If you are one of the four out of five people will go on to develop regular bouts of back pain after an initial attack, this is an important question to answer. For over 100 years chiropractors have claimed that regular treatment can prevent recurrences of back pain. Are we right?

For most of the 20th century, medical treatment, including here in Brighton, consisted of bed rest and painkillers for back pain. Unfortunately, this contributed to an increase in the cases of recurrent back pain. From 1980 until 2000 the number of days off work in the UK due to back pain doubled every decade.

Eventually, GPs stopped treating back pain this way and accepted what chiropractors and others had been saying that active treatment is best. It is also true that chiropractors accepted that painkillers and anti-inflammatory medication are also helpful, whereas up until then old school chiro’s often shunned drugs.

Medical Treatment for Back Pain

Even now, however, back pain treatment from the doctor consists of a brief course of physio or medication which stops as soon as the symptoms stop. If you have had recurrent back pain you will be all too familiar with the trips to the doctor, prescriptions for strong drugs, referral to the physio (after a wait of many weeks) then being given a few exercises. You are probably fed up with your back feeling vulnerable and about to go at any time. You may even find that you’re limiting your activities to avoid the things that bring it on. If so, what can be done to prevent the dreaded back pain from returning?

Well, new medical research, published in 2011, suggests that an initial intensive course of manipulation such as our chiropractors in Brighton do here at Sundial, followed by periodic checkups and treatment may help prevent long-term back pain from re-occurring. Interestingly, those that did not receive the continuing course of care lost their earlier improvements.

Preventative Chiropractic Treatment Works

So the evidence seems to point to an initial course of treatment over a few weeks to get rid of the initial pain and improve function followed by a course of care over the next few months to make sure that those improvements are maintained. Here at Sundial we use the best available evidence to guide our treatment and we generally stick to this sort of plan in helping you get better.

If you would like to know if preventative chiropractic care can help you then give us a call for an initial chat, at no charge.

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If you are getting recurrent back trouble what can you do to help yourself and sort the problem out? Back pain usually goes away in a week or two at most but for four out of five people, however, it keeps on coming back.  In a recent study published in the prestigious medical journal, The Lancet, 70-80% of back sufferers were still having pain a year later in spite of receiving treatment.

Brighton Chiropractors Give Three Tips to Prevent Recurrent Back Pain

1 Stay Active

This is counter-intuitive as the temptation is to take it easy. Most people are afraid of moving about in case they make the problem worse and prolong the agony. This, however, is exactly the wrong thing to do.  It is OK to rest for a day two or three days but after that doing gentle exercise is actually helpful even if is sore doing it or for a while afterwards. Walking, swimming, cycling, Pilates or yoga can all be a helpful start. Gradually increasing the intensity of the exercise as your muscles and joints get used the restored function is a helpful way to prevent recurrences. Our Exercise Video Programme is here.

2 Avoid aggravating activities

If your back goes bending over to tie your shoe laces or getting out of the car, the chances are that this activity is not the cause of the pain but rather the trigger factor. It is unlikely that something you have done hundreds of times before would suddenly become a problem without a change in the underlying condition of your back. A gradual weakening of your back muscles due to lack of core muscle strength leads to stress on the spinal joints which gradually stiffen and can eventually sprain.

There are certain activities that can often aggravate your back. These include prolonged sitting, lifting badly with your knees straight or lifting and twisting. Certain specific tasks can cause stresses on back joints and muscles like hoovering or gardening and you probably recognise what these are for you. Sometimes doing the activity for a brief period is okay but doing it for a prolonged period brings the pain on. It is helpful to start the activity gently, gradually increasing the effort you put in to it and then finishing with a few back stretches.

It is also worth noting when the pain comes on. If the back ache is worse in bed it could be an old sagging mattress that is not supporting your spine. If your back is stiff after sitting in low sofa for an evening then perhaps this is the culprit. These are obvious potential causes of back strain but our lifestyle is jammed full of hidden causes of back pain. A car with offset pedals or steering wheel twists the spine on every journey for instance.  A computer monitor off to one side has the same effect. Even baby care has its own hazards. Bending over a changing mat or putting a baby in a car seat is a potential back strain in the making. If you do a lot of work at a desk there are tips to set up your desk and chair here.

