Lower back pain is an undesired consequence of the activities that our patients partake in on a daily basis. Without appropriate intervention and adequate rest, these repetitive stressors can lead to injury.
Desk jockeys are filling chiropractic offices with complaints triggered by cumulative stressors, compounded by inactivity. Prolonged seated postures and general deconditioning lead to overloaded spinal ligaments, muscles, and discs.
Altering seat and keyboard height, as well as monitor elevation & distance are all critical variables for those who spend their day sitting. But more recently, increasing numbers of workstation users are transitioning to standing desks; and standing in one spot for an extended period is not without its own set of risks.
What advice should an evidence-based chiropractor give to patients concerning their standing workstation?
Do you know why taverns have foot rails around their bars? The foot rails originated during a time when stools were not common, and patrons would stand, i.e. ‘belly up to’ the bar. The rail was intended to give patrons the ability to alternate legs, giving one a rest while providing a little flexion for those stenotic cowboy spines.
A new study examined the impact of standing workstations on LBP. (1) The authors concluded that one variable, footrest height, had a significant contribution to muscle fatigue and lower back pain. Their recommendation:
“The results suggest that a footrest height of 10% of the body height can be recommended as a normalized height for prolonged standing work in subjects with a history of non-specific lower back pain during prolonged standing.”
The take away from this is to incorporate a foot rest with your standing workstation. You can't argue with the evidence!
1. Son JI, et al. Effects of footrest heights on muscle fatigue, kinematics, and kinetics during prolonged standing work. J Back Musculoskelet Rehabil. 2017.
Reprinted with permission from ChiroUp
1.A systematic review of 11 pertinent articles determined that cervical HVLA manipulation increased pain-free handgrip strength in patients with lateral epicondylagia. Galindez-Ibarbengoetxea Xabier, Setuain Igor, Andersen Lars L., Ramírez-Velez Robinson, González-Izal Miriam, Jauregi Andoni, and Izquierdo Mikel. The Journal of Alternative and Complementary Medicine. September 2017, 23(9): 667-675.
2.A cross sectional study confirmed that in patients with adolescent idiopathic scoliosis, the Cobb angle has a direct correlation to pain and disability. Bracing was associated with lower disability and pain. Théroux J et al. Back Pain Prevalence Is Associated With Curve-type and Severity in Adolescents With Idiopathic Scoliosis: A Cross-sectional Study. SPINE. 42(15):E914–E919, AUG 2017
3.The Journal of Rheumatology published an articulate narrative on the genesis of arthritis: “Following skeletal maturation, chondrocyte numbers decline while increasing senescence occurs. Lower cartilage turnover causes diminished maintenance capacity, which produces accumulation of fibrillar crosslinks, resulting in increased stiffness and thereby destruction susceptibility. Mechanical loading changes proteoglycan content. Moderate mechanical loading causes hypertrophy and reduced mechanical loading causes atrophy. Overloading produces collagen network damage and proteoglycan loss, leading to irreversible cartilage destruction because of lack of regenerative capacity. Thus, age seems to be a predisposing factor for OA, with mechanical overload being the likely triggering cause.” Jorgensen AE et al. The Effect of Aging and Mechanical Loading on the Metabolism of Articular Cartilage The Journal of Rheumatology April 2017, 44 (4) 410-417
4.“The knee is the most common site of OA. Numerous studies have shown an inconsistency between patients’ reports of pain and their radiographic findings. This inconsistency may be partially explained by the fact that a portion of the pain originates from the myofascial trigger points (MTrPs) located in the surrounding muscles. Treatment focusing on MTrPs seems to be effective in reducing pain and improving function in OA patients.” Dor, Adi et al. A myofascial component of pain in knee osteoarthritis. Journal of Bodywork and Movement Therapies , Volume 21 , Issue 3 , 642 – 647
5.In patients undergoing MRI for degenerative spinal disease, expanding the regional study to include a T2 whole spine screen identified incidental findings in 15.8% of patients, 4.3% of which required further medical or surgical intervention. The authors concluded: “Considering the potential advantages in identifying significant incidental findings and the minimal extra time spent to perform whole spine screening, its application can be considered to be incorporated in routine imaging of spinal degenerative diseases.” Kanna, R.M., Kamal, Y., Mahesh, A. et al. The impact of routine whole spine MRI screening in the evaluation of spinal degenerative diseases. Eur Spine J (2017) 26: 1993.
6.A small randomized clinical trial demonstrated that periodic chiropractic maintenance care can prevent and/or minimize episodes of LBP. Patients who underwent an average of 7 visits per year suffered on average 19.3 fewer days with LBP. Eklund A, et al. Prevention of low back pain: effect, cost-effectiveness, and cost-utility of maintenance care – study protocol for a randomized clinical trial. Trials. 2014;15:102 Eklund A et al., Prevention of Low Back Pain: Effect of Chiropractic Maintenance Care as Compared to Symptomatic Treatment – A Pragmatic Randomized Clinical Trial. First prize 2017 European Chiropractors Convention, Cyprus.
