Low back pain (LBP) is VERY common condition, and research shows that up to 50% of the adult population in the United States will experience LBP in any three-month timeframe over the course of a year. Worse, low back pain can persist for months, years, and even longer, significantly reducing one’s ability to work, play, and enjoy life. So, let’s take a look at where LBP can come from…

ANATOMY: There are five lumbar vertebrae located just below the last rib and extending down to the sacrum. The FRONT of the vertebral column is made up of large box-shaped “vertebral bodies” that are strong and made to bear heavy weight. Between the vertebral bodies are shock-absorbing “intervertebral disks” that have a tough outer layer that surrounds a liquid-like center, giving it the ability to absorb vertical loaded pressure.

The spinal cord runs through the MIDDLE of the vertebra through the spinal canal. Nerves also exit the spine at each spinal level.

The BACK of the vertebra is made to protect the spinal cord. There are two gliding joints on the either side (called facet joints) of the vertebrae, which allow us to bend sideways, backwards, forward, or a combination of movements.

Below the lumbar spine sits the sacrum. The sacrum is wedged between the left and right wings of the pelvis, the ilia, forming the sacroiliac joint (SIJ). For many years, anatomists didn’t believe the SIJ could move and thus, could not be a pain generator. More recent research has concluded that not only is there movement in the SIJ but it may be the primary pain generator in up to 30% of lower back pain cases.

CASE STUDIES: Each of the above anatomical structures can be potential causes of LBP, and the presenting patient’s symptoms and clinical signs can help a doctor of chiropractic figure out what’s going on. For example, when a patient states, “My back kills me and the pain shoots down my leg when I bend over and feels better when I bend backwards and leg pain disappears,” this is most often caused by a herniated disk pinching a nerve in the low back.

In the above case, it’s important to examine the nerves that run down the leg, as the nerve can become damaged if too much pressure is exerted on the nerve for too long. Here, your doctor will ask you to walk on your toes and heels, check your reflexes at your knee and heel, and test your ability to feel sensations on the skin. If any of these tests reveal loss of function, the first goal of care will be to remove the pinch on the nerve to restore leg feeling and strength.

On the other hand, when a patient feels better bending over and worse bending backwards, the facet joints and/or the SIJ may be the culprit.

 

DIGESTION: Prolonged sitting is bad enough all by itself, but adding a slouched, slumped posture can distort or compromise the space that houses internal organs and negatively affect MANY vital functions, including digestion. This can lead to complaints including (but not limited to) discomfort, constipation, and heart burn.

BREATHING: Slouching can also reduce the space occupied by the lungs, hindering the ability to take in a deep breath and/or force air out of the lungs. This is the reason why good conductors have their musicians sit up straight with both feet on the floor (it’s not just to “look good”)!

MOOD: Did you know that sitting for seven or more hours per day increases the risk of depression by 47% compared with sitting for four hours a day or less? Our energy levels also decrease with prolonged poor posture, further complicating this negative side effect.

WORK PERFORMANCE: Researchers have observed that sitting up straight increases alertness, reduces fatigue, and improves productivity. Moreover, co-workers may conclude that someone slumped over their desk is unmotivated, disinterested, or at the least, tired. Sit/stand workstations are gaining popularity, especially with the availability of low-cost options to transform a traditional desk into a standing desk. Studies show improved work performance when we have the option to change positions as needed during the day. Exercises you can perform at your desk, such as chin retractions, help strengthen the deep neck flexor muscles, which can help reduce poor neck posture. Stretching the chest muscles and keeping the “core” fit with pelvic stabilization exercises are also GREAT methods to improve our sitting posture!

VARICOSE VEINS: Prolonged sitting raises the risk for the formation of spider veins, especially in women, which can lead to varicose veins. Compression from sitting alters the flow of blood into the legs, and a proper fitting chair and sitting “correctly” can reduce the risk of developing circulatory dysfunction leading to varicosities or worse, blood clots.

Low back pain (LBP) is a very common problem that many, if not most of us, have had at some point in life. In fact, about 80% of adults experience LBP in their lifetime, and it’s the leading cause of job-related disability and missed work days. According to the National Institutes of Health, more than 25% of adults have had a recent episode of LBP.

Men and women are equally affected by LBP, which can occur abruptly following a specific incident (such as over lifting), or it can develop slowly over time due to wear and tear. Studies show a sedentary lifestyle during the week can set the stage for developing LBP, especially when it’s followed by strenuous weekend workouts.