3 Get regular check-ups from a back specialist

If getting a fistful of anti-inflammatory drugs from the GP doesn’t help resolve your back pain quickly then you might choose not to wait for referral to the local physio department. Currently the national average waiting time is twelve weeks by which time, if you are still getting pain, it is becoming chronic. If it does resolve the chances are that it will recur in a few months or a year or two.  There are other options for back care though.

The National Institute for Health and Clinical Excellence (NICE), the government body that recommends the best treatments for all sorts of conditions says that manipulation from a chiropractor, osteopath or specialist physiotherapist should be part of effective care for back pain. A short course of treatment will often restore strength and flexibility to the back allowing you to get back to full activity. Once you have the initial problem under control and the pain has resolved there is some evidence that a periodic session of treatment can help prevent back pain from recurring.

Back pain can limit what exercise and activities you are able to do but with the right approach you can get rid of the problem and carry on as normal. These straightforward steps will help you get better.

If you want to find out if we can help you – call for a free check-up.

For more information look at our Treatment and Fees FAQ’s

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It is incredible to think that even children can get back pain but it’s true. At Sundial we did free half-term kids and teachers chiropractic checks in Brighton. 32 per cent of six and seven year olds get back ache at some time according to research by the British Chiropractic Association. This rises to 45 percent by the age of eleven. To highlight this issue the focus of last year’s BackCare Awareness Week, 17th-23rd October, was school children and their teachers.

One of the main reasons school children are prone to getting back strains is because they are carrying heavy school bags. Now school lockers are no longer available in most schools, children have to carry a bag with the full day’s books as well as all the other stuff that they need. Some kids carry all their books around for the whole week and then games bags as well. An adult wouldn’t put up with it.

Not only are the bags heavy they are often not very well designed. A hand strap sport type bag or book bag means all the weight is carried on one side of the body. A better option is a shoulder strap ideally carried across the body. The option, however, is a rucksack with both shoulder straps used and has been shown to reduce back pain by a third.

School Chairs Cause Back Problems

Schools themselves can also do more to prevent back problems in their students. Budget constraints mean that classroom chairs are often cheap and nasty providing poor support and no adjustability. If an adult was provided with a similar design of chair they would refuse to work in it for more than a few minutes with out screaming for a better one. Indeed, employers have a legal duty to provide a decent chair which is fully adjustable and supportive. Schools have no such duty.

Brighton Chiropractor Interviewed by BBC

The fashion of having children seated in groups around circular tables also adds to back strain some children have their back to the teacher and are constantly twisting round to see what is going on at the front of the class. Chairs that swivel would make this much safer. See an interview with Brighton chiropractor, Matthew Bennett by BBC Newsround on this issue here.

It is not just poor chairs that are associated with more back pain in school kids. The length of lessons themselves is also associated with more back aches. The longer the lesson the more aches and pains children reported in a study at the University of Surrey. Researchers visited classrooms and looked at what children were sitting on and how they perched on chairs as well other factors like length of lessons and how much movement was allowed. They found that if children sat in a flexed posture they had an increased incidence of low back pain. If the children did not move much and sat still they had an increase in upper back and neck pain.

Lifestyle Factors

A recent survey by Ofcom showed that computer game use and watching DVD’s has actually declined in teenagers it has been replaced by other screen based entertainment such as iPads and laptops to browse the internet as well as texting. In fact most teenagers do these things whilst also watching television. It is not just teenagers who are glued to screens, 40 percent of five year olds use an internet enabled computer at home.

But does this digital overload lead to health problems. Previously boffins in Scandinavia found that increasing television watching led to an increase in back ache in children. Certainly sedentary lifestyles have been associated with more back pain in children but does screen time also lead to obesity. The answer is maybe.

Studies are unclear whether gaming and computer use are one cause of obesity. Still, it is probably a good thing if children are running around rather than sitting around. Weak core abdominal and back muscles are more likely in children who get back trouble. It seems however, that you can have too much exercise if you are a child. High level sport and training is associated with more pain.

