six weeks. f) Night pain or pain at rest.

2) Infection: a) Persistent fever (>100.4º F). b) Current/recent URI (upper respiratory tract infection like pneumonia) or UTI (urinary tract or kidney infection). b) History of intravenous drug abuse. c) Severe back pain. d) Lumbar spine surgery within the past year. e) Recent bacterial infection (cellulitis or persistent wound – e.g., a decubitus ulcer or “pressure sore” in the low back region). f) Immunocompromised states such as those caused by systemic corticosteroids, organ transplant medications, diabetes mellitus, human immunodeficiency virus (HIV).

3) Cauda Equina Syndrome: a) Urinary incontinence or retention. b) Saddle anesthesia. c) Anal sphincter tone decrease or fecal incontinence. d) Bilateral lower extremity weakness or numbness. e) Progressive neurologic deficit or loss – major muscle weakness or sensory deficit.

4) Fracture: a) Prolonged corticosteroid use. b) Age >70. c) History of Osteoporosis (poor bone density). d) Mild trauma over age 50. e) Major trauma at any age (such as a fall).

            Another red flag is an Abdominal Aortic Aneurism. Signs include: a) Abdominal pulsations. b) Hardening of the arteries (atherosclerotic vascular disease). c) Pain at rest or night time pain. d) Age >60.

Spinal Manipulation AFTER Surgery HELPS!

              Unfortunately, low back pain (LBP) is something MOST of us cannot avoid. There is solid evidence that chiropractic care is one of the most effective methods of treating LBP, but there are times when a referral for surgery is needed. What about manipulative therapy (MT) AFTER surgery? Is this a good idea? Does it help?

            In March 2015, an article published in the Journal of Back and Musculoskeletal Rehabilitation discussed the pros and cons of MT after lumbar open laser microdiscectomy, a common surgical technique used to treat patients with a pinched nerve due to a herniated lumbar disk. Unfortunately, patients who undergo this procedure can experience early post-surgical physical disability that reduces their ability to perform required daily activities. For this reason, the objective of this study was to look at whether early individualized spinal manipulation would reduce the occurrence of post-surgical disability. To do this, 21 patients (aged 25-69) who had a microdiscectomy were randomly placed into either a spinal manipulation or an active control group. Manipulation was performed two to three weeks after surgery, at two times a week for four weeks.  The researchers found patients in the MT group experienced a 55% reduction in disability while those in the control group reported a 5% increase in disability! Also, leg pain was reduced by 55% in the MT group compared with only 9% in the control group. This pilot study concluded that while a larger-scale study is recommended, the findings indicate that manipulation “…may be an important option for post-operative management after spinal surgery.”

            This is yet another testimony that spinal manipulation can not only help many people avoid surgery, but it can also significantly reduce or eliminate back pain and disability AFTER surgery! Spinal manipulation is the most common treatment approach performed routinely by chiropractors. And although other healthcare professionals are showing an increasingly greater interest in learning this skill, manipulation must be performed on a regular, concentrated basis in order to obtain the best outcomes or therapeutic results for patients. So, regardless if you have or have not had surgery for LBP, the benefits of chiropractic and spinal manipulation are recognized as a recommended course of treatment!

Low Back Pain? Should You Take an NSAID?

              Statistics suggest that low back pain (LBP) will plague most of us at some point in our lives, if it hasn’t already. Most healthcare professions that manage patients with low back pain focus on pain management. In fact, studies have reported that 67% of patient satisfaction is driven by pain elimination. One of the most common strategies for reducing pain is managing inflammation. The “easiest” way to do this (according to the many TV commercials and magazine advertisements) is to take one of the many non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen (Advil, Nuprin), Piroxicam Flurbiprofen, and Indomethacin. Let’s take a closer look to see if this is a good or bad idea!

            In a recent March 2015 article, researchers investigated the use of NSAIDs between 1993 and 2012 in patients who had fractures that failed to heal, technically called “non-union fractures.” They found that non-union fractures increased during years when NSAID use was increasingly recommended for patients with fractures and dropped in years when NSAID use declined. This isn’t the first study to report poor fracture healing results from NSAIDs when they’re used as the primary form of pain relief and in fact, studies on this subject date back to the early 1990s. So how does this equate to LBP? Most directly, fractures are one of the many causes of LBP, so for that population, the answer is clear. However, LBP is much more commonly caused by sprains (ligament injuries) and strains (muscle/tendon injuries), as well as cartilage injury. Here too, studies show that the healing rate of sprains, strains, and cartilage is also delayed when NSAIDs are used as the primary pain relief approach. This healing delay is reportedly due to NSAIDs' inhibition of “proteoglycan synthesis,” a component of ligament and cartilage tissue regeneration and repair. NSAIDs also inhibit release of prostaglandins (especially prostaglandin E2), which is needed for tissue repair. These effects are ESPECIALLY observed with long-term use, but recent studies show injured athletes are best off NOT taking NSAIDs AT ALL as these drugs delay the healing process and thus the athlete's ability to return to their sport.

            In a January 2015 study, researchers criticized the common use of NSAIDs in elderly patients for the treatment of non-cancerous pain. They found 75% of the elderly population studied was prescribed NSAIDs which, in retrospect, the researchers determined to be inappropriate!  Because NSAIDs interfere with healing, the net effect is an ACCELERATION of osteoarthritis and joint deterioration! In 1995, a North Carolina School of Medicine study compared four groups of patients with soft tissue injuries (tendon strains): Group 1 received NO treatment (control group); Group 2 received exercise only; Group 3 received exercise AND Indomethacin; and Group 4 received Indomethacin only. At 72 hours post-injury, ONLY the exercise group had an INCREASE in prostaglandins (E2 particularly – necessary for healing). This effect was even more profound at 108 hours after injury. The research team also found DNA synthesis in the fibroblasts (an important part of the repair mechanism) was greatest in the exercise group and was completely lacking in the NSAID-only group.

