Many patients with chronic back pain wonder how to keep the pain from becoming worse or returning. Research suggests that exercise may be the best way to prevent back pain.
The recent literature review involved an analysis of 20 studies testing various methods of preventing back pain such as exercise, stress management, ergonomic education, training in ergonomic lifting methods, lumbar-support back belts, shoe inserts, and programs to reduce lifting frequency at work. The authors of the review analyzed and compared the outcomes of each treatment.
Of the treatments analyzed, only exercise was shown to consistently produce substantial relief of back pain. Most of the exercise studies focused on methods of strengthening the abdominal and back muscles. Of the studies involving exercise intervention, 7 of 8 scientific studies concluded that exercise resulted in a statistically significant improvement in back pain. In one study, patients who exercised had 127 fewer sick days than those who were inactive.
Exercise is crucial component of chiropractic treatment. A doctor of chiropractic can show you how to perform safe exercises for reducing back pain.
Bigos S, Holland J, Holland C, Webster J, Battie, Malmgren J. High-quality controlled trials on preventing episodes of back problems: systematic literature review in working-age adults. The Spine Journal 2009; 9: 147-168.
Growing Confusion About Vitamins
More than half of Americans report taking dietary supplements or multivitamins. Several recent studies have raised new questions about vitamins, and new information has added to the confusion surrounding which vitamins are best to take. Some recent news headlines have claimed that vitamin D helps fight tuberculosis, calcium may not improve outcomes for pregnant women, and vitamin E does not prevent cancer, but may slightly elevate the risk of prostate cancer. This confusing information has led many people to question which nutritional supplements they should start, continue, or stop using.
The varying information resulting from recent research serves to remind us that vitamins are complex. Many supplements can be beneficial, but others need more research to understand their full impact. However, there are some guidelines that can help you decide which supplements you should be taking.
Guidelines For Selecting Vitamins
Not all supplements are of equal quality. There are low-grade, low-priced supplements that are not as soluble, making it more difficult for the body to absorb the nutrients. If you're taking vitamins, make sure they are high quality so that you can reap the full benefits they offer.
Eat Healthy Foods
Among doctors, there is a consensus that eating healthy food is the best way to receive vitamins. However, many people eat a diet of primarily processed foods, which often lack the same nutritional benefits. Taking a vitamin may seem like an easy solution, but in fact the ways that nutrients interact within food can't always be replicated in pill form. While taking dietary supplements is a good way to enhance an already healthy diet or make up for a specific vitamin deficiency, it should not be seen as an alternative to eating healthy foods packed with vitamins and minerals.
Everyone Is Different
Every person's vitamin needs are unique. What supplements are right for you depend on many factors, including age, diet, sex, and current nutritional deficiencies. Your doctor can help you determine which supplements you should consider taking. Many chiropractors are also trained nutritionists who can advise you in selecting the right vitamins for your needs.
In an article written to educate the public about back pain, the Journal of the American Medical Association (JAMA) has suggested that patients seek chiropractic and other conservative back-pain treatment before taking more invasive measures.
The article says that surgery is not usually needed for treating back pain and should only be considered when other conservative methods fail.
This recommendation reinforces what the American Chiropractic Association (ACA) teaches patients, as well. Chiropractic should be the first line of defense against musculoskeletal pain.
The article has been published online on the JAMA patient page titled "Low Back Pain," and discusses the causes, symptoms, diagnosis, treatment options, and prevention of low-back pain. The doctors who wrote the article go on to explain that the back is comprised of bones, nerves, muscles, and soft tissues like ligaments and tendons. Back pain can be a result of problems with any of these structures.
Because chiropractors are neuro-musculoskeletal experts, they are well equipped to manage and prevent low-back pain.
In an interview about the JAMA article, ACA President Keith Overland, DC, said that he and his colleagues at ACA were encouraged to see chiropractic suggested for back-pain treatment. He confirmed that in many cases, back pain can be alleviated without the use of drugs or surgery, "so it makes sense to exhaust conservative options first."