If a child does get a bout of back pain it will usually disappear in a few days. For a third of kids this doesn’t happen however and they go on to have longer term or recurrent symptoms.  It is important to take steps to reduce the postural stresses and other lifestyle factors that can aggravate the spine and if symptoms are not resolving to get a chiropractic check up.

At Sundial we are doing free half-term kids and teachers checks and have reduced our treatment fee to £24, saving £10 per visit. For a video showing treatment of a six year old go here.

Top Ten Tips to Prevent Back Pain In Children

1. Use a back pack and use both shoulder straps
2. Ask the school if they have ergonomic chairs
3. Don’t sit on the floor to play computer games, use a chair
4. Don’t allow long periods of laptop use in a poor posture
5. Limit television to 1-2 hours maximum per day
6. Ideally use a PC rather than a laptop
7. Set up the computer screen so the top is at eye level
8. Consider a office swivel chair at a desk for homework
9. Build in active games and moderate levels of sport
10. Get a chiropractic check-up if back or neck pain persists

Further information

http://sundialclinics.co.uk/2008/11/

http://www.advms.pl/?q=system/files/53_52SBockowski.pdf

http://www.ft.com/cms/s/0/779f55c2-5110-11dc-8e9d-0000779fd2ac.html#axzz1b7a3nwEv

http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=40136

Troussler B et al. Back pain in school children: A study among 1178 pupils. Scandinavian Journal of Rehabilitative Medicine, 1994, Vol 26, 143-146.

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Nearly 20 years Matthew took part in a training programme to help a national pub chain reduce injuries due to lifting. He helped put a seminar series and video together to help publicans and their staff prevent back pain on the job. Roy Castle and Geoff Capes were the talent. Matthew says “It was a gruelling 16 hour day of shooting. The director couldn’t make his mind up about how to do it and the shots took ages to set up. Geoff and I were getting tired and cranky by 10pm but Roy was as cheerful at the end as he was at the start of the day.”
Here it is.

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In a recent study chiropractic care was compared with usual medical care for patients with acute low back pain. The chiropractic patients did much better.

More than 90 patients with back pain lasting from 2-4 weeks were randomly allocated either usual GP type care or a package of care , including 4 weeks of manipulation, delivered by chiropractors. The group treated by the chiropractors had significantly less disability.

This echoes other studies going back to 1990 when the Medical Research Council  compared chiropractic care to medical care including physiotherapy. Here too the results favoured chiropractic in the treatment of back pain. In the conclusion of this research the authors suggested that chiropractic should be included on the NHS. 21 years on little has changed.

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The NHS is suffering an ailment of its own. Despite cash being poured into it at unprecedented levels over the last decade or more it is creaking and groaning, showing every one of its 63 years.  The talk of cutbacks is becoming deafening and waiting lists are growing. If you are on the end of a long list, putting up with the daily misery of back pain you don’t want to wait at all. As with many facets of modern life mixing and matching different providers may well be the best option, even if that means paying for some treatment yourself.

If you have a bout of back pain the first thing to do is nothing. Many early episodes of pain get better by themselves and are not too disabling anyway. Carry on with your normal life remaining gently active. Consider avoiding things that tend to make the pain worse like bending and lifting and especially long periods of sitting. Break up long tasks or long periods of sitting with other activities.

Medication for back pain

If the pain persists for more than a few days consider taking some over the counter pain relief or anti-inflammatory medication. Your pharmacist should be able to recommend something suitable. If pain persists for a week or more or is severe initially then see your GP for stronger medication. See the course of drugs out and don’t just stop when you feel a bit better as things can get bad again.

Physiotherapy combined with chiropractic

If the back pain carries on for more than two weeks or you keep getting recurrent episodes see a physio or chiropractor privately here at Sundial. You have a window from two weeks to six weeks to get the best response to treatment. If pain persists for more than six weeks the problem is becoming chronic (ie long-term) and is more difficult to treat, so don’t leave it. GP’s are only likely to refer to physiotherapy after six weeks of pain and then there is the wait to actually see one. This is too late for early treatment to have an effect and increases the likelihood of chronicity.

