Back Pain

A case report study published on November 21, 2011 in the Annals of Vertebral Subluxation Research documents the improvement of a person who was suffering with lower back pain and had a reversal of their neck curve.

The authors of the study start by noting that lower back pain is one of the most common conditions today with between six and twelve percent of the population suffering from this problem. They also report that medical care has not found a solution for this issue in spite of the fact that there has been a 629% increase in medical spending on lower back care.

The authors point out that chiropractic has consistently been shown to be effective in helping people with lower back pain. They also report that other studies have shown that abnormal curvatures of the spine have been linked to a variety of health related problems, including back pain. In this case the authors show a correlation between the two.

In this case a 41-year-old woman went to a chiropractor with lower back pain that she had been suffering from for two years. It had started when a chair she was sitting in gave way and she fell on her back. She had gone to multiple doctors including chiropractors and had not gotten relief. Her MRI showed problems with the vertebrae and discs in the lower back.

A motion x-ray (video fluoroscopy) was also done and showed abnormal spinal motion in both her lower back and her neck. X-rays also revealed a reversal of the neck, which should have a bending curve forward when viewed from the side on x-ray. Based on the x-rays and an examination, it was determined that spinal subluxations were present in her lower back and neck. A series of specific adjustments were initiated.

The case study reports that by the 11th visit the patient was completely pain free in her lower back and her leg, with only minimal pain still in her hip. After 6 weeks of care a follow-up set of x-rays were taken to monitor the progress. What was noticed was that the curve in the neck had gone from a reversal, to a normal curve during the course of care. This, coupled with the fact that the woman was feeling much better led the researchers to the conclusion that the neck was a large contributing factor in this persons lower back pain.

In their conclusion, the authors noted that the structure of a neck curvature can have a profound effect on lower back issues. They state, “Correcting the abnormal structure within the cervical spine can alleviate most symptoms associated with LBP.”

The above was the conclusion of a study published in the December 6, 2000 issue of the Journal of the American Medical Association, (JAMA). The report in JAMA started off by noting that usage of these devices is becoming more common. “Despite scientific uncertainties about effectiveness, wearing back belts in the hopes of preventing costly and disabling low back injury in employees is becoming common in the workplace.”

The study interviewed 9377 employees from 160 stores. Of those stores in the study, 89 required back-belt use and 71 had voluntary belt use. The study would then track the incidence rate of material-handling back injury workers compensation claims as well as a 6-month incidence rate of self-reported low back pain among the workers.

The conclusion of the study was clear. As explained by the JAMA article, “In the largest prospective cohort study of back belt use, adjusted for multiple individual risk factors, neither frequent back belt use nor a store policy that required belt use was associated with reduced incidence of back injury claims or low back pain.” In simpler terms, these belts do not work to prevent the problems for which they were designed.

Several articles in British news publications in October 2008 reported that a survey conducted by the British Chiropractic Association (BCA) showed that nearly one third of six to seven-year-olds complain of back pain. In the October 15, 2008 issue of the British publication the “Telegraph” and the October 17, 2008, Daily Express” the culprit for such a high rate of back problems in children is identified as lifestyle.

A combination of slumping in front of the TV, lazier lifestyles and heavy school bags are given the blame in these articles. The BCA reported that 45 per cent of children spent the majority of their time off playing computer games or watching TV, while 10% of eight and nine year olds said they didn’t do any sport at all. The BCA also noted that 72% of children said they carried around heavy books and sports equipment in their back packs, but only a third said they wore their back packs on both shoulders to distribute the weight evenly.

The articles report that according to the BCA, six years ago 29 percent off all 11 to 18-year-olds said they spent part of the day suffering back pain. Now they note that by age 11, as many as 45 percent of children have suffered some kind of back pain.

British Chiropractic Association spokesperson, Tim Hutchful, stated, “With children as young as six complaining from back pain, this survey clearly highlights the alarming rate at which back pain is growing within the UK.” He continued by adding a word of advice, “There are simple steps parents can take such as checking that children aren’t carrying around unnecessary items in their bags and encouraging them to use a rucksack worn correctly on both shoulders. But we are in no doubt that lack of exercise is children’s number one enemy.”

New research published in the May 28, 2005 British Medical Journal suggests that surgery to relieve chronic lower back pain is no better than intensive rehabilitation and nearly twice as expensive. The study did not look at the benefits of chiropractic care, but did compare patients who underwent surgery for lower back pain and those who had rehabilitation led by physiotherapists.

Dr. Jeremy Fairbank, an orthopedic surgeon and lead researcher at the Nuffield Orthopaedic Center in Oxford, England, along with his co-researchers studied 349 chronic back pain sufferers, defined as pain lasting more than 12 months. Of the 349 patients, 176 had spinal fusion surgery while the remainder underwent intensive rehabilitation involving exercises and cognitive behavioral therapy.

Dr. Fairbank stated, “This is strong evidence that intensive rehabilitation is a good thing to do for people with chronic back pain who are thinking about having operations.” The researchers concluded that there was no evidence that surgery was any better than the rehabilitation they compared the surgery to. However, there was a big difference in price with the surgical expense being nearly twice as expensive according to the study.

Helen Campbell of the University of Oxford summed up the results by commenting, “In the short term, compared with intensive rehabilitation, surgical stabilization of the spine as first line treatment for chronic low back pain patients who have already failed standard non-operative care seems not to be cost effective.”

The May 2001 issue of the Journal of Manipulative and Physiological Therapeutics (JMPT) carried a report of a study on the effect of chiropractic care on patients with recurrent or long lasting low back pain. Numerous studies over past years have shown that chiropractic care was beneficial for patients with acute and short term back pain. However, due to the difficulty of conducting a large study, research to show what thousands of chiropractors and their patients have known about help with long term back pain was scarce.

