Back Pain Breakthrough - Update

Over the past couple of weeks, as I've had conversations with some patients about the recently released research regarding the use of antibiotics to help some forms of back pain (see earlier blog post), I've encountered some recurring questions. Patients wanted to ask about concerns over the long course of antibiotics required to get results in the study and antibiotic resistance. They also had questions about the quality of the research. Some were also surprised that I would openly talk to them about a back pain treatment that might result in less patients requiring treatment from chiropractors.

It seems to me that concerns over long courses of antibiotic used for treating any condition are real. Antibiotic resistance is an increasing problem. There are serious concerns about how long it will be before antibiotics are no longer effective for many common ailments. I suspect those with chronic, severe pain will be willing to take their chances if such treatment becomes openly available. Over time, if antibiotic resistance continues to develop, this treatment option may not be viable.

I was interested to read a review of this new research on the NHS Choices website. The article was generally complimentary about the quality of the study. It did however raise some questions about the impartiality of a neurosurgeon who has been quoted in much of the popular media in connection with this study. The emphasis now seems to be that further research is required to test the reliability and potential scope of this treatment protocol.

I will continue to talk openly with my patients about this topic. My aim is to help people recover from back pain and other musculoskeletal problems. It seems to me that the type of patients who may benefit from antibiotic treatment, are patients who are less likely to make good progress with standard chiropractic treatment and if there is another potentially more effective treatment option available, I will be very happy to recommend it.

Finally, if you are interested in reading the research in full click here.

Guest Post: Treadmill desk update

I'm still walking as I work. It's a bit addictive to be honest and it's starting to feel odd when I sit down. The walking doesn't seem to require any extra thought and it's really easy to concentrate on other things while my feet move. 

One of the great things about the desk space is it's big enough to hold huge piles of student essays, stories and a rather odd PC solution (while I decide what to do about my ancient, but very much loved laptop). I've got a monitor propped up on packs of A4 paper so it's at eye level which works well (there's probably a more aesthetically pleasing solution, but I'm quite happy with it like this).

I've walked more than 40 miles in the past 3 weeks. I had expected the total to be higher and I think it may have something to do with the amount of time I've spent reading and marking student work - I found I needed to walk really slowly as I did this, sometimes at 0.5 mph - perhaps slower speeds are necessary for contemplation.  

Now that I'm back to editing my novel a steady 1.4 mph seems to be working pretty well and I take back what I said previously about not being able to eat or drink while walking - it's actually pretty easy (although probably not recommended).

The children love the desk, too. They like to take it in turns to use it for homework - and anything that makes homework more enjoyable gets a massive thumbs up from me.

Carys

Back Pain Breakthrough

The European Spine Journal has just published a new piece of research which may prove to be a breakthrough for sufferers of some types of chronic low back pain. The type of person who may benefit from this breakthrough is one who has experienced a disc herniation, often referred to as a 'slipped disc'.

It has been observed that on MRI (Magnetic Resonance Imaging) scans individuals who have disc herniations will also often have changes in the appearance of the bone in the adjacent vertebrae. These changes are described as modic changes. The cause of these vertebral changes has until recently been unclear, however it is now thought that they are caused by a low grade bacterial infection within the spine.

This new research (a double blind RCT) investigated the effect of a 100 day course of antibiotic treatment for patients suffering with low back pain of greater than 6 months duration. These subjects had confirmed disc herniation and vertebral modic changes on MRI scans. The results showed that the group treated with antibiotics had a highly significantly greater reduction in back pain and back pain related disability at 1 year follow-up when compared with the control group who took the placebo.

In my chiropractic practice I certainly see some patients who may benefit from this new treatment. I don't as yet know how the national health service here in the UK will respond to this new research. It appears that there may already be some private options for those keen to investigate this further.

It should be noted that this treatment is not for all chronic back pain patients. Back pain is common; said to affect 80% of people at some point in their lives and nearly 50% of people are likely to have an episode of back pain at some point this year. This new treatment looks most likely to help those with severe, chronic back pain following a disc herniation confirmed by MRI.

Chiropractic continues to be well positioned to help treat simple or mechanical low back pain as outlined in 2009 NICE Guidelines. I am however excited by this new research as it may provide a new and effective avenue to help some sufferers of back pain.

Finding My Feet

A few years ago a good friend of mine took the bold decision to live a barefoot lifestyle. Steve Bloor of Natural Feet is bio-mechanical podiatrist with a particular interest in foot and lower limb mechanics. He was instrumental in the development of a barefoot trail created by the National Trust and also runs a weekly barefoot walking group. Following conversations with Steve I decided to try out some barefoot activities for myself. I read 'The Barefoot Book - 50 Great Reasons To Kick Off Your Shoes'. It reminded me how important proper foot function is to the ankles, knees, hips, pelvis and spine. I learned that removing the artificially flat, smooth cast of a shoe improves proprioception (the ability of the body to know exactly what position and where the limbs are relative to the rest of the body).

For about a year now I've been experimenting with a little barefoot running and walking. Last Autumn I attended a workshop run by Anna Toombs and David Robinson from Barefoot Running UK. They evaluated my shod running style and then taught, evaluated and corrected my barefoot running technique. Thanks to my training as a chiropractor much of the theoretical instruction was just revision, however I came away realising that running in shoes and running barefoot are quite different activities. When running barefoot, strides are shorter and faster, knee lift is higher, the feet strike the ground fairly flatly and are directly under the hip when ground contact is made. You also run with very light steps.

The past winter has felt very long and cold and I've not been inclined to brave the world while barefoot on more than the odd occasion. Spring finally seemed to arrive in Liverpool two or three weeks ago, so since then I've put my 'best (barefoot) foot forward' and got out for some barefoot walking and running at least a couple of times each week.

Yesterday was the 2013 International Barefoot Running Day. Official events were organised in countries all over the world. The UK event was held in Brighton. Unfortunately the distance between Liverpool and Brighton is over 270 miles, so it was impractical to join the official UK event. A small group of keen 'athletes' joined me for our own local event around Hesketh Park in Southport. We ran a refreshing 2km around the circumference of the park on the wonderfully smooth  and forgiving surface of quarry tiles. Thanks to those who joined me in our little local Barefoot Running Day. My appreciation also goes out to Steve, Anna and David for their invaluable instruction, which has helped me find my feet again.