Who Gets Low Back Pain?

            Low back pain (LBP) occurs all over the world. Between 2004 and 2008, an estimated 2.06 million EPISODES of LBP occurred in the United States (US) alone! Each year, LBP accounts for 3.15% of all emergency visits with 65% of LB injuries occurring at home. According to estimates, two-thirds of all Americans will experience at least one episode of back pain during their lifetime. Interestingly, according to one study, LBP peaks two times during life: between 25-29 years of age and 95-99 years of age, regardless of cause. Looking at gender differences, when analyzed by five year age groups, males aged 10-49 and females aged 65-94 had a greater risk for LBP when compared with the opposite gender. Those with European or African ancestry have significantly higher rates of LBP when compared with those of Asian ancestry. Also, older patients have the greatest risk of hospital admission for LBP. 

            In order to study the incidence of LBP among active duty US military service members, a 2012 study investigated the US Defense Medical Epidemiology Database and looked at 13,754,261 person-years of data (100 25-year-olds would equal 2,500 person-years, for example). The authors of the study report that women have a 45% higher incidence rate than men, and personnel over age 40 are 1.28 times more likely to experience back pain than those who are 25-29 years old. Looking at single vs. married service members, married personnel have a higher incidence rate (1.21) than non-married personnel, though there is no consensus as to why this is the case. In conclusion, the female gender, age >40 years, and those who are married have the greater risk for LBP in the military.

            One study looked at alcohol consumption and the incidence of LBP to see if there was a causal relationship between the two. After searching the literature, no positive link between alcohol consumption and LBP was found. On the other hand, smoking clearly contributes to the incidence of LBP (yet another reason to quit smoking!). One study looked at daily use, number of years smoked, and total cigarette use during the years of smoking in relation to LBP in 29,424 monozygotic (identical) twin pairs where only one of the two twins smoked. Researchers determined how many days in the past year LBP was present (1-7 days, 8-30 days, and >30 days) and age, gender, and size/body mass index for each participant. The results revealed a positive association with smoking and the duration of LBP at 1-7 days (1.4 odds ratio), 8-30 days (2.1), and >30 days (3.0) during the past year.

Back Pain and Posture

            Low back pain (LBP) is one of the most common ailments that chiropractors treat. That’s probably because MOST of us will suffer from low back pain that requires outside help at some point in our lives! Posture has long been studied as a potential cause of low back pain, and this month’s topic will take a closer look at some recent research discussing this issue.

            A December 2014 study looked at low back posture in two groups of LBP patients and its relationship with problems associated with intervertebral disk diseases. Looking at a person from the side, have you noticed that the low back area has an arched or inward curve? This is called the “lumbar lordosis” (or, the “sway back” area), and this can be highly variable in terms of the angle or amount of arch. It normally differs between males and females. Degenerative disk disease (DDD) is a common condition affecting virtually all of us at some point in time. DDD results in narrowing of the disk spaces, which there are five total in the lumbar spine (twelve in the thoracic spine/mid-back, and six in the cervical spine/neck). One particular study evaluated a group of 50 patients with long-term intractable (chronic) low back pain with intervertebral disk disease and a group of 50 chronic LBP patients without DDD that served as a “control group.” Researchers measured the degrees of lordosis, or amount of curve (lumbar lordosis), by looking at the person from the side using two different methods in the two patient groups and compared the data. The group with degenerative disk disease had an overall reduction in the lumbar lordosis curve (less arched) using both methods of measuring. The authors concluded that the patients with intervertebral disk lesions had a straighter, or more flat curve (less sway back), when compared to those without disk degeneration. What they were unable to determine was which came first, the disk degeneration or the reduction in the lumbar lordosis?

            This study points out several important points. When treating patients with low back pain, some patients feel better when placed in a bent forwards position, or they favor a flat low back curve. Others have the opposite response, or their position of preference favors a more curved (arched) lower spine. The reason for this difference is that LBP is generated from different tissues in the low back, and some tissues favor or feel better in one position and typically feels worse in the opposite direction when injured. The intervertebral disks in the spine lie between the vertebral bodies and serve as “shock absorbers” for the spine and trunk. The center, or “nucleus,” of the disk is liquid-like and is usually well contained inside the disk, held by a tough, outer fibrocartilage material (the “annulus”). The disk is approximately 80% water, and as we age, the water content gradually reduces and the disk spaces narrow, thus limiting the mobility of that part of the spine. More importantly, DDD usually narrows the size of the canals through which the spinal cord and nerve roots travel. When we bend forward, these canals open up wider placing less pressure on the nerves and/or spinal cord. This is why we often see elderly people leaning on grocery carts when shopping, as it hurts less and they can walk longer / farther. Those with herniated disks tend to be the opposite, as they favor bending backwards as this position shifts the nucleus or liquid center forwards and away from the nerve root thus reducing the pinched nerve resulting in less or complete elimination of radiating leg pain.

Back Pain and Lyme Disease

             Low back pain (LBP) affects most of us at some point in life, and usually its cause is mechanical. We typically do not think about low back pain resulting from a virus or bacteria, though we might be quick to recall times when LBP occurred suspiciously close to an infection such as a flu or a cold. Today's topic looks at a less common but dangerous cause of low back pain: Lyme disease.

            Lyme disease (LD) was originally recognized in 1975 when an unusual number of children were diagnosed with juvenile rheumatoid arthritis in the city of Lyme, Connecticut and a neighboring town. The investigators at that time thought it was suspicious that these affected children lived near woods and that their symptoms would recur during the summertime, the height of the tick season. Unique findings included a peculiar rash on the skin that developed just prior to the onset of arthritic-like symptoms, and many recalled being bitten by a tick near the rash site. Further investigation led to the discovery that tiny DEER ticks infected with a spiral shaped bacterium or spirochete, later named Borrelia burgdorferi, were indeed the responsible culprit of the LD associated arthritis. Ordinarily, wood ticks or dog ticks do not carry the infection.

