Back Pain

The British Medical Journal reports that a three-year study proves what most chiropractic patients already know. Chiropractic care is more effective with higher patient satisfaction than outpatient medical care for these types of problems. The study reported involved 741 men and women with low back pain. A 3 year follow up showed that there was 29% higher improvement in those receiving chiropractic care over those receiving out-patient medical care. In addition more of the patients rated chiropractic more helpful than the hospital management. The conclusion of the study was that those seen by chiropractors derive more benefits and long-term satisfaction than those treated by hospitals.

A study published in the June 2010 issue of The Journal of the American Board of Family Medicine, showed that people who used what the study called “Complementary and alternative medicine (CAM)” received a “great deal” of benefit. Chiropractic was included in what this medical study defined as CAM care.

The study received attention in a number of news stories including an article in the July 4, 2010 Medical News Today, and in a June 30, 2010 Business Wire release by the Foundation for Chiropractic Progress. The study surveyed people who had suffered from back pain and had used at least one CAM therapy in the last 12 months. Of these participants the results showed that over 60% found remarkable relief using the top six CAM treatments. Those treatments were chiropractic care, massage, yoga/tai chi/qi Cong, acupuncture, herbal therapies, and relaxation techniques – with chiropractic care being the most popular choice.

The Medical News Today story reported that back pain is the second leading reason people walk into a doctor’s office in the U.S. The survey looked at a total of 17 CAM therapies choices. Of those, Chiropractic care was the most popular approach at 74 percent, with massage a distant second at 22 percent.

Dr. Gerard Clum, Foundation for Chiropractic Progress spokesperson and president of Life Chiropractic College West noted, “What we are seeing with these studies is compelling evidence that there is a light at the end of the tunnel for back pain sufferers more and more, that light is chiropractic care and other CAM approaches.”

One of the interesting findings of the study was that an overwhelming number of the people in the survey did not go to a CAM practitioner because of a referral from a medical doctor. In fact only 24 percent of respondents with back pain who received CAM stated that care came at the suggestion of their conventional medical practitioner.

In their study conclusion, the authors of the study stated, “CAM is used by 40% to 60% of the population yearly, and back pain is the most common medical condition for which people use CAM. Using a nationally representative survey, our analyses documented that the majority of respondents who used CAM for back pain perceived great benefit and identified specific factors associated with perceived benefit.”

In the Foundation for Chiropractic Progress release on the study Dr. Clum summed up the study by stating, “Back pain sufferers should be made aware of all treatment options, especially alternatives that have been scientifically proven to provide relief. While chiropractic care has in the past been considered alternative there is now a case to be made for making it the first choice for patients and in the process making interventions like injections and surgery the alternative approach.”

A documented case study published in the July 4, 2006 issue of the Australian research journal, Chiropractic & Osteopathy, follows the recovery of a fighter pilot who was helped to get back in the air with chiropractic care. In this case a 36-year-old male USMC F/A-18 aviator instructor with 15 years of flying experience had experienced a severe episode of acute lower back pain. He did note a history of lower back pain but did not recall any specific traumatic incident that initiated this pain episode.

When this problem hit he immediately went to his squadron flight surgeon, who prescribed pain medications and confined him to quarters, thus grounding him from flight. The pain got worse thus landing him in the hospital the next day where he remained for 24 hours. After his hospital stay he was confined to quarters for 72 hours and then cleared to fly but sent for consultation to neurosurgery and physical therapy.

As a result of these consultations and examinations the pilot was given anti-inflammatory medication, physical therapy, acupuncture, osteopathic treatment and exercise. The patient experienced some relief but was still in significant pain. He was finally referred to a chiropractor for evaluation.

By this point the pilot had been suffering with his pain for 4 months which he described as an intense spasm in his lower back. He reported his pain was consistently worse in the morning and that it would take him up to 10 minutes to get out of bed due to the stiffness and pain. He had to discontinue his regular Marine Corps fitness training, and he reported that it would take as long as 15 minutes to get out of the jet and climb to the ground after flying. On many occasions he had himself removed from flight duty due to the pain.