7.In athletes who sustained an acute musculoskeletal sports injury, three minutes of acupressure was effective in decreasing VAS pain intensity. Macznik AK. Does Acupressure Hit the Mark? A Three-Arm Randomized Placebo-Controlled Trial of Acupressure for Pain and Anxiety Relief in Athletes With Acute Musculoskeletal Sports Injuries. Clin J Sport Med. 2017 Jul;27(4):338-343.
8.A new study in Spine confirms that adults who participate in muscle strengthening exercise suffer lower incidence of LBP. Alnojeidi AH et al. Associations Between Low Back Pain and Muscle-strengthening Activity in U.S. Adults. Spine (Phila Pa 1976). 2017 Aug 15;42(16):1220-1225.
9.For patients with Failed Back Surgery Syndrome, evidence supports exercise or spinal cord stimulation as opposed to medication and re-operation. Amirdelfan K et al. Treatment Options for Failed Back Surgery Syndrome Patients With Refractory Chronic Pain: An Evidence Based Approach. Spine (Phila Pa 1976). 2017 Jul 15;42 Suppl 14:S41-S52.
10.A systematic review and meta-analysis found that workplace exercise programs and workstation modifications reduce the prevalence and intensity of shoulder pain. Lowry V et al. Efficacy of workplace interventions for shoulder pain: A systematic review and meta-analysis. J Rehabil Med 2017 Jul 7;49(7):529-542.
Reprinted via Permission from ChiroUp
Between 80% and 90% of the general population will experience an episode of lower back pain (LBP) at least once during their lives. When it affects the young to middle-aged, we often use the term “non-specific LBP” to describe the condition. The geriatric population suffers from the “aging effects” of the spine—things like degenerative joint disease, degenerative disk disease, and spinal stenosis. Fractures caused by osteoporosis can also result in back pain.
The “good news” is that there are rare times when your doctor must consider a serious cause of LBP. That’s why he or she will ask about or check the following during your initial consultation: 1) Have you had bowel or bladder control problems? (This is to make sure a patient doesn’t have “cauda equina syndrome”—a very severely pinched nerve.) 2) Take a patient’s temperature and ask about any recent urinary or respiratory tract infections to rule out spinal infections. 3) To rule out cancer, a doctor may ask about a family or personal history of cancer, recent unexplained weight loss, LBP that won’t go away with time, or sleep interruptions that are out of the ordinary. 4) To rule out fractures, a doctor may also take x-rays if a patient is over age 70 regardless of trauma due to osteoporosis, over age 50 with minor trauma, and at any age with major trauma.
Once a doctor of chiropractic can rule out the “dangerous” causes of LBP, the “KEY” form of treatment is giving reassurance that LBP is manageable and advise LBP sufferers of ALL ages (especially the elderly) to KEEP MOVING! Of course, the speed at which we move depends on many things—first is safety, but perhaps more importantly is to NOT BECOME AFRAID to do things! As we age, we gradually fall out of shape and end up blaming our age for the inability to do simple normal activities. Regardless of age, we must GRADUALLY increase our activities to avoid the trap of sedentary habits resulting in deconditioning followed “fear avoidant behavior!”
Here are a few “surprising” reasons your back may be “killing you”: 1) You’re feeling down – That’s right, having “the blues” and more serious mood disorders, like depression, can make it more difficult to cope with pain. Also, depression often reduces the drive to exercise, may disturb sleep, and can affect dietary decisions—all of which are LBP contributors. 2) Your phone – Poor posture caused by holding a phone between your bent head and shoulder (get a headset!) or prolonged mobile phone use can increase your risk for spinal pain. 3) Your feet hurt, which makes you walk with an altered gait pattern, forcing compensatory movements up the “kinetic chain” leading to LBP. 4) Core muscle weakness, especially if you add to that a “pendulous abdomen” from being overweight—this is a recipe for disaster for LBP. 5) Tight short muscles such as hamstrings, hip rotator muscles, and/or tight hip joint capsules are common problems that contribute to LBP. Stretching exercises can REALLY help!
Reprinted with Permission from Chiro-Trust
Opioid Use Disorder (OUD) has quietly but quickly become the hottest topic in healthcare public policy. More than 1/3 of Americans use opioids and 11.5 million misuse or abuse the drug. (1) Tragically, more than 20,000 people died in 2015 due to an opioid overdose. (2) Over a ten-year period, the opioid death rate quadrupled in direct proportion to the number of prescriptions. (3)
Currently, almost every governmental and healthcare group on the planet is working to combat this problem. Solutions range from prescription limits to equipping all first responders with Narcan™. However, the underappreciated issue is that opioids are most frequently prescribed for chronic non-cancer pain, primarily spinal pain. The vast majority of spinal pain is mechanical in origin. Prescribing a chemical does not adequately address that problem. Fortunately, there is abundant research that shows chiropractic spinal manipulation is very effective at resolving mechanical problems.