            Investigators found that the Borrelia burgdorferi bacterium usually feed and mate on deer during part of their life cycle. With the expansion of suburban developments in rural regions alongside a growing deer population, more and more people have been infected by this bacterium. Geographically specific regions include the coastal Northeast, mid-Atlantic states, Wisconsin, Minnesota, and Northern California. Lyme disease has also been found in large areas of Asia and Europe and more recently, in South America.

            Lyme disease can affect the heart, brain, nervous system, and other parts of the body in varying degrees as it progresses. The bacteria enters the body where the tick bite occurs and days to weeks later, as the bacteria spread in the skin, an expanding reddish rash often with flu-like symptoms occurs. Later, it can produce abnormalities in the joints, heart, and nervous system. Three phases of LD include: 1) Early localized disease with skin inflammation; 2) Early spread of the disease with heart (arrhythmias and more) and nervous system involvement (e.g. Bell’s palsy and meningitis); 3) Late disease includes motor and sensory nerve damage and brain inflammation, as well as arthritis. More than 25% do not develop a rash and many cannot recall a tick bite. A rash can develop within days to weeks of the bite, may or may not itch, is often accompanied with fatigue, muscle and joint stiffness, painful and swollen lymph nodes, headache, and less often, fever. The rash usually resolves without treatment in approximately one month, and from weeks to months later, the effects of the bacteria can spread through the body, potentially affecting the joints (especially the knees), heart, and nervous system.

            The “ideal” treatment is antibiotics within the first four to six weeks because of the potential harm Lyme Disease can cause. Kids 5-14 and adults 40-50 are the populations that are most often affected. Lyme disease is NOT contagious. As chiropractors, we recognize the importance of an accurate diagnosis and will promptly refer you for conditions such as this!

What's Causing My Back Pain?

             Low back pain (LBP) is one of the most common reasons patients seek out Chiropractic care, and they appreciate being told what is causing their back pain. This is why doctors gather a careful and complete history from new patients and perform a physical examination.  Once the "pain generator" is determined, a doctor can discuss various treatment options and develop a plan for managing the patient. Let’s review some causes of LBP!

            If we divide the various conditions into three categories, it significantly improves diagnostic accuracy. These include: 1) Mechanical LBP; 2) Nerve root pain; and 3) “Red Flags” (serious conditions). The most common conditions are those belonging to the first group. The following is a partial list of conditions that belong to each category:

1)      Mechanical LBP: Causes of mechanical LBP include Lumbar and sacroiliac (SI) sprains, lumbar muscle strains, facet syndrome, degenerative disk disease (DDD) and/or injury to the disk without nerve pinch, osteoarthritis (this can affect different parts of the spine), spinal instability, spondylolysis and/or spondylolisthesis, and more. The pain pattern is usually localized to the low back and may spread into the buttocks, hips, thighs, but rarely extends past the knee. Usually, there is NO numbness or weakness in the leg or foot because that symptom suggests a spinal nerve pinch.

2)      Nerve root pain can result from herniated disk (from either direct nerve pinching and/or chemical irritation inflaming the nerve), central or lateral spinal stenosis (usually caused by a combination of things including DDD), arthritis, and/or calcification of ligaments near the nerve. These can be managed very successfully without surgery but the careful monitoring of numbness, muscle weakness, and treatment satisfaction is important!

3)      Red Flags: These are the potentially dangerous conditions such as cancer, fracture, infections, cauda equina syndrome (spinal cord pinch creating bowel and/or bladder weakness). Referred pain from organs may be included here as well. As you can see, these carry potentially lethal consequences and require immediate referral and specialty management.

            The majority of patients suffering from LBP fall into the first two categories, and the HISTORY can tell us a lot! If the patient complains of pain that stays mostly in the low back but may spread into the buttocks or thigh without numbness/weakness in the leg and feels better with leaning forwards or curling up in a ball, it probably is a Group 1 (mechanical) diagnosis. If there is numbness, tingling, and/or weakness in the leg to the foot and bending over hurts, it’s most likely disk derangement (bulge, herniated, etc.) with a nerve pinch. If there is unexplained weight loss, a past history of cancer, non-responding LBP to treatment, sleep interruptions, and age >50 years old, we may now be in category three and further tests are needed!

            The IMPORTANT point is that spinal manipulation (chiropractic) can manage the most common causes of LBP as a non-surgical, low-risk form of care.

Low Back Pain – What To Do & NOT Do!

            Low back pain (LBP) can strike at any time or place, often when we least expect it. There are “self-help” approaches that can be of great benefit, but many of these approaches can fail, or worse, irritate the condition. Here are some “do’s and don’ts” when self-managing low back pain!