By the 5th visit to the chiropractor the patient reported that there was no longer any sharp muscle spasm. He still did experience some stiffness but he was able to return to regular flying status and he had discontinued taking any medications. The patient had 15 chiropractic office visits where he received care over a 26 week period and continued to show improvement.

The case study notes that at a follow-up visit 1 month after his last chiropractic visit he was pain free and had full function. He was flying multiple training missions per week including high G flights and sorties of several hours in duration and had passed his required physical fitness test the prior week with no pain.

In the October 8, 2002 issue of the online magazine “The Beacon Journal” at Ohio.com, appears a story with the simple headline, “Adjusting baby”. The story talks about pregnant women’s success in going to chiropractors as part of their care. The article states that many women who go to chiropractors during pregnancy do so for back pain related issues. The misconception is that we treat pain,’ says Dr. Joseph Medina, an Ohio chiropractor. “My job in health care is to find pressure that’s in the spinal column and take it off. When I do that, back pain tends to clear up.”

Additionally, the article highlights that more women are going to chiropractors for a procedure known as the Webster technique. This technique is specifically intended to help women who have a breech pregnancy when the baby should be positioned with the head downward. Dr. Jeanne Ohm, a chiropractor from Philadelphia and executive coordinator and instructor for the International Chiropractic Pediatric Association, described the Webster technique this way: “It’s a specific chiropractic adjustment that removes interferences of the nervous system, balances out pelvic muscles and ligaments, which in turn removes constraint to the woman’s uterus and allows the baby to get into the best possible position for birth.”

The article ended with a response from the patient who originally went to the chiropractor for the pain she was experiencing. Her comments about her results were, “In the morning, my back would hurt so bad it would be hard to walk,” she stated. “Now it’s not bad at all. I really think it’s helping.”

From the Journal of Manipulative and Physiological Therapeutics (JMPT) comes a case study of a 35-year-old woman with cauda equina syndrome helped by chiropractic care. The case study was published in the November-December 2004 Issue of the peer-reviewed research periodical.

In this evidence-based case report, the woman presented with complaints of midback pain, low-back pain, buttock pain, saddle anesthesia, and bladder and bowel incontinence, for a period of 6 months. She had undergone emergency surgery for acute cauda equina syndrome due to lumbar disc herniation, six months earlier. The cauda equina (CE) is formed by nerve roots at the end of the spinal cord inside the spinal column. Cauda equina syndrome (CES) is when there is low back pain, unilateral or usually bilateral sciatica, sensory disturbances, bladder and bowel dysfunction, and variable lower extremity motor and sensory loss.

The patient eventually began chiropractic care and received a series of adjustments. After only 4 adjustments, the patient reported full resolution of midback, low back, and buttock pain. After an additional 4 visits the patient had not yet seen improvement in her neurologic symptoms. However, even though this patient had received surgery, there were no adverse effects noted. This case study did not look at possible results beyond the initial 8 visits. The study noted that a review of previous studies showed that 2.3% to 12% of chiropractic patients have a history of at least one prior spinal surgery.

The conclusion of the published case study noted that this case appeared to be the first published case of chiropractic adjustments being used for a patient suffering from chronic cauda equina syndrome. It seems that this type of spinal adjustment was safe and effective for reducing back pain and had no effect on neurologic deficits in this case. They noted that rapid pain relief seen in this case is extremely unusual for patients with cauda equina syndrome. They therefore concluded that it was very likely that the adjustments contributed to the resolution of spinal pain in this patient

According to a report in the October 22, 2002 issue of the “Guardian Unlimited” from England, back pain among children is becoming a growing epidemic. Professor Peter Buckle, of the University of Surrey’s Robens centre for health ergonomics in Guildford England, as many as 40% of schoolchildren could be affected. He also noted a Danish study which showed that 51% of 13- to 16-year-olds had reported lower back pain in the previous year, as well as a study in the north-west of England which found 24% of 11 to 14-year-olds had complained of backache in the previous month.