And chiropractic makes sense for reducing health-care costs as well. Dr. Overland went on to say, "Research confirms that the services provided by chiropractic physicians are not only clinically effective but also cost-effective, so taking a more conservative approach at the onset of low back pain can also potentially save both patients and the health care system money down the line."
If you have low-back pain, follow the advice of these reputable medical communities. See a chiropractor first.
American Chiropractic Association. JAMA suggests chiropractic for low back pain. Businesswire May 8, 2013. businesswire.com.
Goodman D, Burke A, Livingston E. Low back pain. JAMA Patient Page April 24, 2013; 309(16): 1738. doi:10.1001/jama.2013.3046.
Carrying Kids Increases Risk
Mothers may have an increased risk of back pain from carrying children. In a new small study, 64% of mothers reported pain in the lower back.
Studying Mothers Lifting Children
Researchers from New Zealand asked 25 mothers aged 28-40 years to rate their pain levels as they performed routine tasks. They also observed mothers as they lifted children in various ways.
Several factors were found to increase low-back pain risk including the child's weight, the mother's grip, reaching above the shoulder or below the mid-thigh, tight space constraints, and combining rotation and side-bending with lifting children.
Another new study of female health-care workers suggests that lifting with an upright position and avoiding heavy loads could reduce back-pain risk. Just as proper posture and lighter loads assisted health-care workers frequently lifting patients, these techniques could also help mothers carrying kids on a daily basis.
More research is needed to learn whether teaching mothers safe lifting practices could decrease their likelihood of developing back pain.
Vincent R and Hocking C. Factors that might give rise to musculoskeletal disorders when mothers lift children in the home. Physiother Res Int 2012; doi:10.1002/pri.1530.
Chiropractic care has successfully relieved patients of spinal pain for over a hundred years, and a new study shows that chiropractic is not only effective, it's safe.
Earlier research has examined the safety of chiropractic, but no studies had used sham or placebo interventions to assess the relative safety of chiropractic.
Researchers from Australia sought to fill that gap in knowledge by analyzing the likelihood that patients experienced adverse events after chiropractic care compared to sham interventions. The study involved 183 patients with spinal pain who were randomly selected to receive either real chiropractic care or sham interventions. Patients were then asked to complete questionnaires regarding any side effects they may have experienced immediately after treatment, after 24 hours, and after 2 days or more post-treatment.
The majority of patients did not experience any adverse events, regardless of whether or not they were treated with chiropractic or sham interventions. A minority of patients had mild side effects like muscle stiffness or headache that typically resolved itself within 24 hours post-treatment. The researchers could not detect any major differences in the risk of adverse events between sham and chiropractic treatments. No patients experienced any serious side effects.
The authors pointed out their study was underpowered by 20%, which likely influenced their ability to detect differences between the groups. However, they noted their results were consistent with earlier research showing that any side effects associated with chiropractic are typically mild, temporary, and benign.
This study demonstrates that chiropractic care is a safe, non-invasive way to relieve spinal pain and improve your health. Previous studies have also demonstrated that chiropractic is safe for children, older adults, and pregnant women.
Walker BF, et al. Outcomes of Usual Chiropractic; Harm (OUCH). A randomised controlled trial. Spine 2013; DOI: 10.1097/BRS.0b013e31829fefe4.
A panel of experts recently collaborated in a study which analyzed orders for MRI scans in two large hospitals. They found that more than half the cases in which a lumbar spine MRI scan were done should not have been ordered in the first place. The panel deemed 29% of the MRI referrals inappropriate, and another 27% of "uncertain value".
It was also discovered that family physicians were the biggest culprits in ordering unnecessary low-back MRI scans. Only 34% of family doctors' orders were considered appropriate, compared to 58% of orders by physicians of other specialties.
The research team, lead by Dr. Derek Emery, wrote, "Eliminating inappropriate scans and some uncertain value could reduce the harm that accrues from unneeded investigations and result in significant cost savings."
The use of lumbar spine scans has risen drastically, even though there is a weak correlation between their findings and clinical signs and symptoms. The study noted the possible reasons for their overuse, including patient expectations, doctors' concerns about litigation, and lack of physician accountability in regards to cost. The expert panel recommended strict guidelines for doctors and better patient education.
