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Back pain research - Common misconceptions on Back pain - Resting your back - What does a chiropractor do for back pain?

 

Chiropractic has never cured anyone of anything.

 

If we go looking for the named condition that Chiropractic can be applied to and produce change in we will find ourselves in a merry-go-round of symptoms, loosing sight of the whole because of an obsession with the parts. So the question of What can Chiropractic Cure should be changed to "How" can Chiropractic Assist? The answer is simple. A well functioning mind and body has a greater opportunity to heal, repair and function than a poorly functioning one. A well functioning mind and body depends to a significant degree on a well functioning spine and nerve system. This is Chiropractic's contribution.

 

People find that chiropractic's ability to produce better spine and nerve system function changes their life expression. There are thousands of symptoms and conditions that chiropractic has been associated with helping, however don't ask "Can Chiropractic Cure this or that condition" - instead ask "If my mind and body was functioning better through Chiropractic would I be better placed to handle this condition?"


Back Pain Research

"On the evidence, particularly the most scientifically valid clinical studies, spinal manipulation applied by chiropractors is shown to be more affective than alternative treatments for low back pain (LBP). Many medical therapies are of questionable validity or are clearly inadequate."

Manga P. PhD. Et al.The study to examine the effectiveness and cost-effectiveness of chiropractic management of low-back pain. Funded by The Ontario Ministry of Health. The Manga Report, August 1993.


"Those treated by chiropractic derived more short-term and long term benefit and satisfaction than those treated by hospital therapists."

Reinhold M. PhD, Et al. Chronic Spinal Pain: A randomized clinical trial comparing medication, acupuncture, and spinal manipulation. The Spine Journal, July 15, 2003; 28(14) 1490-1502


"There is no clinical or even case controlled study that demonstrates or even implies that chiropractic spinal manipulation is unsafe in the treatment of low back pain. Some medical are equally safe, but others are unsafe and generate iatrogenic complications for LBP patients. Our reading of the literature suggests that chiropractic manipulation is safer than medical management of low back pain."

Manga P. PhD. Et al. The study to examine the effectiveness and cost-effectiveness of chiropractic management of low-back pain. Funded by The Ontario Ministry of Health. The Manga Report, August 1993.


"Flexion distraction spinal mobilization is superior to a combined exercise program for pain in the short term and superior/similar in the long term."

Bronfort G. DC. PhD. Et al. Evidence informed management of chronic low back pain with spinal manipulation and mobilization. The Spine Journal 8:2008:213-225


"Patients with low-back pain (LBP) who undergo chiropractic care require significantly fewer office visits before their pain abates, compared with patients who receive physical therapy."

Chiropractic and Osteopathy- August 24, 2006;14;19


"There is moderate evidence that spinal manipulation and mobilization is superior to usual medical care and placebo for patient improvement."

Bronfort G. DC. PhD. Et al. Evidence informed management of chronic low back pain with spinal manipulation and mobilization. The Spine Journal 8:2008:213-225


"576 patients with low back pain - with or without leg pain- averaged 43 days to attain maximum improvement after an average of 19 chiropractic visits."

-OHU(JMPT 1984;7:1-11)


Back pain what is it?

Treating back pain has always been considered to be an enigma. Probably partly because the general understanding for how back is constructed and how it works is poor. The recommendations from a recent national report to investigate the increasing problem of back pain and how it was treated were that back pain sufferers should have treatment, not bed rest and pain killers. Chiropractic was one of the preferred treatments.


The success of any treatment depends on the mutual cooperation between patient and practitioner and this is particularly true in the treatment of back pain. A good starting point is to have a better understanding of the causes of back pain. This information sheet will start by clarifying some common misconceptions.


I think I have slipped a disc!

Fortunately discs do not slip out; they are firmly attached to the vertebrae above and below. The discs consist of layers of strong ligaments surrounding the centre or nucleus can rupture and press onto nerves if the ligaments have been damaged. This is called a disc hernitaion.


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The signs and symptoms are very characteristic and a qualified chiropractor can determine this by the physical examination. A disc herniation will improve with treatment but is a relatively serious injury compared to a sprain and therefore tends to take longer to improve. Some people who do not improve with treatment may require surgery to remove part of the herniated disc. Disc herniations are more common in people who had recurrent back injuries, which is a good reason to deal with the problem before it gets to that stage.


My back is out!

Again, fortunately, vertebrae do not slip out, nor are they pushed back in by manipulation, but dislocations do happen. It happened to Christopher reeves (superman) and he now is in a wheelchair paralysed. He had a so called fracture dislocation. This is a serious often resulting in damage to the spinal cord. So when you think your vertebra is out of place, it probably isn’t.


I have a trapped nerve!

A nerve can get compressed suddenly by a herniated disc or gradually by entrapment by bony spurs developing form wear and tear of the spine. Nerves do not simply get trapped and untrapped. If the nerve is compressed or injured the chiropractor can quite easily determine this by performing an examination. Nerve injuries are normally associated with a feeling of "pins and needles", numbness and radiating pain in one side, but you can have limb pain without the nerve being trapped. This is called referred pain.


I have back pain, I need rest!