In response the British Chiropractic Association (BCA), is recommending that parents bring their children in to see chiropractors. Dr. Stephen Hughes, a member of the BCA says, “It’s something I’m seriously worried about.” “The critical issue is that these youngsters are still growing, and they are already experiencing difficulties. The spine is incredibly resilient and usually it can put up with a lot of wear and tear over many years before it starts to actually hurt. When you’re getting real pain in a child that means there’s already going to be some considerable inflammation – so by the stage you see them it’s an established problem

The article blames several causes for the back problems in children. They mention the long hours sitting at desks, lack of physical exercise, carrying heavy loads of books and working at computers for long periods as some of the possible culprits. According to the article the suggested remedies for this situation include encouraging children to play sport outside of school as well as looking for opportunities for active family pursuits such as walking, cycling, swimming, and a chiropractic spinal checkup.

The Foundation for Chiropractic Progress issued a release published on May 6, 2009 in Earthtimes noting that according to a recent Consumer Reports study, consumers ranked chiropractic highest for relief of back pain. The release noted that Consumer Reports Health Rating Center surveyed over 14,000 people to determine their preferred method of care for back pain. Chiropractic came out the highest with 59% choosing chiropractic.

Gerard W. Clum, D.C., president of Life Chiropractic College West, Hayward, California, and spokesperson for the Foundation for Chiropractic Progress, commented, “Individuals who accessed care from a hands-on methods approach, such as chiropractic, expressed the highest satisfaction rates.” Dr. Clum continued, “These people sought relief, having suffered with back pain that undoubtedly interfered with their everyday activities and limited their daily routines, sleep patterns, work responsibilities, and efforts to maintain healthy weight. Chiropractic care provided the help they were looking for.”

The release notes that traditionally, people thought first about drugs or surgery for back ailments. This past misinformation created many problems. “Unfortunately, this lack of information can lead to costly and unnecessary interventions and diagnostic testing by physicians who take an ‘ideological approach’ to back pain,” says Dr. Clum. “It is wise to explore conservative options for pain management once a more serious condition has been ruled out.”

Dr. Clum noted the real value of a study that actually asks consumers their opinion. “The Consumer Reports survey is an example of end-user oriented research,” he says. “As more evidence emerges, we hope that physicians will start to shift from traditional treatment ideology to approaches to back pain that would offer more benefit to patients and avoid medication and surgery whenever and wherever possible.”

It is the hope of the Foundation for Chiropractic Progress and Dr. Clum that the previous medical mind-set will shift with this new information. Dr. Clum summed up his feelings by saying, “The traditional, often outdated approaches may lead to unnecessarily expensive and invasive treatment with undesirable results. It is clear that patients now recognize and appreciate the benefits of chiropractic care.”

A new poll from Canada points to snow shoveling as the leading cause of back and neck pain during the winter months. In the poll, 73 per cent of Ontario chiropractors surveyed say improper shoveling technique tops the list of reasons for winter back pain problems.

The story, reported in the January 9, 2003 Canadian News Wire, Quotes Dr. Dennis Mizel, President of the Ontario Chiropractic Association, who said, “Chiropractors are finding that some patients experience back and neck pain as a result of improper snow shoveling technique. Improper technique can be anything from bending at the waist instead of the knees to throwing snow instead of pushing it. When you combine improper technique with the average weight of one shovelful of snow (five to seven pounds) it becomes even more evident that this is a serious problem for both adults and the children who help them.”

Dr. Kristina Peterson, a chiropractor in Thunder Bay was also quoted in the article, “Back problems can surface in patients during the winter, especially those who are unaccustomed to participating in challenging physical activity on a regular basis. Activities requiring exertion that is higher than one’s daily routine such as winter sports or pushing stuck cars can cause back injuries. However, snow shoveling is the number one reason patients present with back pain in the winter.”

