Chiropractic Can Prevent Back Pain

Back pain is a very common condition, affecting one out of three adults. Experts estimate that chronic back pain costs the US about $100 billion each year in direct and indirect costs. As with all health issues, it’s better and easier to prevent back pain than it is to treat it after it occurs. A recent study set out to see if chiropractic was effective in treating chronic low back pain and preventing flare-ups in the future.

The authors studied 30 patients who had back pain for at least six months. All patients were subjected to a one-month control period that consisted of no treatment. This was included so that the researchers could observe the natural course of the back pain symptoms.

After this baseline period, half of the patients received intensive chiropractic treatment consisting of 12 treatments in one month, then no treatments for nine months. The other half of the patients received the same intensive treatment, but also received maintenance chiropractic treatments every 3 weeks for nine months. At the end of the nine-month period, both groups were again examined.

The authors found that both groups experienced a dramatic reduction in pain from the treatments that lasted during the entire study period. The patients who received continuing care, however, had significantly reduced disability from their back pain, while the patients who received the initial care with no follow-up had their disabling symptoms return to pre-treatment levels.

The authors conclude that chiropractic is effective at relieving pain and keeping your back healthy over the long term. If you or someone you know is suffering from back pain, give us a call us at for an appointment.

Descarreaux M, Blouin JS, Drolet M, Papadimitriou S, Teasdale N. Efficacy of preventive spinal manipulation for chronic low-back pain and related disabilities: a preliminary study. Journal of Manipulative and Physiological Therapeutics 2004;27:509-514.

Chiropractic "Effective Treatment" of Whiplash

Over the last ten years, a great deal has been written on the problem of whiplash biomechanics, but little study has been done on treatment of whiplash injuries. As the authors of a new study write, "Conventional treatment of patients with whiplash symptoms is disappointing." ¹

This study examined the effectiveness of chiropractic treatment in patients with chronic whiplash pain. The mean time from injury to treatment was about 12 months.

The authors began with 93 patients with chronic whiplash pain and divided them into three groups:

Group I: patients with "neck pain radiating in a 'coat hanger' distribution, associated with restricted range of neck movement but with no neurological deficit."

Group II: patients with "neurological symptoms, signs or both in association with neck pain and a restricted range of neck movement."

Group III: patients who described "severe neck pain but all of whom has a full range of motion and no neurological symptoms or signs distributed over specific myotomes or dermatomes." These patients also "described an unusual complex of symptoms," including "blackouts, visual disturbances, nausea, vomiting and chest pain, along with a nondermatomal distribution of pain."

The patients underwent chiropractic treatment for 4.1 months, with a mean of 19.3 treatments per patient. The patients were graded before and after treatment on a four-point scale that described their symptoms:

Grade A was the absence of symptoms. Grade B patients had symptoms described as a nuisance. Grade C patients had symptoms that were intrusive. Grade D patients had symptoms considered disabling.

The authors found that in Group I, 72% of the patients improved; in Group II, 94%; and in Group III, only 27% of the patients reported improvement. So, there seem to be certain factors that can increase or decrease the effectiveness of chiropractic with these patients.

The study discusses the ramifications of the findings:

"Woodward et al² found improvement in chronic symptoms in 26 of 28 patients (93%) following chiropractic treatment. Our results confirm the efficacy of chiropractic, with 69 of our 93 patients (74%) improving following treatment.

"Our study suggests that such a group of nonresponders does exist, represented by group 3. The defining characteristics of patients in this group were the full range of neck movement in association with neck pain, bizarre symptoms, female sex and ongoing litigation. The mean age of the group at 29.5 (16-43) was lower than that of the other two groups (mean 36.8, range 18-65).

"The results from this study provide further evidence that chiropractic is an effective treatment for chronic whiplash symptoms. However, our identification of a group of patients who fail to respond to such treatment, highlights the need for a careful history and physical examination before commencing treatment."

The authors conclude: "Whiplash injuries are common. Chiropractic is the only proven effective treatment in chronic cases."

1. Khan S, Cook J, Gargan M, Bannister G. A symptomatic classification of whiplash injury and the implications for treatment. Journal of Orthopaedic Medicine 1999;21(1):22-25.
2. Woodward MN, Cook JCH, Gargan MF, Bannister GC. Chiropractic treatment of chronic whiplash injuries. Injury 1996;27:643-645.

Chiropractic Increases Spinal Flexibility for Low Back Pain

For many people who suffer from low back pain, chiropractic treatments ease their symptoms and increase flexibility. But why does it work? And which patients are most likely to benefit? Recently, a team of researchers based in the United States and Australia set out to investigate the effect of one chiropractic technique on spinal stiffness in patients with low back pain. They found that chiropractic manipulation can have an immediate effect on spinal stiffness and muscle growth in certain patients.

Repeated studies have confirmed the effectiveness of high impact, low velocity spinal manipulation (SMT) for reducing low back pain. Yet although it is known that SMT has a direct effect on spinal muscles, and that it stimulates a patient’s nervous system, many questions remain about exactly how SMT works. For this study, the researchers recruited 48 subjects with low back pain from physical therapy clinics and through community advertisements. The subjects were evaluated for several factors that might decrease the likelihood that their treatment would succeed – factors such as longer length of injury and fear avoidance (avoiding activity because of the fear that it may cause pain).