Rest or activity? Rest is important in the early stages of an injury but not inactivity! Bed rest has been shown to prolong and worsen the recovery if used for more than three days. "Active rest" including simple walking is the best way forward. Later in the treatment other exercises specifically chosen for your condition can be started.


I need a hot water bottle!

Ice packs should be used if you have any inflammation in your back. The inflammatory process is started when there is tissue injury, damage to the ligaments, bone or muscle. You should not use heat over an area of inflammation; it may increase the heat and prolong the healing and pain.


Exercise

Exercise is important to prevent recurrent and chronic pain. Important muscle to build up to support the spine include: the deeper muscles which provide two thirds of the spine’s support; and the stomach muscles. The more superficial muscle produces movement rather than stability and is therefore not targeted in spinal rehabilitation exercise.


Heavy lifting and back pain

It is commonly believed that heavy lifting is the cause of back pain, but most people actually hurt themselves when performing relatively simple tasks that they done hundreds of times before. E.g. bending down to pick up an empty milk bottle, sneezing or coughing, turning in bed or getting out of the car. When you have back pain you realise how much every little movement affects your back. When we are about to lift something heavy we prepare ourselves and tense our muscles which help to protect our backs, but when we turn around just to speak to somebody we do not tense muscles. That is why we are more likely to hurt ourselves during such activities.


Posture

The way we sit, lie; stand or move can have a big impact on the health of our spine. Good posture cannot cure a bad back but it can help to prevent problems. Generally, static postures such as sitting are more detrimental than being mobile. Our bodies were made to move not to sit in front of a TV or a computer. Recently more importance has been given to the way we perform our daily tasks, so called movement patterns. By observing how you perform certain movements the chiropractor can tell if you have a muscle imbalance that is affecting your spine. The chiropractor can then teach you how to improve the way you move and how to use your muscles to support and protect your back, by giving specific exercises.


Pain and healing

Being pain free does not necessarily mean that there is not a problem with the back. Often, in initial stages, patients aren’t in any pain. Pain only develops if there is an injury, which is more likely to happen if there is a weakness. Back pain often becomes a recurrent problem from neglect. In the beginning the pain often goes within a week or so, but each time an injury occurs again, it takes longer to get over it until one day it does not go away. That is the time when most people seek treatment. At this stage a lot more effort and work is needed to restore the normal function. Gradually the pain subsides, but that doesn’t mean that normal function is restored. It can take as long as 6-12 months to restore normal function in a chronic sufferer.


Arthritis

Many people have been told that they have "arthritis" and nothing can be done for their backs. Osteoarthritis is "wear and tear" and is considered normal after a certain age. That does not mean that nothing can be done to help get rid of pain and dysfunction. Wear and tear is normally a sign of longstanding dysfunction or previous injuries. The majority of patients over the age of forty have some signs of osteoarthritis. There are of course other types of arthritis, so called inflammatory arthritis like rheumatoid arthritis and gout, but they are fortunately rare in comparison.



Resting Your Back


Modern society has led to an increase in back pain, as we put our spines under more and more stress.


During the day, especially if you have been working hard, sitting a lot, or have an aching back, is advisable to rest your spine by lying down on your back for about twenty minutes. There are a few important reasons why you should do this:


The discs between the vertebrae have a centeral jelly section that contains water. During the day, the spine is put under pressure, the discs lose this water, and the discs become thinner and stiffer. During the night, by lying down, the discs regain their height, and for this reason we are often taller in the morning than last thing at night.


Unfortunately, we put an enormous compression force on the spine and discs during the day, particularly by sitting and standing.


By lying down in a position where the compression forces in the discs are minimal, the discs can regain full height and flexibility.


By lying down correctly the large postural muscles of the back relax, helping to reduce any muscle spasm.


Often they are not able to relax properly (even when we lie down at night, die to stress, tension and poor sleeping positions).


Lying on the floor is best, giving good support to the spine. Lie on the bed if this is too sore, or getting up and down is too difficult. Place about 2-3 inches of soft books under your head (with a towel or cushion if painful). Keep your neck level, neither forced up, nor allowed to drop down. You should be able to swallow comfortably, but if in doubt opt for a little extra height.


Raise your legs in the air, either with the feet flat on the floor, or with the lower legs supported by a chair, sofa or cushions.


It is the lifting of the legs that allows for relaxation of the lower back muscles. Relax your arms by your sides, or with your hands resting on your abdomen.


Helpful hints

Try to find at least 20 minutes to lie down, to fully relax the muscles and replenish the discs. Don’t lie down however, for so long that you stiffen and seize up. After lying for about 2 minutes get up and walk about.


Whilst lying down try to keep your head resting on the books, and not to lift your head up (like watching the TV). This prevents both neck and lower back muscles from relaxing properly. Lifting arms up (I.e reading a book) also prevents proper muscle relaxation.


Once you are resting, please don’t undo all the good work by leaping up (especially to answer the phone). Roll over on to all fours and get up slowly. Don’t use your stomach muscles to get up by doing a "sit up", as this can often strain the lower back muscles.


What does a chiropractor do for back pain?

Your chiropractor will perform a complete consult and examination and may take radiographs (x rays). After review of the examination findings your chiropractor will recommend an appropriate and individual care program. Treatment consists of specific manual adjustments, to the individual joints of the body and spine, which restore damaged neurologic function.