Although about 80% of acute LBP (lasting a few days to weeks) resolves with self-care or short-term management, about 20% of those with acute LBP will still have persistent symptoms after a year. So what can be done to manage chronic LBP and prevent disability?

One study looked specifically at maintenance spinal manipulative therapy (SMT) to determine its effectiveness in managing chronic LBP, which they defined as LBP that persists for more than six months. Researchers randomly assigned sixty patients to receive either 1) 12 treatments of sham SMT for one month; 2) 12 treatments of SMT for one month but no treatment thereafter; or 3) 12 treatments for one month followed by SMT twice a month for the following nine months.

The research team found that groups two and three experienced significantly lower pain and disability scores than the sham treatment group at the end of the first month. However, only the third group experienced more improvement in regards to pain and disability at the ten-month evaluation. In the absence of continued SMT, the second group’s pain and disability scores returned back to near pre-treatment scores. The authors concluded that SMT is effective for chronic nonspecific LBP, but to obtain long-term benefit, patients should continue to receive care on an ongoing basis.

 

Around the world, low back pain (LBP) is a leading cause of disability and ranks sixth in terms of “overall disease burden.” Chronic low back pain (cLBP) has a profound socioeconomic impact on individuals, families, and communities—so much so that the World Health Organization has identified LBP as a major disabling condition.

Older people tend to have greater physical disability caused by LBP compared with younger individuals, and old age is often associated with non-recovery and poor outcomes. One study found that more than a quarter of older people in the United States had cLBP upon entering retirement and that baby-boomers (those born between 1946 and 1964) account for 51% of all costs (over $10 billion) associated with cLBP.

So the question of the month is: how safe and effective is chiropractic care for older patients with cLBP? To help answer this question, researchers searched multiple sources for studies that included patients over 55 years of age with cLBP (more than three months of LBP), that utilized some form of manual therapy, that included tools that measured pain and disability, and that utilized a randomized control trial design. Researchers excluded data from experiments in which subjects had prior back surgeries, had pelvis-only pain (e.g. tail bone pain), or had received only a single treatment without follow-up.

Though only four studies met these stringent criteria, the authors did conclude that manual therapies, which include spinal manipulation delivered by doctors of chiropractic, can improve pain and function in older patients with chronic low back pain with very few adverse side effects.

This study supports the benefits of chiropractic care for the aging population and emphasizes the need for effective treatment options for cLBP with a low risk for serious adverse effects. With the size of the senior population expected to double over the next several decades, Chiropractic care will surely continue to play an important role in improving the quality of life of the elderly.

 

For most of us, neck pain has reared its ugly head more than once. In fact, there are estimates that anywhere from one-in-ten to one-in-five people will experience an episode of neck pain in a given year. Though some studies report that between 33% and 65% of these people will recover within twelve months, many individuals will experience either a relapse of their neck pain or their neck pain will become a chronic health issue.

So what can a doctor of chiropractic do about it? The answer is simple: spinal manipulation (SM) and exercise. Spinal manipulation is the most common form of treatment delivered in a chiropractic setting, and many studies note that neck pain is the second most common reason patients seek chiropractic care (back pain is number one). Regarding exercise, patients may be advised to engage in stretching exercise, strengthening exercises, or both.

For example, after an hour of seated computer work, one might experience muscle fatigue from prolonged static postures, especially for those outside of a neutral position. For this scenario, here’s a great STRETCH option to do every 30-60 minutes (yes, SET A TIMER): 1) Tuck the chin (and keep it tucked); 2) reach with the right hand over the top of the head and gently pull the right ear toward the shoulder while the left hand reaches down to the floor (as if to pick up a dollar bill); 3) next, nod the head (as if gesturing “yes”) multiple times; 4) follow this by shaking the head left to right (as if gesturing “no”); 5) repeat steps one through four with the head/neck flexed forward and backwards, “searching” for the tightest spots and “work” them until they loosen up. Repeat on the opposite side.

Here is an exercise to STREGTHEN the neck muscles. 1) Tuck in the chin while looking straight ahead; 2) place the back of your second and third fingers under your chin and nod (up/down) against mild resistance; 3) repeat five to ten times SLOWLY; 4)  repeat steps one through three with head/neck flexed forward and then again backwards (looking towards the ceiling). Repeat multiple times each day.

The KEY is to set the timer to remind you to do these! If you have significant forward head carriage and rounded shoulders, your doctor of chiropractic can show you addition important exercises, but this will be a great start for you to gain control over that chronic, recurring neck pain that you’ve been putting up with for far too long!