The only orders where the MRI scans were routinely deemed appropriate was in cases of post-operative leg or back pain. However, these accounted for only 17% of the low back MRI orders.
The findings of the study confirmed what many doctors already understand about MRI overuse. Imaging for low-back pain is one of the top five overused tests and treatments listed by both the American Academy of Family Physicians and the American College of Physicians.
Other studies have pointed out overuse of MRI for other patient conditions, including headache and sciatica.
Emery D, et al. Overuse of magnetic resonance imaging. JAMA Internal Medicine 2013; online first 25 March: doi 10.1001/jamainternmed.2013.3804.
More Than Fun & Games
Jumping rope may be more than a fun recess activity for kids; it could stave off osteoarthritis later in life. Children with diabetes who regularly did jump rope or other weight-bearing activities had improved bone mineral density in a new study. Having a high bone mineral density is believed to be protective against osteoarthritis. The study points to important preventative measures for diabetic and healthy children alike.
Improved Bone Mineral Density
Researchers measured the bone mineral density of 27 children with type 1 diabetes and 3 healthy children. After 9 months, children who participated in two 90 sessions a week of weight-bearing physical activities significantly improved their bone mineral density. These changes weren't observed in children who did not engage in weight-bearing activities.
The study echoes the results of another recent study involving young men participating in loading sports. Young men who performed at least 4 hours a week of basketball, volleyball, soccer or other loading activities had increased volumetric bone density. Participants not involved in loading sports did not experience the same benefits.
Not Just for Kids
You don't have to be young to benefit from weight-bearing activities. Older adults can could also reduce their risk of osteoarthritis with resistance training and loading sports.
Taking vitamin D supplements is another way for older adults to improve bone health.
Maggio AB, Rizzoli RR, Marchand LM, et al. Physical activity increases bone mineral density in children with type 1 diabetes. Med Sci Sports Exerc 2012;44:1206-1211.
Nilsson M, Ohlsson C, Odén A, Mellström D, and Lorentzon M. Increased physical activity is associated with enhanced development of peak bone mass in men: a five-year longitudinal study. Journal of Bone and Mineral Research 2012; 27 (5): 1206–1214.
Chiropractic Speeds Recovery from Sciatica
Most Disabling Low Back Pain
Many people with sciatica find the pain to be so debilitating that they are forced to miss work and social gatherings. Among patients with lower back pain, those with sciatica experience the highest level of disability. According to public health records in Norway, patients with sciatica are disabled for an average of 72 days a year.
Study Finds Chiropractic Speeds Recovery
A recent study offers hope to patients suffering from sciatica pain. The new research suggests that chiropractic treatments may speed sciatica recovery, enabling patients to return to work faster. The researchers evaluated 44 Norwegian workers who had visited the hospital with severe sciatic pain. Most of the participants had been experiencing pain for at least three weeks before visiting the hospital.
In the hospital, a chiropractor evaluated each patient's posture, gait, range of motion, and palpation of the lumbar spine. The chiropractor then performed joint adjustments to the spine, in addition to other joints that had been injured as patients compensated for the pain. Soft tissue soreness was relieved with ice treatment. Patients received daily treatments while in the hospital, and then three times a week for a period of two weeks. Some patients also underwent additional follow-up treatments, but most did not receive more than 14 treatments.
91% of patients had returned to work full-time"
Within 21 days, 91% of patients had returned to work full-time. An additional 2 patients were back at work part-time. The researchers concluded that the study demonstrates the potential benefit of chiropractic care for sciatica patients.
Arana E, Marti-Bonmati L, Vega M, et al. Relationship between low back pain, disability, MR imaging findings and health care provider. Skeletal Radiology 2006;35(9):641-7.
Orlin JR, Didriksen A. Results of chiropractic treatment of lumbopelvic fixation in 44 patients admitted to an orthopedic department. Journal of Manipulative and Physiological Therapeutics 2007;30:135-139.
Weight loss is known to have substantial health benefits. A new study has confirmed that patients who lose weight may experience substantially reduced back pain and sciatica.