            Ice vs. Heat? Typically, people are almost always confused about which is better, ice or heat? This decision can be significantly helpful or hurtful, depending on the case. Generally, “ice is nice,” as it vasoconstricts and pushes out inflammation or swelling, which usually feels relieving and helpful even though the initial “shock” of ice may not be too appealing to most of us! This is probably why MOST people will wrongly choose heat as their initial course of self-care. This is usually wrong because heat vasodilates, which draws blood into the injured area that is already inflamed and swollen, thus adding more fluid to the injured area -- sort of like throwing gas on a fire! Heat may feel good initially, but often soon after, increased pain intensity and frequency may occur. When LBP is chronic or NOT new / acute, heat can be very helpful, as it relaxes muscles and improves movement by reducing stiffness (but never use heat more than 20 minutes per hour). The biggest mistake about the use of heat is leaving it on too long – some people even burn themselves with a heating pad they’ve left on for hours of continuous use – sometimes overnight (PLEASE DON’T DO THAT!). When using ice, there are MANY ways one can apply it. If you only have 5-10 minutes, that is better than nothing! However, an ideal approach is to apply the ice pack or bag as follows:  On 15 min. / off 15 min. / on 15 min. / off 15 min. / on 15 minutes (total time: 1:15 hr). The “off 15 minutes” helps the area to warm up by allowing the blood to come back into the low back area, which avoids frost bite and sets up a pump-like action. Even better is an approach called “CONTRAST THERAPY” where we start and end with ice and use heat in between as follows: ICE 10 minutes / HEAT 5 min. / ICE 10 min. / HEAT 5 min. / ICE 10 min. (total time: 40 minutes). This approach creates a stronger pump-like or “push-pull” action that pushes out fluids/inflammation (with ice) followed by pulling in fluids (with heat). Both approaches are effective! If you ever feel worse after icing, PLEASE STOP AND CONTACT US, as you may have a unique case or situation.

            How active should I be? Here too, most people usually try to do too much even after they feel “warning signs”. It's human nature to want to “…get things done,” so sometimes we push ourselves beyond the limits of our tissue’s capacity, resulting in an injury. Once we’ve hurt our back, we STILL try to stay with our daily routine, ignoring our LBP the best we can. Generally, it’s BETTER to be a little active than it is to be too sedentary, but there is also a limit, as too much activity is like “…picking at a cut,” only prolonging healing and recovery. If every time you bend over results in a sharp, dagger-like pain in your low back, PLEASE STOP and assess the situation! Position preference is the KEY to determining what type of stretches or other exercises may be best for you. So, if bending over REDUCES LBP, pull your knees to your chest (we’ll show you how)! If bending backwards feels better, we’ll show you several extension exercises that can be done multiple times a day. Remember, too much sitting or lying down will weaken your low back muscles. Emphasize positions that feel good and avoid sharp, lancinating pain!

Low Back Pain – What To Do Immediately (Part 1)

            Low back pain (LBP) will most likely strike at some point for all of us, at least that’s what statistically happens. How we “deal with it” initially can be critical in its progression or cessation. Here are some “highlights” of what to do “WHEN” this happens to you.

STOP:  The most important thing you can do is STOP what you are doing. That is, IF you’re “lucky enough” to be pre-warned BEFORE the crisis point of LBP strikes. This step can be critical, as once it hurts “too much,” it may be too late to quickly reverse the process. The “cause” of LBP is often cumulative, meaning it occurs gradually over time, usually from repetitive motion that overloads the region. As stated previously, “IF YOU’RE LUCKY” you’ll be warned BEFORE LBP becomes a disabling/preventing activity. Typically, when the tissues in the low back are over-stressed and initially injured, the nerve endings in the injured tissue trigger muscle guarding as a protective mechanism. This reflex "muscle spasm" restricts blood flow resulting in more pain creating a vicious cycle that needs to be STOPPED!

REACT: This is the “hard part” as it requires you to perform something specifically, but once you prove to yourself that this approach really works, you won’t hesitate. You'll need to determine your “direction preference”, or the position that reduces LBP. Once established, you can perform exercises to help mitigate your back pain. To make this work, you must be able to perform these exercises in public without drawing too much attention so you can feel comfortable doing them at any time at any place.

EXERCISE A: If BENDING FORWARD feels relieving, the exercise of choice is to sit and a) cross one leg over the other, b) pull that knee towards the opposite shoulder, and c) move the knee in various positions so the area of “pull” changes. Work out each tight area by adding an arch to the low back, rotate your trunk towards the side of the flexed knee (sit up tall and twist – if it doesn’t hurt) and alternate between these positions (10-15 seconds at a time) until the stretched area feels “loosened up.” A second exercise is to sit and rotate the trunk until a stretch is felt. Again, alternate between different degrees of low back arching during the twists, feeling for different areas of stretch until it feels looser, usually 5-15 seconds per side. A third exercise is to sit and bend forward, as if to tie a shoe, and hold that position until the tightness “melts away.” 

EXERCISE B: If BENDING BACKWARDS feels best, exercise options include placing your fists in the small of your back and leaning backwards over the fists, or bending backward and holding the position as long as needed to feel relief (usually 5-15 seconds). From a sitting position, try placing a rolled-up towel (make one with a towel rolled tightly like a sleeping bag held with rubber bands) in the small of the back to increase the curve. Lying on your back with the roll and a pillow under the low back can also feel great!

            We will continue this discussion next month!

            We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for back pain, we would be honored to render our services.

Low Back Pain and Younger Adults

            Low back pain (LBP) is so common that if you haven’t had it by now, you will! Let’s take a look at some the possible causes of LBP and what we might be able to do when LBP strikes.

            Typically, younger individuals are NOT immune to LBP. In fact, those between 30-60 years of age are MORE likely to experience LBP caused from a muscle strain, ligament sprain, or disk “derangement” such as a herniated disk. Here are some specific causes:

            LBP from a sudden movement or lifting a heavy object - Typical symptoms include: a) Difficulty moving that can be so severe it can prevent walking or standing. b) Pain that does NOT radiate down the leg past the knee but may refer pain into the groin, buttock, or upper thigh. c) Pain that tends to be achy and dull. d) Muscle spasms (that can be severe). e) Local soreness noted upon touch. DIAGNOSIS: The most likely injuries described by the scenario above include a muscle strain or ligament sprain (or, a muscle or ligament pull/stretch/tear that can broken down into mild vs. moderate vs. severe, or, microscopic tears vs. up to 75% tearing vs. >75% tearing may occur, respectively). The severity of the injury and how well you take care of yourself will determine healing time. TREATMENT can include Chiropractic care, ice (15 min. rotations on/off/on/off/on), activity modifications (usually, a combination of walking and resting for the first day or two will help but after that, we will guide you in the proper exercises for stretching and eventually strengthening), and anti-inflammatory care. We prefer herbs such as ginger, turmeric, boswellia, and other nutrients over NSAIDs -- like Advil, Aleve, and aspirin -- as these irritate the stomach and can damage the liver and kidney. Recent studies show that NSAIDs can also inhibit important chemical activities in the body that may actually slow the healing process. For this reason, studies have concluded that athletes who are trying to get back into their sport should be advised NOT to take NSAIDs! The same should apply to everyone, don’t you think?