The Ontario Chiropractic Association offers the following preventive measures to help keep backs in shape:

Warm-up. Before beginning any snow removal, warm-up for five to ten minutes to get the joints moving and increase blood circulation. A good warm-up should include stretches for the back, shoulders, arms and legs. This will ensure that your body is ready for action.

Don’t let the snow pile up. Removing small amounts of snow on a frequent basis is less strenuous in the long run.

Pick the right shovel. Use a lightweight push-style shovel. If you use a metal shovel, spray it with Teflon first so snow won’t stick.

Push, don’t throw. Push the snow to one side and avoid throwing it as much as possible. If you have to throw, avoid twisting and turning – position yourself to throw straight at the snow pile.

Bend your knees. Use your knees, leg and arm muscles to do the pushing and lifting while keeping your back straight.

Take a break. If you feel tired or short of breath, stop and take a rest. Stop shoveling immediately if you feel chest or back pain.

A study published in the July / August 2004 peer-reviewed scientific journal, “Journal of Manipulative and Physiological Therapeutics”, compared the effects of chiropractic adjustments to muscle relaxants in a group of patients with subacute low back pain.

This study defined subacute low back pain as lower back pain (LBP) with a duration of 2 to 12 weeks. The study noted that in the United States the incidence of low back pain is as high as 75% to 85% of the population being affected at some time in their lives. On a yearly basis, the study noted that between 15% to 20% of the adult population can expect to experience LBP in any given year.

In the study, conducted at Life University in Georgia, 192 subjects with LBP from 2 to 6 weeks were separated into three groups. One group received Chiropractic adjustments with placebo medication. The second group received muscle relaxants with sham (fake) adjustments. The third group was a control group and received both placebo medication as well as the sham (fake) adjustments. Care was rendered to the group for a 4 week period with evaluations being done at the 2 week and 4 week marks.

Results were measured in terms of patient reported pain, severity, disability and depression, as well as measured flexibility and the patients self usage of over the counter acetaminophen (Tylenol). The results of this short study showed that for the two primary indicators of pain and severity, the chiropractic group did better than the other two groups. No significant differences were seen for disability, depression, flexibility, or acetaminophen usage across groups in a study of this short a period of time. All three groups showed improvement in the areas of depression, disability and drug usage.

The authors of the study did note that a longer study could have yielded more differences in recovery. However, in the area of pain, a primary patient concern in subacute LBP cases, the group that received the chiropractic adjustments faired the best. Their comments were: “Statistically, the chiropractic group responded significantly better than the control group with respect to a decrease in pain scores.”

The above is a direct quote from a headline that appeared in of all places, the November 17, 2005, Medical News Today. The article, also picked up by UPI news and several other sources, was reporting on a new study published in the October 2005 issue of the scientific journal, The Journal of Manipulative and Physiological Therapeutics (JMPT).

In this study 2780 patients with mechanical low-back pain referred themselves to 60 doctors of chiropractic and 111 medical doctors. These cases were reviewed for effectiveness of care and for costs. One of the articles noted that back pain care in the United States alone is estimated to reach $48 billion this year, and, at any given time, 80 percent of the U.S. population suffers from back pain.

The results of the study showed several interesting facts. With regards to the outcomes, the study showed that both the acute and chronic patients showed better outcomes in pain and disability reduction and higher satisfaction with their care after undergoing chiropractic care, as compared to medical care.

The costs of the care for the medical and chiropractic showed different results depending on the usage. Without adding the costs of any over-the-counter drugs, hospitalization, or surgical costs, when you simply compared the costs of in-office chiropractic to in-office medical care, the chiropractic care was slightly more expensive. If you then add in the additional costs for any referrals made by the chiropractor or the medical doctor, the chiropractic care costs for chronic patients were then 16 percent lower than medical care costs.

The authors of the study, noting that the satisfaction for the chiropractic care was higher, and the overall total costs were lower, made a concluding statement urging more chiropractic utilization in the health care system. They stated, “With their mission to increase value and respond to patient preferences, health care organizations and policy makers need to reevaluate the appropriateness of chiropractic as a treatment option for low-back pain.”