Each participant underwent three SMT sessions, held over a one-week period. Before and after each session, the participants rated their pain levels on a scale of 0-10 and were measured for spinal stiffness. The researchers also took ultrasounds to assess the thickness of the patient’s back muscles.

Their results showed that after patients received SMT, there was an immediate and measurable improvement in stiffness. The patients also reported experiencing less disability from their low back pain after SMT. In their measurements of muscle growth, researchers found that muscle thickness increased more quickly in patients who had been categorized as likely to have a positive outcome. This muscle increase lasted through the one-week follow-up period, which indicates that the benefits of SMT could be prolonged, especially when combined with exercise treatments designed to build muscle in the lower back.

Although the researchers acknowledge that their sample size was small, and their results preliminary, these findings help confirm that chiropractic can have immediate beneficial effects for patients suffering from low back pain. They also show that the human body has a complicated reaction to SMT, with both stiffness and muscle thickness playing a roll in the outcome of treatment.

Fritz JM, Koppenhaver SL, Kawchuk GN, Teyhen DS, Hebert JJ, Childs JD. Preliminary investigation of the mechanisms underlying the effects of manipulation: exploration of a multi-variate model including spinal stiffness, multifidus recruitment, and clinical findings. Spine. 2011 March 15.
 

Chiropractic Can Be Effective Treatment of Work-Related Sciatica

Work-related sciatica is clinically challenging and an expensive problem for our health care systems. One recent study found that workers with sciatica are significantly more likely to be prescribed opioids for their condition.¹ Another study found that workers with low back pain and sciatica showed the highest level of disability of all back pain patients.²

With these issues in mind, the orthopedic medicine department of a hospital in Norway has examined the effectiveness of chiropractic treatment with patients with severe sciatic pain. This new study³ looked at 44 workers who presented at the hospital with severe sciatic pain that required hospitalization. “The patients underwent clinical, neurologic, and radiological examinations as well as laboratory screening, including urine specimens, parameters of infection, and system diseases.”

The hospital chiropractor then performed a chiropractic examination on each patient that included an analysis of posture and gait, passive and active range of motion, and palpation of the lumbar spine. “The main treatment consisted of joint adjustment techniques of the lumbopelvic fixations, usually performed in a side posture position...Joint adjustments in other parts of the spine and limbs were usually necessary as a result of the compensatory dysfunction.” Ice treatment was applied after the adjustment, since there was soft-tissue soreness experienced by the patients.

“Patients were treated daily while they were in the hospital; they were treated for 3 days a week for the first 2 weeks while they were in the clinic. Depending on need, some patients received follow-up treatment once or twice a week for some time. Following Norwegianpublic health regulations, cost refunding is limited to 14 treatments; therefore, the total number of treatments rarely exceeded this number.”

The authors found the following:

• All of the patients had experienced three or more weeks of pain before hospitalization.
• 35 patients underwent MRI and 7 had CT scans; there were no structural changes on any of the imaging tests.
• After the treatment, 40 patients (91%) returned to work full-time within an average of 21.1 days.
• Two patients returned at reduced work levels: one at 80% and another at 50%.

“The positive effects of cooperation between orthopedic surgeons and chiropractors may be measured in the reduced duration of sick leaves.” The study refers to Norwegian public health records that show that the average patient with sciatica is disabled for 72 days; in this study, the time to return-to-work was just 21 days—a 70% reduction.

The authors point to how chiropractic can improve functioning in the spine:

Stimulation of “muscle spindles caused by sprain strain has been shown to be capable of starting a long-lasting train of action potentials in the motor neuron (i.e., long-lasting muscle contraction in the motor unit in question). Similarly, a brief inhibitory impulse, such as that from antagonistic muscles, may stop the signal train in the motor neuron. Chiropractic joint adjustment probably provides a similar inhibitory impulse. The chiropractic joint adjustments must cross the barrier of passive joint motion range to stimulate muscle spindle receptors.”

1. Stover BD, Turner JA, Franklin G, et al. Factors associated with early opioid prescription among workers with low back injuries. Journal of Pain 2006;7(10):718-25. 
2. Arana E, Marti-Bonmati L, Vega M, et al. Relationship between low back pain, disability, MR imaging findings and health care provider. Skeletal Radiology 2006;35(9):641-7.
3. Orlin JR, Didriksen A. Results of chiropractic treatment of lumbopelvic fixation in 44 patients admitted to an orthopedic department. Journal of Manipulative and Physiological Therapeutics 2007;30:135-139.

Chiropractic More Effective Than Physical Therapy for Back Pain

Numerous studies have shown that chiropractic can be an effective treatment for patients with low back pain. Now a new report¹ has looked further into the effectiveness of chiropractic by comparing it to physical therapy treatment, and, more significantly, studying the long-term benefits of chiropractic as measured by the annual number of office visits.