            LBP that travels past the knee down the back of the leg often to the ankle or foot is frequently referred to as sciatica. This may include: a) Pain that is longer lasting rather than flaring up for a few days or one to two weeks. b) Pain may be greater in the leg than the low back. c) Pain is commonly on one side. d) Pain is worsened by sitting and or bending forwards, and improved by standing and or bending backwards. e) Symptoms often includes pain, in addition to numbness/tingling, and/or burning. f) Muscle shrinkage and weakness on the involved side may occur as well. DIAGNOSIS: In this age group, lumbar herniated disk (LDH) is the most likely cause.  The lower two disks – L4/5 and L5/S1 -- are the two most common locations for herniated disks. The odd thing about LDH’s is that about 50% of us have bulging disks and 20% of us have herniated disks but have NO pain! TREATMENT: Try chiropractic first. It works and you can always have surgery later, but you can’t go back after it’s done! We will refer you if our approaches are not satisfying!

            We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for back pain, we would be honored to render our services.

Low Back Pain in the Older Adult

            Last month, we addressed low back pain (LBP) in the younger patient (age 30-60), so it only seems appropriate to continue the discussion for those over the age of 60. As previously mentioned, back pain does NOT discriminate when it comes to age. In fact, chiropractors see many children and teenagers with LBP as well as 90+ year-olds! Let’s take a look at the “usual” differences...

            In the younger adult, facet syndrome and disk derangement are common conditions, and though this can still occur in the older adult, it becomes less common after age 60. The primary reason is because our disks become dehydrated or “dry up” as we age, making them less likely to herniate compared to a young, well-hydrated disk. During this “dehydration” process, the disks gradually narrow and bulge outwards. Therefore, in the 60+ year-old adult, disk-related pain is typically NOT from the soft liquid center herniating through the tough outer “annular” layer as it does in the younger patient. Rather, it’s from a combination of conditions. These conditions combine together and result in narrowing of the openings through which the nerve root exits the spine (called the neuroforamen).

            The multiple conditions that contribute to this process include (but are not limited to): narrowing and bulging of the disk, osteoarthritis, or spurring extending off the vertebral endplates where the disk attaches, facet joint arthritis resulting in “hypertrophy” or enlargement, calcification of ligaments, and more. WHEN the neuroforamen narrows to the point of pinching the nerve root, symptoms occur. This condition is called “spinal stenosis” (SS), which literally means, “narrowed spinal canals” with entrapment of the spinal cord and/or nerves. Classic symptoms associated with SS include low back pain and stiffness. Most importantly, SS causes a gradual reduction in the amount of time that people with this condition can tolerate walking. Restricted mobility is initially subtle, but after months and years, walking may become more and more limited. That is, every time a certain time frame is reached (like 5 or 10 minutes of walking), the symptoms become significant to the point they force the SS patient to stop and sit or bend over often for one to two minutes, after which time they are able to resume walking for a similar amount of time.

            Another common feature is that bending forwards HELPS (because it opens up the neuroforamen), and many SS patients walk bent over as their “norm.” When walking in a grocery store, they may lean forwards on the grocery cart because it allows for a longer, less painful walk. Other symptoms common with osteoarthritis (which always precedes SS), include morning stiffness, stiffness and pain when rising from sitting, decreased range of spinal motion or flexibility, localized painful joints, and others. As mentioned previously, degenerative joint disease or osteoarthritis is a slow, smoldering process that can often be traced back over the past 5, 10, and even 20 years.

            As chiropractors, we can improve spinal joint flexibility and slow this process down. Give chiropractic a try as back pain in our elderly years DOES NOT have to be disabling!

            We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for back pain, we would be honored to render our services.

Low Back Pain – What To Do Immediately (Part 2)

            Low back pain (LBP), as previously stated, will affect most (if not all) of us at some point in time. Knowing what to do when the warning signs occur is essential to avoiding a disabling level of LBP. Last month, we started the discussion about offering ways to manage the LBP using exercises with the objective of stopping and reversing a potentially serious level of LBP. We offered ways of stretching from a sitting position that can be done in public. Here are some standing exercise options.

1. EXERCISE C: THE HAMSTRING & GROIN STRETCH: From standing 1) Place your foot up onto a seat, bench, chair, pipe of a railing, or anything about knee level (it doesn’t have to be very high). If your balance isn’t very good, make sure to hold onto a wall or counter to keep your balance. 2) Keep your knee bent 20-30 degrees and arch your lower back by sticking out the buttocks until you feel the pull or stretch in the hamstrings (back of the leg). 3) Slowly straighten your knee (keep the buttocks poked out and the low back arched) and you will feel the hamstrings gradually get tighter. 4) Change the angle of the knee and/or the amount of l  ow back arch/pelvic tilt to modify the pulling intensity in the hamstrings. Continue this stretch for 15-30 seconds or until you feel the muscles loosening up. 5) Stay in that EXACT SAME POSITION and rotate your torso inwards (towards the leg you’re standing on) until you will feel the pull change from the hamstrings to the groin (inside thigh) muscles. You can also go back and forth between the hamstrings and the groin (adductor) muscles and continue the exercise until the back of the leg and groin feel adequately stretched (usually 5 to 15 seconds/leg).