If you do get to see an NHS physio then the four or six sessions can be helpful and can be combined with chiropractic care to get the best outcome if the response is too slow. The clinical guidelines body NICE recommend manipulation as done by chiropractors, osteopaths and specially trained physio’s  as well as exercises and drug treatment for back pain. The problem is there are only a few physios who have trained to do manipulation so the chances of seeing one on the NHS is small. In a recent study(1) manipulation got better results than physio care that included exercises, mobilisation and soft-tissue treatment for back pain.

Some physio’s think that mixing two treatments is not a good idea but that is not our experience. Many of our private patients see our physio and one of our chiropractors to get the best from both. By working together in the best interests of the you the patient the best package of care can be given.

If this state of back care persists in the NHS, with long waits for sub-optimal treatment the next 22 year follow up of low back sufferers may not show any improvements over the first one. Make sure you are not one of the statistics.

Further information

Patients Association on how to get the most out of a consultation

http://www.bbc.co.uk/news/health-14390041 waiting times rising

(1) Spinal manipulation compared with back school and with individually delivered physiotherapy for the treatment of chronic low back pain: a randomized trial with one year follow up. F Checchi et al: Clinical Rehabilitation 2010; 24: 26-36

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It is a disturbing fact that most people who get a bout of back pain go on to get it year after year. A recent study(1) found that 4 out five people had episodes of back pain over 20 years later. This is especially concerning because they had attended their GP initially and this had obviously failed to bring them long term relief.

There were other factors which were also looked at to see if they could be the cause of this long term pain. The severity of the pain as well the clinical signs and work history were examined to see if these were likely to upset back problems. Interestingly only how hard individuals perceived they worked seemed to have a negative influence on the pain two decades later.

Why do back problems become long-term?

It is likely that most long-term back problems are caused by many factors. Some, like work related stress, can play a key role but probably the single most important influence over the past few decades has been poor initial treatment. In his 1999 book The Back Pain Revolution, Dr Gordon Waddell described how “the medical model of back pain was inadequate for evaluating and treating many patients.” He showed how bed rest and pain-killers, the mainstay of treatment at the time actually contributed to more back pain.

Things have improved since then. Bed rest is not routinely prescribed anymore; exercise and encouragement to stay active are recommended by the NICE guidelines and most GP’s, if not all, are aware of these recommendations. Pain-killers and anti-inflammatory drugs are still also recommended although the incidence of serious side-effects can be a concern.

But it is not all good news for back sufferers though. The recent well publicised increases in NHS waiting times are likely to delay prompt treatment for back pain. Physiotherapy departments are being stretched more and more and the waiting times rarely approached the recommended maximum wait of 6 weeks even at the best of times. Few physiotherapy departments employ specialist manipulative physio’s, fewer still an osteopath or chiropractor, in spite of this being a key recommendation of the NICE guidelines. This means  patients are still being denied the best care.

How to prevent long-term back pain

There are some simple guidelines to prevent a bit of back ache becoming an ongoing, recurrent disabling problem. Put simply it is not to ignore it. All the evidence is that back pain tends to keep coming back if the underlying causes are not dealt with. Most simple low back pain is a caused by a combination of stiffness in the spinal joints, often brought on by poor posture. Poor trunk muscle conditioning also leads to spinal joint damage. So the simple solution to prevent chronic back trouble is:-

• get the stiff joints unlocked by a chiropractor or osteopath
• do regular trunk muscle exercises for core stability
• watch you posture whilst lifting, sitting and other daily activities

If back problems keep on recurring or an episode lasts more than a few days you might need help from us to get back to normal activities. If you are unsure then we offer a free initial check to see if you have a problem that may be helped by our chiropractors or physiotherapists.

(1)

Early predictors of the long-term outcome of low back pain—results of a 22-year prospective cohort study

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Cliff Cox is one on Britain’s top surfers and lives here in Brighton. He has won the English Masters Championship twice, the South Coast Championships several times and won a bronze medal at European level. He has done all this  and yet has suffered bouts of back pain for years. He believes his participation in elite surfing has put considerable stresses and strains on his back and knees.

