Chiropractic does better than medical care for back pain

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.

Poor posture – do you have it and what causes it

Poor posture is often blamed for contributing to aches and pains in the back, neck and shoulders. But how do you know if you have poor posture, what causes it and how does it affect your health?

You might like to check yourself out or instead you could make an appointment for a posture check-up at Sundial. We have new digital postural analysis software. This is free to people who Like our Sundial Facebook page here.

It is easy to see if you have poor posture by looking in the mirror. Stand in a normal relaxed posture with your eyes closed. Often we correct our posture as soon as we look in the mirror so we don’t get the true picture. Slowly open you eyes. If one shoulder is higher than the other or your head is tilted off to one side then you posture is not ideal. Is you weight shifted over to one side more than the other? Is one hand rotated more or is one foot turned out?

All these clues tell our chiropractors and physio’s a lot about the dysfunction in your muscles and joints. It may surprise you to know that we automatically check this as you walk in to the treatment room. This information can tell us where the joints are under the greatest pressure and which muscles are not working correctly.

It is harder to view yourself from the side but more important than just looking from the front as this affects pressure on the spine far more. If you can, get someone to take a photo of you from the side. Your ear, shoulder, hip, knee and ankle should all be aligned. If not, you have a postural problem.

The spine is a bit like a tent pole with the muscles acting as the guy ropes keeping it up. If the tension in the guy ropes is strong and equal on all sides then the tent pole is straight and rigid – if not then it wobbles around. There are two main causes of postural defects

  1. muscle imbalance
  2. bone shape

Poor Posture Caused By Muscle Imbalance

If the muscles on one side of your spine are weaker than on the other side, your spine will lean in that direction. There are different causes of muscle weakness. Sometimes it is lack of exercise or a sedentary lifestyle, sometimes it is a spinal problem affecting the nerves that supply those muscles. For instance, lots of computer work with your chin poking forward to view the screen will activate the muscles at the back of the neck and switch off the muscles at the front leading to a postural imbalance. Laptop screens are particularly bad as they are so low.

If your head is carried too far forward your muscles have to work harder to keep your head up. Think of holding a heavy weight close to your body. If you extend your arms holding it away from your body the muscle in you shoulders and arms have to work a lot harder. Your head weighs about 7% of your body weight so for the average 70kg (11st) man that is a whopping 6kg (14lbs). If your posture forces your head forward this load can easily double. Weeks and months of this posture slowly change the strength and length of  the muscles and put pressure on the spinal joints at the top and bottom of the neck. The delicate neck joints then get more wear and tear and stiffen due to extra loading. These abnormal forces on the joints eventually cause neck and shoulder pain and possibly headaches.

Poor Posture Caused By Bone Shape

Back PainThe other main cause of posture problems is one that you can not do much about. Sometimes the bony architecture of the body causes poor posture. For example a scoliosis, or side-ways curve of the spine. This is more common in women and often starts showing in the teens. No-one yet knows why. The bones are pulled out of shape and the curve is permanent. In extreme case surgery is needed to stop the problem worsening.

Another form of bone shape causing poor posture is the gradual stoop of old age. The vertebrae in the mid back (thoracic spine) are wedged shaped with the longer edge at the back. The discs are wedged the other way so cancelling the effect out. As we get older though the discs shrivel up a bit and the cancelling effect is decreased leading to a stoop as the shoulders become more rounded.

Effects of Poor Posture

Poor posture causes aches and pains in the back, neck and shoulders and can lead to headaches and accelerated wear and tear on the joints. This maybe a contributing factor to osteo-arthritis.  After twenty to thirty minutes of slouching the muscles fatigue and can’t hold your weight anymore. This stretches the ligaments that hold the joints together leading to further joint trouble.

As your shoulders become more rounded  your shoulder joints become more restricted making it difficult to reach up. Your neck and low back lose flexibility making things like gardening and driving troublesome. As your chest and tummy become compressed your breathing can become affected as your diaphragm cannot work properly. Blood circulation and digestion may also suffer.

In part two next week we will look at how you can improve your posture

How to get the best from NHS back pain care

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

Decades of back pain is preventable

Sports Injury Clinic at SundialIt 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 four out of 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 backache 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 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
  • 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

  1. F Lønnberg
  2. PA Pedersen and
  3. V Siersma

Family Practice,Volume27, Issue6 Pp. 609-614. 2010