A total of 19 Norwegian chiropractors participated in this study. In all 158 patients were studied, all of whom fit the criteria of suffering from long lasting or reoccurring lower back pain for at least two weeks duration, with at least one previous occurrence in the previous 6 months. All subjects could not have had any chiropractic care in the prior 6 months to be eligible to participate in the study. Participants were questioned each visit to rate their progress as it relates to the pain.

The results showed that approximately 50% of patients reported that they had “improved” at the 4th visit. By the 12th visit, approximately 75% of the patients reported that “improvement” had occurred. The study only recorded data for the first 12 visits so no data on additional benefits after 12 visits was available. The researchers did conclude, “there seems to be a distinct recovery pattern among chiropractic patients with relatively long-lasting or recurrent lower back pain.”

A review of previous studies on the effectiveness of chiropractic for pregnant women with lower back pain was published in the July 2008 edition of the Journal of Manipulative and Physiological Therapeutics (JMPT). This study looked at previously published works on this subject to review the body of evidence for the effectiveness of chiropractic care.

The JMPT report starts off by noting that between 50% and 80% of pregnant women suffer from low back pain (LBP) during their pregnancy. They noted that a review of previous work showed that from 68% to 85% of pregnant women with back pain during pregnancy do not look for any care for their lower back pain. The authors theorize that this is because most pregnant women consider back pain to be a normal part of the pregnancy.

In reviewing all the scientific literature on the subject of chiropractic for low back pain in pregnancy, the authors of the JMPT review narrowed their selection down to 6 studies that met their specific criteria. The results of the various studies showed a high percentage of pregnant women did get relief from their lower back pain through chiropractic.

In one reviewed study 84% of the 25 subjects reported relief of their lower back pain. In a larger study of 103 patients who received chiropractic care during their pregnancy, all of the women reported greater than 50% decrease in back pain on a questionnaire. In yet another case series where 120 pregnant women with LBP underwent an average of 15 chiropractic treatments, the results showed that 25% had complete remission of their back pain, 50% reported feeling very well, 15% were feeling better, and 10% noted no change in condition.

Interestingly, none of the studies reviewed for the JMPT report indicated any adverse effects or evidence of harm to either the pregnant woman or unborn child from the chiropractic care. The authors of the JMPT report noted that there was a need for more comprehensive studies involving control groups, but they did note that all studies they included reported positive results for the subject under chiropractic care. They noted in their conclusion, “Results from the 6 included studies showed that chiropractic care is associated with improved outcome in pregnancy-related LBP.”

A case study published in the January 10, 2009 issue of the scientific periodical, the Journal of Vertebral Subluxation Research documented the recovery of a 58 year old man who was suffering from low back pain and left lateral leg pain and had lower back surgery that was unsuccessful in helping his problems.

The study starts off by noting that approximately 80% of adults will have low back pain at some time in their lives. The authors of the case study point out that, “Back pain is treated by surgical means and non surgical means and literature has shown that many low back surgeries are not successful.”

In this particular case a 58 year old man was reaching out for an item at work when he felt a “pop” in his back that resulted in pain radiating down the back of the right thigh and into the leg. He initially tried chiropractic care for an unspecified time with little initial results but then he elected to have spinal surgery, where he had a laminectomy of L5/S1. After his surgery the pain was worse and more extensive. This problem left him disabled and unable to return to work. His condition remained for 3 years before seeking chiropractic care for a second time.

A chiropractic examination and x-rays were performed and a diagnosis of “lumbar and pelvic segmental dysfunction (subluxation) with associated left lateral leg pain.” A regimen of specific chiropractic adjustments was initiated to correct the subluxations.

After about 5 weeks of chiropractic adjustments, the patient reported that his left leg pain had diminished significantly and the low back pain had diminished but was present more than the leg pain. This was an improvement as in the initial stages of care, the man reported that his leg pain was worse than the low back pain. After a total of 32 visits, the man reported that he had no leg pain and only complained of mild low back pain on one visit. He reported feeling much better since beginning chiropractic care and that chiropractic care had made a big difference in his life.

In the conclusion, the author stated, “Literature has shown that failed back surgery syndrome is a common problem, and that more patients are seeking chiropractic care for the solution to such a devastating condition. Chiropractic care can improve function and quality of life as it did in this patient.”

According to an April 11, 2008 release by the British Chiropractic Association (BCA) and reported on in the April 16, 2008 issue of the Guardian UK, Germany is the number one country for people complaining of back pain with a rate of 67 percent. The BCA reviewed the number of back pain cases by country and issued their “Euro Backpain Barometer” to highlight the results.

According to the BCA survey study, back pain in the United Kingdom is on the increase, rising by 5% in just 12 months, with 52% of the country currently suffering, compared to 47% in 2007. Overall, the study shows that cultural differences create back problems at different rates. The study showed the rate and order of back problem frequencies to be as follows:

Germany 67%

Italy 63%

UK 52%

France 50%

Finland 50%

Sweden 36%

Netherlands 26%

The reasons people blame as the cause of their pain varies from country to country with Italians blaming high heels, Germans blaming sitting in front of computers for long periods of time and in the UK pregnancy is a large identified reason.

The study also shows that many do not seek help for their back problems, with most suffering for 3 to 5 years. The BCA study notes that the Swedes are the longest suffering, with 78% claiming to have had back pain for three or more years. In Finland 11% of those with back pain have been suffering for as long as they remember and 23% of the British with back pain have been suffering for 10 or more years.

Tim Hutchful from The British Chiropractic Association comments: “Incidence of back pain is continuing to rise at an alarming rate in Britain and across Europe as a whole, and poor posture continues to be the main culprit. This study highlights what a detrimental effect back pain can have on people’s lives.”