Most studies that look at long-term effects of treatment simply look at self-reported outcomes: level of pain and disability. This study took a different approach. By examining how much care patients sought after the initial study period, they could determine the effect each treatment method had on future health care consumption:

“Care seeking behavior by patients with low back pain is most commonly associated with increased pain and disability, meaning more care is sought when worse symptoms are experienced. The amount of health care utilized may therefore be used as a measure of patient health status, and thus may be compared between groups of patients to determine effectiveness of certain therapies.”

“Proctor et al.² determined that about 25% of patients with chronic, disabling, work-related musculoskeletal disorders pursue new health care services after completing a course of treatment, and among those who sought additional health care from a new provider, a subgroup of <15% accounted for a disproportionate share of lost worker productivity, more surgical procedures, and ongoing financial disputes. They further stated that in patients with chronic, disabling, work-related musculoskeletal disorders, post-treatment utilization of health care from a new provider is an important dimension of outcome…”

The authors started with 191 patients with low back pain. 107 patients received chiropractic care (flexion/distraction treatment, or FD) and 84 patients received active exercise therapy (EP) from physical therapists. All patients received treatment 2 to 4 times per week for four weeks. The study subjects were then followed for one year to assess outcomes. The authors found:

• 38% of the FD patients and 54% of the EP patients sought care for their back pain during the one-year follow-up.
• FD patients had an average of 2.2 visits to a health care provider after the treatment period, while EP patients had an average of 6 visits.

“We hypothesized that there would be no group difference in the average number of visits to any health care provider. The results demonstrated that actually there were significant group differences during the year after trial participation, with a higher number of visits to any health care provider and to a general practitioner in the EP group.”

The authors conclude:

“Based on one-year follow-up data imputed for complete analysis, participants who received physical therapy (exercise program) during a clinical trial attended a higher number of visits to any health care provider and to general practitioners during the year after care when compared to participants who received chiropractic care (flexion distraction) within the trial.”

1. Cambron JA, Gudavalli MR, McGregor M, et al. Amount of health care and self-care following a randomized clinical trial comparing flexion-distraction with exercise program for chronic low back pain. Chiropractic and Osteopathy 2006:14:19.
2. Proctor TJ, Mayer TG, Gatchel RJ, McGreary DD: Unremitting health care utilization outcomes of tertiary rehabilitation of patients with chronic musculoskeletal disorders. Journal of Bone and Joint Surgery 2004, 86A:62-69.

Chiropractic Reduces Unnecessary Interventions in Low Back and Neck Pain Cases

Over the last few years, there have been increasing pressures to reduce the costs associated with treating low back pain, while, at the same time, increasing the effectiveness of that treatment. A recent study¹ sums up the problem:

“A growing body of clinical evidence and expert opinion indicates that a more conservative approach to the treatment of low back pain and cervical spine pain is appropriate. The evidence indicates that procedures and practices such as inpatient care, advanced imaging, surgery, and even plain-film radiographs are only infrequently necessary for the successful treatment of most cases of low back pain and neck pain.

“In spite of the evidence, these procedures and practices continue to be used at rates in excess of that which the published literature defines as clinically indicated.”

Previous studies have found that chiropractic adjustments can be an effective treatment modality for certain types of low back and neck pain. In this current study, the authors set out to examine the “effects of managed chiropractic benefit on the rates of specific diagnostic and therapeutic procedures” for the treatment of these patients.

The authors analyzed the claims data from a managed-care health plan over a period of four years. The study looked at four different medical procedures and tests and compared employer groups that provided a chiropractic benefit with those that did not.

The authors found reductions in nearly every area per episode of back pain or neck pain in the groups that had a chiropractic benefit:

This is not the first study to find that chiropractic care reduced overall costs when included in managed care programs. A 2004 study² also found that these patients had a lower utilization of plain film radiographs, MRI, hospitalizations, and surgery.

The 2004 study put forth four possible explanations for these findings:

1. Positive risk selection.
2. Substitution of chiropractic for traditional medical care.
3. More conservative, less invasive treatment protocols.
4. Lower health service costs associated with managed chiropractic care.

These two studies show that not only can chiropractic care be an effective treatment for certain patients with low back or neck pain, it can also reduce the use of unnecessary and expensive interventions:

“Among employer groups with chiropractic coverage compared with those without such coverage, there is a significant reduction in the use of high-cost and invasive procedures for the treatment of low back pain and neck pain…The resultant chiropractic care is far less likely to lead to the use of these invasive procedures.”

1. Nelson CF, Metz RD, LaBrot T. Effects of a managed chiropractic benefit on the use of specific diagnostic and therapeutic procedures in the treatment of low back and neck pain. Journal of Manipulative and Physiological Therapeutics 2005;28:564-569.
2. Legorreta AP, Metz RD, Nelson CF, Ray S, Chernicoff HO, Dinubile NA. Comparative analysis of individuals with and without chiropractic coverage: patient characteristics, utilization, and costs. Archives of Internal Medicine 2004;164(18):1985-1992.