Patients who utilize chiropractic co-management have significantly lower rates of opioid use (19% vs 35%) and are 30 times less likely to undergo surgery. (4,5) Health plans realize significant savings by incorporating chiropractic care, with some carriers reporting a 2:1 ROI. (6,7)
Not surprisingly, in the past year chiropractic or spinal manipulation has been endorsed as an alternative to opioids by the FDA, CDC, Joint Commission, American College of Physicians, and 37 State Attorney Generals. (8-12) Earlier this week, a Presidential Commission Report on Opioids echoed those recommendations. (13)
1. Substance Abuse and Mental Health Services Administration. 2017. Results from the 2016 National Survey on Drug Use and Health: Detailed Tables. Table 1.28A and 1.28B. Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.pdf, accessed on October 26, 2017.
2. Center for Behavioral Health Statistics and Quality. (2016). Key substance use and mental health indicators in the United States: Results from the 2015 National Survey
3. Paulozzi MD, Jones PharmD, et al. Vital Signs: Overdoses of Prescription Opioid Pain Relievers – United State, 1999-2008. Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Center for Disease Control and Prevention. 2011:60:5.
4. Whedon J. Association between Utilization of Chiropractic Services and Use of Prescription Opioids among Patients with Low Back Pain. Presented ahead of print at the National Press Club in Washington DC on March 14, 2017. Accessed online at http://c.ymcdn.com/sites/www.cocsa.org/resource/resmgr/docs/NH_Opioids_Whedon.pdf on Drug Use and Health (HHS Publication No. SMA 16-4984, NSDUH Series H-51). Retrieved from http://www.samhsa.gov/data/
5. Benjamin J. Keeney , Ph.D., et al. Early Predictors of Lumbar Spine Surgery After Occupational Back Injury. SPINE Volume 38, Number 11, pp 953–964
6. Feldman V, Return on investment analysis of Optum offerings — assumes Network/UM/Claims services; Optum Book of Business Analytics 2013. Analysis as of 12/8/2014.
7. Liliedahl RL, Finch MD, Axene DV, Goertz CM. Cost of care for common back pain conditions initiated with a chiropractic doctor vs medical doctor/ doctor of osteopathy as first line physician: experience of one Tennessee-based general health insurer. J Manipulative Physiol Ther. 2010;33:640–643.
8. FDA Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain. May 2017. Accessed on May 12, 2017
9. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain- United States, 2016. MMWR Recom Rep 2016;65(No. RR-1):1–49.
10. The Official Newsletter of The Joint Commission. Joint Commission Enhances Pain Assessment and Management Requirements for Accredited Hospitals. July 2017 Volume 37 Number 7. Ahead of print in 2018 Comprehensive Accreditation Manual for Hospitals.
11. Joint Commission Online. Revision to Pain Management Standards. http://www.jointcommission.org/assets/1/23/jconline_november_12_14.pdf
12. Attorney General Janet Mills Joins 37 States, Territories in Fight against Opioid Incentives. Accessed 9/19/17 from http://www. maine.gov/ag/news/article. shtml?id=766715
13. The Presidents Commission on Combating Drug Addiction and the Opioid Crisis. https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-3-2017.pdf
Reprinted with Permission from Chiro Up.
As exciting as the holidays can be, the added stress that comes along can really affect how your body functions. Whether you’ll be doing a lot of shopping, cooking, wrapping presents, or attending holiday parties, chances are you’ll be putting your body through a lot more than it’s normally accustomed to and all of this can trigger back and neck pain. Here are 11 tips to help you prepare for a happy and healthy holiday season.
• Dress appropriately before heading out for a day of shopping. Wear comfortable low-heeled shoes with arch supports and leave your heavy purse at home. Opt for a light backpack or a fanny pack to carry your personal belongings.
• Drink plenty of water to stay hydrated.
• A long day of shopping, i.e. walking, should be treated like an athletic event. Make sure you stretch before and after.
• Make extra trips to the car to drop off your goods so you don’t have to carry those heavy bags around all day.
• Take advantage of online shopping. Skip the long lines and crowded malls completely and shop from the comfort of your own home.
• Simplify your to-do list by picking up gift cards at the grocery store. You’ll get two errands done in one stop.
• Use a table or a counter to wrap gifts. The floor is a less than ideal spot to do your wrapping. Standing or sitting in a chair will promote better posture and help you avoid back and neck pain.
• Don’t wait until the last minute to wrap all of your gifts. Wrapping a few at a time is best.
• Don’t neglect your fitness routine. Although you’ll be busier than normal, it’s important to keep those workouts on your daily to-do list. Even a quick 20-minute workout is better than skipping it all together and you’ll be helping to manage your stress.
• Get enough sleep. The holidays won’t be as enjoyable if you aren’t catching enough z’s. Make sure you’re getting the recommended 7-9 hours of sleep every night.
• Try to stay on track with your healthy eating. Gaining extra weight will only contribute to back pain and health problems. Before attending a party, make sure you eat something healthy and drink plenty of water to avoid overeating while you’re there. It’s ok to indulge a little with holiday treats, just be sure to be sensible about it.
With some simple preparation, you can manage holiday stressors and ward off debilitating back and neck pain. If you do experience pain this season, please give our office a call. We’re experts at finding the root cause of your pain and can help you get back to a better quality of life.
Cliff Atwell, B.S., D.C.