2. EXERCISE D: THE HIP FLEXOR STRETCH: From standing: 1) Step forwards with one leg and stand in a semi-long, stride position (one foot ahead of the other). 2) On the back leg side, rotate the pelvis forwards until the hip lines up with the forward leg hip (or, the pelvis is square). 3) Add a posterior pelvic tilt (tuck in your buttock/pelvis or, flatten your low back). 4) Lean backwards (extend the low back) holding the above position. As you extend back, feel for the pull deep inside the upper front part of the thigh/groin area. You can alter between the third and fourth steps to release and re-stretch the hip flexor. Continue the stretch for 5-15 seconds or until you feel it’s stretched out and repeat on the opposite side. This one takes a little work but once you feel it, you will see why it’s so good!

3. EXERCISE E: THE ADDUCTOR STRETCH: As an alternative to the second part of EXERCISE C (step 5 of the standing hamstring stretch), stand with your legs spread apart fairly wide. Shift your pelvis from side to side (left then right) and feel for the stretch on the inner thigh/groin region. You can increase the stretch by adding a lean to the side you’re shifting the pelvis. Try holding the stretch for 5-15 seconds, alternating between sides 5-10 times.

            These exercises are meant to be done in public WHEN you need to stretch. Stop the vicious cycle from getting out of control by STOPPING, STRETCHING, and then resuming your activity if you can! 

            We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for back pain, we would be honored to render our services.

The “Aging” Lower Back – Part 2

            Last month, we started a series on low back pain (LBP) in the geriatric population, and we discussed osteoarthritis (OA) and degenerative disk disease (DDD). As reported last month, this group of conditions often co-exist in this population, so we will continue this discussion this month…

            A unique condition associated with OA and DDD is called “spinal stenosis” (SS).  Stenosis means “narrowing,” and it applies to two locations in the spine: 1) The holes through which the nerves in our neck and back exit out of the sides of the spine (called “intervertebral foramen” or, IVF); and, 2) The “spinal canal” through which the spinal cord travels. When narrowing occurs on the sides of the spine where the nerves exit, it’s called, “lateral spinal stenosis.” When the spinal canal narrows, it’s called “central spinal stenosis.” Our spinal cord starts up in the neck as an extension off the brain stem and usually ends at the junction between the middle and lower back (around T12/L1) with the “cauda equina” (which literally means, “horses tail”) and extends downward. The cauda equina is made up of many nerves that travel down and exit out the sides of the lumbar spine (through the IVFs) and sacrum (tail bone) and transfer information (motor and sensory) to and from our legs and brain. When the size of the canal through which these nerves travel close down or narrow enough, sufferers will initially start feeling vague symptoms of leg heaviness or fatigue after walking for 30 or more minutes. As years pass and the IVFs or central canal become gradually more narrow, it may get to the point where a person can only walk a short distance because their legs, “…just won’t move.” A classic complaint of SS is only being able to walk for four to five minutes prior to needing to sit down for 30 seconds to a few minutes (usually five minutes at the most) after which time the leg complaints resolve and the process repeats itself. When the nerves are compressed in these tight canals and the legs become heavy and hard to move, the term, “neurogenic claudication” is used. Another “classic” finding of SS is that RELIEF occurs when the patient bends forward, such as on a grocery cart or, simply stopping and bending over can be immediately relieving in many cases.

            Chiropractic adjustments and other techniques are often very helpful in these cases if it is not too far advanced. The good news is that it usually helps, so prior to considering surgery or injections for this, give chiropractic a try – it’s less invasive and safer. We can always refer you to the next step if the condition becomes too advanced and/or if the results become less satisfying.

            Compression fractures are another common cause of back pain in the elderly population. They're often caused by minor trauma in the presence of poor bone density (osteoporosis) which accounts for about 700,000 of the 1.5 million osteoporotic fractures. Interestingly, many patients do not know what they did to cause these fractures so only 25-30% actually go to doctors and have this positively diagnosed (by x-ray). Treatment varies depending on what the percentage of fracture occurred (a little vs. a lot), and in unstable cases, a procedure called kyphoplasty (where cement is injected into the collapsed vertebral body) may be appropriate. As chiropractors, we can help this population by offering nutritional counseling to improve bone density and often provide symptomatic relief with adjustments (low force types) and other modalities.

            We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for back pain, we would be honored to render our services.

The “Aging” Lower Back – Part 1

            Low back pain (LBP) can arise from many causes. Nearly everyone has or will suffer from LBP at some point in time, though it is most common in the 30-year-old to 50-year-old group and it affects men and women equally. However, what about the elderly population and low back pain? Let’s discuss back pain unique to the geriatric population...

            We’ve all heard of the “wear and tear” factor as it applies to clothing, automobiles, shoes, and tires, but it affects our bones and joints too! A condition that none of us can fully avoid is called osteoarthritis (OA). OA is the “wear and tear” factor on our joints, particularly the smooth covering called hyaline cartilage located on the surfaces of all moving joints. It’s the shiny, silky smooth surface that we’ve all seen at the end of a chicken leg when we separate it from the thigh. Osteoarthritis is the wearing away of that shiny, smooth surface and it can eventually progress to “bone-on-bone” contact where little to no movement is left in the affected joint. Bone spurs can also occur and be another potential generator of back pain. OA is NOT diagnosed by a blood or lab test but rather by an accurate history, physical examination, and ultimately, an x-ray. However, when the low back is affected by OA, it may not even hurt! Yes, in some cases, there may be a significant amount of OA on an x-ray and that patient may not have significant problems. Or the opposite can occur and some patients with very little arthritis can have a lot of back trouble. It’s FREQUENTLY very confusing. The “take-home” message with OA is that, in and of itself, it does not always generate pain. This is why the history, physical examination, and the response to treatment (chiropractic adjustments, exercise, and possibly some lifestyle changes in diet and activity) are MORE important than the amount of arthritis found on the x-rays. Ultimately, we will ALL get OA sooner or later. It’s usually a slow, gradual process that may slowly change our activity level. Ironically, KEEP MOVING is the best advice we can give to the patient with OA.