Obese patients frequently report lower back pain and sciatica. Research shows that having a higher body mass index (BMI), a measure of obesity, may slow recovery from back pain and increase your risk of common sciatica causes such as lumbar disc degeneration. Decreased space between spinal discs, a potential result of obesity, can cause nerve impingement and sciatica pain.
The new study involved 30 morbidly obese participants who underwent weight-loss surgery. As they lost weight, the space between lumbar spinal discs increased, reducing pressure on the nerves. Patients reported a substantial reduction in lower back pain and radiating leg pain. Weight loss has also been shown to alleviate knee pain.
For patients who are concerned with the risks and costs of bariatric surgery, there are non-invasive weight loss methods available. A new literature review found that exercise and physical therapy may also reduce obese patients' back pain. Chiropractic care can also provide back-pain relief for overweight and obese patients.
1. Djurasovic M, Bratcher KR, Glassman S, et a. The Effect of Obesity on Clinical Outcomes After Lumbar Fusion. Spine 2008; 33(16): 1789-1792.
2. Baumgarten K, Walter C, and Watson E. The Effect of Obesity on Orthopaedic Conditions. South Dakota State Medical Association. http://www.sdsma.org/documents/Carlson.pdf.
3. Samartzis D, Karppinen J, Chan D, et al. The association of lumbar intervertebral disc degeneration on magnetic resonance imaging with body mass index in overweight and obese adults: A population-based study. Arthritis and Rheumatism 2012; 64(5): 1488-1496.
4. Lidar Z, Behrbalk E, Regev GJ, et al. Intervertebral Disc Height Changes after Weight Reduction in Morbid Obese Patients, its Effect on Life Quality, Radicular and Low Back Pain. Spine 2012. doi: 10.1097/BRS.0b013e31825fab16.
5. Atchison J and Vincent H. Obesity and low back pain: relationships and treatment. Pain Management 2012; 2(1): 79-86/(doi: 10.2217/pmt.11.64)
A new study from Egypt reports that chiropractic care can be an effective treatment strategy for fibromyalgia treatment with chiropractic care.
The study involved 120 people between the ages of 40 and 65 who had suffered with severe fibromyalgia for four years or more. Each person rated their pain as a 4 or higher on a pain scale and also had limited movement in their cervical (neck area) spine, specifically in their C1-C2 area.
All of the individuals participating in this study engaged in 12 weeks of therapy which included:
- An education program (one two-hour session per week) designed to provide the participant with more information about fibromyalgia and available treatment options;
- Cognitive behavioral therapy (one two-hour session per week) which involved discussion regarding pain management via relaxation exercises, challenging treatment-prohibitive beliefs about fibromyalgia, and positive reinforcement about what types of actions can be taken to ease fibromyalgia symptoms; and
- An exercise program (three one-hour sessions per week plus 20-minute session twice daily at home) which included relaxation techniques, as well as active and passive stretches.
One-half of the individuals were also randomly assigned to a treatment group, which meant that they also engaged in upper cervical chiropractic adjustments. This involved a high-velocity, low-amplitude thrust to the C1-2 motion segment three times per week for the first month. This was then reduced to once a week sessions for the remaining eight weeks.
At the beginning of the study, the conclusion of the study, and at one year post-study, each participant was asked to complete various questionnaires to help the researchers determine what effect, if any, the chiropractic had on easing fibromyalgia symptoms and reducing its impact on their lifestyle. Specifically, questions were asked regarding physical function abilities, work days missed due to fibromyalgia symptoms, sleep disturbances, level of pain, fatigue, depression, and anxiety.
The individuals who participated in the cervical chiropractic care group showed more improvement and better results than the control group who had no chiropractic intervention. This was validated by questionnaire scores that improved by 15 or more percent. The researchers concluded that adding chiropractic to your current fibromyalgia treatment regimen may offer even more benefits when it comes to getting to the root off the problem.
Moustafa IM, Diab AA. The addition of upper cervical manipulative therapy in the treatment of patients with fibromyalgia: a randomized controlled trial. Rheumatology International 2015;35(7):1163-1174.