He has been a client at Sundial now since 1998 and attributes his long career to Matthew and the team at Sundial. He says

“I have had really bad back problems off and on Matthew sorts me out every time. I recently had a knee injury where my ligaments became strained and between Matthew and Antony [the physio at Sundial], I am coming through it”

Cliff also runs the South Coast’s leading surf school Pure Spirit Surf School based here in Brighton.

No related posts.

Could this cute dog cause back pain?

Walking your dog and avoiding back ache

Bend your knees

Muki and I

When you have to bend down to greet your puppy or smaller dog always bend your knees. It may seem obvious but so many of us just bend our backs and as a result take all the strain through those muscles and joints. Add to that the awkward positions that we can get in trying to coax our puppy in training classes to follow our lead and you can imagine how tired those muscles get. And to then get into our car and drive home again can often spell an aching evening and set up for a bigger problem later on.

Regular breaks

Avoid lifting them up

Sensible footwear

Warm up

Vary routines

Go off road

Start horsing around

Amanda Goring

Chiropractor

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Here are some top tips to prevent back and neck pain caused by cycling. How you position yourself, how you set your bike up for you and even what clothing and equipment you use can have a massive impact.

When most of us begin cycling – either just to work, on odd weekends or as a pleasurable sport – we are largely under the impression that the hardest aspect is building up our fitness to a level that is sufficient to cycle to the top of the notorious local steep hill (or just to make it to our destination without collapsing from an angina attack). However there is a lot more to the cycling than just having balance enough to stay on or a steely determination to keep pedalling.

Bike set up to prevent back and neck pain

The most important aspect which needs to be sorted out before you even begin, and is a must for any type of bike and any number of hours spent on it; the set up.

Whether you have a road bike or a mountain bike it should be set up so that it fits you, not the other way around. As with a pair of shoes one size does not fit all and your gender as well as your whole body measurements will affect your set up. Why bother to get it right? Because not doing will undoubtedly lead to poor performance as well as opening you up to the risk of all manner of possible injuries and aches, especially back pain.

Even those who train religiously on their bike to a high standard are exposed to back pain. A study looking at a group of Japanese tri-athletes found that the most common complaint was back pain and of all three disciplines, cycling was the highest causative risk factor (1.). In fact one article even found that anything from 30-70% of cyclists suffered with some kind of back pain. In the study they found that even just by angling the saddle it reduced back pain in more than 70% of participants (2.)

Once you have ensured that your bike is actually roughly the right size for you the best plan is to then take it to a reputable bike shop which offers a check service and get them to assess and measure the two of you. But in the meantime here is a general overview, broken down to make it more user-friendly.

1. Picking the right bike.

Deciding if a bike is right for you is not as easy as meeting someone on a dating site and reading that they have a GSOH, or noticing that they have kind eyes’ as you would with a horse, or even going to see them with their mum and the rest of the litter. Bike shops will usually take one look at you and bring you out bikes that are suited to your height and build, but if you are a little unsure the easiest way is to check the bike frame against your height and the length of the crank (the metal part attached to the pedal) against your leg. Standing astride the bike there should be a 2 inch distance between the cross tube and your groin with a road bike, or 3 inch distance with a mountain bike. There are exact figures but as a rule of thumb the crank should measure approximately 20% of the length of your inside leg (3.).

2. Handlebars.

The distance from the seat to the handlebar stem and the height of the handlebars should allow you to ride in a relaxed position through the upper body without adopting tension through the neck and shoulders. Handlebars are often lowered when racing to favour aerodynamics but unless you are heading out of the shop and straight to the local time trial it is wise to always be sensible with these things. Excessively lowered bars can cause flexion or rounding of the thoracic spine, more stress through the shoulders and onto the wrists, and therefore leave you needing to raise the head up higher to avoid riding into obstacles, putting undue stress on your lower neck region and giving you tension through the neck and shoulders. Never a great combination.

So the best position is to bring the handlebars down so that when sitting on the bike and resting on them you reach a position of 40-60 degrees flexed from sitting up straight.

A good rule of thumb is to stand beside the bike and place your elbow against the tip of the saddle. Your fingertips should be approximately 70mm short of reaching the handlebars. Any more and you will struggle to reach the bars, causing you to lock your arms out and overstretch (4).

