Chiropractic Manipulation Benefits Back Pain Sufferers

A study has just been published in the medical journal Spine titled 'Adding chiropractic manipulative therapy to standard medical care for patients with acute low back pain: the results of a pragmatic randomized comparative study'. It compared outcomes of acute low back pain patients treated either with standard medical care (consisting of pain killers, anti-inflammatories, education about self management, physical therapy and referral to a pain clinic) with patients treated with standard medical care plus chiropractic manipulative therapy (consisting of spinal manipulation and ancillary treatments as indicated, performed by a chiropractor).

At 2 and 4 week follow-up the patients treated with chiropractic manipulation combined with standard medical care reported significantly less disability and pain than did those who received standard medical care alone.

73% of patients in the group which included chiropractric manipulation reported that their pain was either completely gone, much better or moderately better. The figure was 17% in the standard medical care only group.

Finally, the group whose treatment also included chiropractic manipulation had higher satisfaction ratings of 8.9 compared with 5.4 (on an 11 point numerical rating scale) in the standard medical care only group, at 4 week follow-up.

The study does have some limitations (slightly disappointing follow-up rates especially in the standard medical care group; participants and clinicians were not able to be blinded to treatment group assignment) however the overall take home message seems to be that chiropractic treatment for patients with acute low back pain can significantly improve outcomes compared to standard medical treatment alone.

I treat a lot of back pain in my practice and this study supports what I see day to day. It also correlates with the recommendations in the National Institute of Clinical Excellence (NICE) guidelines published in 2009 (page 6-7) regarding the treatment of recurrent or persistant back pain.

Chiropractic spinal manipulation may be the missing link in your recovery from back pain!

Ergonomics

A national newspaper last week reported on a study that found  'Badly set up desks and chairs cost companies more than £7 billion a year in sick pay'. I see patients very regularly who are suffering with neck and shoulder pain, headaches, and back pain. Many of them do not remember a single incident which caused these problems. Further questioning will often reveal that they sit at a desk most of the day. Then in the evening they sit on the sofa with a laptop on their lap for another hour or two. Such a lifestyle can be a recipe for problems.

As you may have seen in some guest posts written for this blog by Carys over the past few weeks, we've just invested in a treadmill desk, which we bought from Gym World. Carys uses it for several hours, most days of the week, as she gets on with her writing. She thinks it's great. A big advantage of working at a treadmill desk is that you are not sat still for what sometimes turns out to be hours at a time. Prolonged sitting at a desk can put a lot of stain on the lower back. I don't believe we were designed to sit nearly as much as many of us do.

Our treadmill desk is set up for Carys to use. The desk height is set so that her elbows are almost bent at right angles. This means her wrists rest comfortably on the foam rubber wrist pad on the front edge of the desk while she's typing. We raised the monitor by placing two reams of paper under it so that it is now just slightly lower than her eye-line. A little further adjustment may still be needed. Having the monitor and desk at the correct height is critical as it can significantly reduce the strain on the neck and shoulders, and lower back. Getting these factors (the ergonomics) right is really important.

When I use the desk I have to adjust the height. I need it to be at least two or three settings higher than Carys because I am several inches taller than she is. This can be done by one person, but is more easily accomplished by two people. The desk is sturdy and heavy, so making the adjustment is a bit of a hassle. If I was planning to use the desk more regularly I would be considering upgrading to the desk which has electronic height adjustment. I would strongly recommend this option for anyone planning to use a treadmill desk in an office where it would have several users - a hot-desk.

The above mentioned report also found that 'Half of office workers say they've had no work station risk assessment in the last 12 months'. Employers should perform these assessments so employees need not be afraid to ask for them. There are also some useful self help guides on-line to assist you in setting up your own work station. I like this one produced by Boston University.

Laptops are a very practical computing solution for many due to their portability. They can however pose some real ergonomic problems. On a desk or table top the screen is likely to be too low and when placed on a higher surface the keyboard will probably be too high. When used on the lap, upper body posture is usually horribly rounded. Neck and shoulder pain and associated headaches are common consequences. The use of a laptop stand, an external keyboard and mouse and separate monitor can all help. I like the pointers this video clip provides for various situations in which a laptop may be used. You can also look at the Open Ergonomics illustrations produced by Loughborough University for further detailed set up advice.

Finally, if you're still experiencing pain, get in touch and I'll do my best to help you.

Book Prescriptions

Today I learned that in some areas of the UK the NHS is providing Book Prescriptions. It is a scheme that aims to help people with mild or moderate emotional problems to make use of high quality self-help books. It has proved to be very successful. GPs and other health professionals recommend/prescribe a therapy book which the patient can then go and borrow from the library. Through reading the book patients are better able to understand their problems and learn more about possible strategies they can employ to help themselves. This is good as it helps the patient feel more engaged and committed to the process of getting better.

This principle is also very relevant to chiropractic care. I encourage patients to get involved in their own care because getting better and improving health is a partnership. I provide some hands-on treatment at the clinic and then I send patients away to do some things to help themselves. I may ask them to do something simple, such as take a 20 minute walk each day or wrap a tea towel around an ice pack and apply it to the painful area for 10 minutes every few hours.

Sometimes I also recommend that a patient read a book, or a chapter of a book. I usually suggest the patient buys the book but occasionally I lend patients my own copies. Books I have recently recommended/prescribed are:

The Barefoot Book by Daniel Howell
Trigger Point Therapy for Myofacsial Pain by Donna Finando
Back Care Basics by Mary Pullig Schatz
Treat Your Own Back by Robin McKenzie

Let me know if you can think of others I should consider.