            There are a number of conditions associated with OA that affect the spine and respond well to chiropractic treatment. Degenerative disk disease (DDD) is one of those conditions found in association with OA. In fact, another name for OA is “degenerative joint disease” (DJD)! The normal anatomy of the intervertebral disk (IVD) consists of a thick, tough outer layer of fibroelastic cartilage and a central “nucleus” that is more liquid-like and allows the IVD to function like a shock absorber. As we age, the water content gradually “dries up” and the shock absorbing quality is lost.

            As chiropractors, we address OA (DJD) and DDD with a number of HIGHLY EFFECTIVE treatments but most important (in many cases) is the use of spinal manipulation or adjustments. “Exercising the joint” with manipulation and mobilization reduces the tightness and stiffness associated with OA and DDD. Exercises are also important and can give the OA/DDD patient a way of controlling this condition on their own. Diet, activity modification/encouragement, and periodic adjustments help a lot! Next month, we will continue this discussion!

            We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for back pain, we would be honored to render our services.

Low Back Manipulation – How Does it Work?

            Low back pain (LBP) is such a common problem that if you haven’t suffered from it yet, you probably will eventually. Here are a few facts to consider:  1) LBP affects men and women equally; 2) It is most common between ages 30-50; 3) Sedentary (non-active) lifestyles contribute a lot to causation; 4) Too much or too little exercise can result in LBP; 5) A BMI around 25 is “ideal” for weight management, which helps prevent LBP; 6) Causes of LBP include lifestyle (activity level), genetics – including, but not limited to, weight and osteoarthritis; 7) Occupation; 8) Exercise habits, and the list can go on and on. Let’s next look at how an adjustment is done.

            When spinal manipulation is performed in the low-back region, the patient is often placed in a side lying position with the upper leg flexed towards the chest and the bottom leg kept straight. The bottom shoulder is pulled forwards and the upper shoulder is rotated backwards at the same time the low back area receives that the manipulation is rotated forwards. This produces a twisting type of motion that is well within the normal range of joint motion. When the adjustment is made, a “high velocity” (or quick), “low amplitude” (a short distance of movement) thrust is delivered often resulting in “cavitation” (the crack or, release of gases). So, WHY do we do this?

            Most studies show that when there is back pain, there is inflammation. In fact, inflammation is found in most disease processes that occur both within and outside the musculoskeletal system. We know that when we control inflammation, pain usually subsides. That is why the use of “PRICE” (Protect, Rest, Ice, Compress, Elevate) works well for most muscle/joint painful conditions. We have also learned that IF we can avoid cortisone and non-steroidal drugs (like aspirin, ibuprofen, naproxen, etc.), tissues heal quicker and better, so these SHOULD BE AVOIDED! If you didn’t know that, check out:

http://www.benthamscience.com/open/torehj/articles/V006/1TOREHJ.pdf

           

            Please see our prior discussions on the use of anti-inflammatory herbs and diets that are MUCH safer than non-steroidal drugs! But what does spinal manipulation DO in reference to inflammation?

            Different things occur physiologically during a spinal adjustment or manipulation. We know that the mechanical receptors located in muscles, muscle tendons, ligaments, and joint capsules are stimulated and this results in muscle relaxation (reduced spasm or tightness), increased measurable range of motion, and a decrease in pain. A recent study also reported that inflammatory markers (CRP and interleukin-6) measured in a blood test, NORMALIZED after a series of nine chiropractic low back manipulations! So, NOT ONLY do spinal adjustments give immediate improvements in pain, flexibility, and muscle relaxation, they also REDUCE INFLAMMATION without the use of any pharmaceuticals!

            So, let’s review what manipulation does for your low back pain: 1) Pain reduction; 2) Improved flexibility – now you can put on your socks with less pain and strain; 3) Improved functions and activities of daily living like sitting more comfortably, getting in or out of your car, bending over to feed the cat, etc.; 4) Improved sleep quality; and 5) Faster healing time by actually reducing the inflammatory markers in the blood! If you have LBP, PLEASE don’t delay – make that appointment TODAY!

            We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for back pain, we would be honored to render our services.

Low Back “ON-THE-GO” Exercises (Part 2)

            Low back pain (LBP) is a reality in most of our lives at one point or another. It can range from being a “nag” to being totally disabling. Let’s look at some exercises for the low back that can be done from a STANDING position so that they can be: 1) Performed in public (without drawing too much attention) and 2) Repeated every one to two hours with the objective to AVOID LBP from gradually getting out of control (STOP the “vicious cycle” so LBP stays “self-managed”).

            RULES: 1) DON’T do any exercise that creates SHARP pain; 2) Stay within “reasonable” pain boundaries; 3) DO these multiple times a day WHEN you feel tight, stiff, sore (take 10-30 sec. every hour rather than 15 min. twice a day).

            STANDING LOW BACK EXERCISE OPTIONS:

1)      STANDING HAMSTRING / GROIN STRETCH: 1) Place your heel on a chair/bench. 2) Arch your low back until you feel a “draw” or pull in the back of the leg. 3) Bend your ankle towards you – feel the pull in your calf). 4) If needed, bend forwards or bend the support leg knee for additional stretch. 5) Hold for 3-10 seconds or until it feels loose. 6) ROTATE your body to the opposite side until you feel the pull in your groin and hold 3-10 sec. 7) Switch legs!