When looking from the side at a pedal position of 3 o’clock the front of the kneecap should line up with the middle of the pedal. If not move the saddle forwards or backwards, raise or lower it and alter the position of your shoe cleat (if using them).

3. Saddle type, height and angle.

The saddle itself is important and should feel comfortable. Just like a mattress there are different sizes and styles with different degrees of cushioning and it is important to decide which you prefer. As a rule, women will require wider seats as their pelvis is wider than men’s but generally most people favour one with additional gel for cushioning. But try out a few.

Ideally the saddle should not be angled unless you are experienced and racing as tilting it down at the front will only drive your weight forwards onto the handlebars and shoulders. This posture can help with increasing the lordosis in your lumbar spine and so reduce back pain in some cyclists but unless you are conditioned to this increase in force it will create all sorts of problems through the shoulders. And of course tilting it backwards only causes you to round through the lower back and flex more at the hips, increasing the pressure in the area and reducing the power generated at the hip flexors for pedalling, which doesn’t benefit anyone.
The height of the saddle is critical and one of the key causes of injuries if not assessed correctly. A seat too high will strain your lower back and hamstrings. Too low and you are likely to round your back, overwork your quadriceps muscles and strain your knees. The seat post that is moved to raise and lower the saddle will come in different lengths so it is worth checking that yours can accommodate the correct saddle height without stressing the frame. The easiest way to check the height for you is to sit on the bike against a wall, holding onto the wall for balance. Letting your legs hang free you should find that your feet can sit in the pedals with only the slightest bend in the knees. If you find that you rock when you later ride out then you are likely to have your seat a little too high so it needs to be lowered (5).

With the foot at 6 o’clock the knee should be bent around 30-35 degrees. If it is not then the height of the seat needs to be changed.

4. Brakes.

These should be easily reached with the fingers when the hands are on the handles in a cycling position. The wrist should not flex in any way.

5. Accessories.

Aside from the obvious helmet it is hopefully pretty transparent that avoiding riding with heavy bags on your back or even dangling from the handlebars can save you twisting forces through your spine or heavy loading around your neck and shoulder region so it is wise to invest in panniers fitted to your bike on either side of the back wheel. It may not look cool but it will save you aches and pains.

6. Cleats.

Not adopted by all who ride a bike, these little devices screw onto the sole of cycling shoes and allow you to clip onto the pedals of your bike, allowing greater control of the bike as well as power deliverance through the legs and pedals. It also reduces all those problems of friction between the shoe and pedal and of course twisting at the ankle joint due to the foot sliding around. To release your foot you simply turn it with some downward pressure onto the pedal and your foot is released. These do require experience on the bike however, as they take a degree of getting used to. No longer can the foot simply lift off from the pedal and initially this can result in falls and injuries (I have a great deal of painful experiences myself!) and so this can cause a number of injuries itself unless care is taken. Not to mention that they must be aligned correctly so as not to cause strain to the inner or outer knee and hip and as they are sprung loaded, if this is not set correctly for the rider it can stress the ankle joint.

References

1. Manninen, J.S., & Kallinen, M. (1996). Low back pain and other overuse injuries in a group of Japanese tri-athletes. British Journal of Sports Medicine. Vol.30. pp.134-9.

2. Salai, M., Brosh, T., Blankstein, A., Oran, A., & Chechik, A. (1999). Effect of changing the saddle angle on the incidence of low back pain in recreational bicyclists. British Journal of Sports Medicine. Vol.33. pp.398-400.

3. Whiteley, A. (2009). Basic bike set-up: 5 tips to set up your bike so as to avoid injury. www.physiobench.com

4. Beer, J. Technique: How to set up your bike.www.bikeradar.com.

5. How to set up a mountain bike. www.snowbikers.com/articles/mtb_setup.html

6. Usabiaga, J; Crespo, R; Iza, I; Aramendi, J; Terrados, N; & Poza, J.J (1997). Adaptation of the Lumbar Spine to Different Positions in Bicycle Racing. Spine. Vol.22. No.17. pp.1965-9.

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