2)      STANDING BACK EXTENSIONS: 1) Place the backs of your hands on your low back. 2) Slowly arch the lower back over your hands – stop if you feel pinch/sharp pain. 3) Release the pressure and re-apply multiple times. 4) Hold for 3-10 seconds or, until it feels loose. 5) REVERSE and bend over to touch your toes and hold until you feel loose.

3)      STANDING HIP FLEXOR STRETCH: 1) Stand straddled with one leg behind the other. 2) Rotate your back leg hip forwards (try to line up the left with the right so the pelvis is square). 3) Tuck in your pelvis (flatten the curve in the low back). 4) Bend backwards until the pull in the groin increases. 5) Hold for 3-10 seconds or, until it feels “loose.” 6) REPEAT on the opposite side. 

            Remember, DO these MANY times a day (at least once every hour). We have many others as well (ask us)!

            We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for back pain, we would be honored to render our services.

Low Back “ON-THE-GO” Exercises (Part 1)

            Low back pain (LBP) is a reality in most of our lives at one point or another. It can range from being a “nag” to being totally disabling. Let’s look at some exercises for the low back that can be done from a SITTING position so that they can be: 1) Performed in public (without drawing too much attention) and 2) Repeated every one to two hours with the objective to AVOID LBP from gradually getting out of control (STOP the “vicious cycle” so LBP stays “self-managed”).

            RULES: 1) DON’T do any exercise that creates SHARP pain; 2) Stay within “reasonable” pain boundaries; 3) DO these multiple times a day WHEN you feel tight, stiff, sore (take 10-30 sec. every hour rather than 15 min. twice a day).

            SITTING LOW BACK EXERCISE OPTIONS:

1)      SITTING BEND OVERS: 1) Slowly bend forward from a seated position and attempt to reach the floor; 2) Spread the knees as needed to allow for a full range of motion; 3) Hold for 3-10 seconds or until it feels “loose.” 4) Do the opposite – sit and arch your low back as far back as is comfortable. Repeat frequently for short hold-times – make it “fit” your time limitations/schedule!

2)      SITTING HIP / BACK STRETCH: 1) Cross your leg; 2) Raise the knee to the opposite shoulder; 3) Arch the lower back until you feel an increase stretch in your buttocks; 4) Twist your trunk to the side the knee is raised; 5) Move your knee up/down and around to “feel” for the tightest “knots” and “work” them loose; 6) Modify by bending forward 7) REPEAT on the opposite side. 

3)      SITTING TRUNK ROTATIONS: 1) Slowly twist your shoulders and trunk to one side while keeping your knees straight; 2) Reach back and pull for additional stretch if comfortable; 3) Hold for 3-10 seconds or, until it feels “loose;” 4) REPEAT on the opposite side. 

            Remember, DO these MANY times a day (at least once every hour). We have many others as well (ask us)!

            We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for back pain, we would be honored to render our services.

Low Back Pain – Is it on the Rise?

            As stated last month, 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?

                                We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for back pain, we would be honored to render our services.

Low Back Pain: Surgery vs. Chiropractic?

            Low back pain (LBP) is the second most common cause of disability in the United States (US) and a very common reason for lost days at work with an estimated 149 million days of work lost per year. The total cost associated with this is astronomical at between $100-200 billion/yr, of which 2/3rds are due to decreased wages and productivity. More than 80% of the population will have an episode of LBP at some point in their lifetime. The good news is that 95% recover within two to three months of onset. However, some never recover which leads to chronic LBP (LBP > 3 months), and 20-44% will have a recurrence of LBP within one year with lifetime recurrences of up to 85%! What this means is that most of us have, have had, or will have LBP, and we’ll get it again! So the question is, what are we going to do about it?

            Surgery has traditionally been considered a “last resort” with less invasive approaches recommended first. Chiropractic adjustments and management strategies have traditionally faired very well when compared to other non-surgical methods like physical therapy, acupuncture, and massage therapy. But, is there evidence that by receiving chiropractic treatment, low back surgery can be avoided? Let’s take a look!

            A recent study was designed to determine whether or not we could predict those who would require low back surgery within three years of a job-related back injury. This is a very important study as back injuries are the most common occupational injury in the US, and few studies have investigated what, if any, early predictors of future spine surgery after work-related injury exist. The study reviewed cases of 1,885 Washington state workers, of which 174 or 9.2% had low back surgery within three years. The initial predictors of surgery included high disability scores on questionnaires, greater injury severity, and seeing a surgeon as the first provider after the injury. Reduced odds of having surgery included: 1) <35 2="" 3="" 4="" a="" and="" b="" chiropractor.="" females="" first="" hispanics="" old="" saw="" those="" who="" years="">Approximately 43% of workers who first saw a surgeon had surgery compared to ONLY 1.5% of those who first saw a chiropractor! WOW!!!

This study supports the FACT that IF a low back injured worker first sees a chiropractor vs. a surgeon, the likelihood of needing surgery in the three years after the injury would be DRAMATICALLY reduced! In fact, the strongest predictor of whether an injured worker would undergo surgery was found to be related to who they saw first after the injury: a surgeon or a chiropractor.

           

If this isn’t enough evidence, another recent study (University of British Columbia) looked at the safety of spine surgery and reported that (taken from a group of 942 LBP surgical patients): 1) 87% had at least one documented complication; 2) 39% of the 87% had to stay longer in the hospital as a result; 3) 10.5% had a complication during the surgery; 4) 73.5% had a post-surgical complication (which included: 8% delirium, 7% pneumonia, 5% nerve pain, 4.5% had difficulty swallowing, 3% nerve deterioration, 13.5% wound complication); 5) 14 people died as a surgical complication. Another study showed lower annual healthcare costs for those receiving chiropractic vs. those who did not. The “take-home” message is clear: TRY CHIROPRACTIC FIRST!!!

            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 both presently and in the future.