The first question to ask is the why question – check this great blog out for why it’s hurting :
causes of low-back pain.
Posts Tagged ‘chronic low-back pain’
I’ve got low-back pain and leg pain – can chiropractic help?
Monday, October 19th, 2009Prevention of low-back pain at work – what really works?
Monday, August 24th, 2009Low-back pain at work – what really does prevent it happening?
Well, I’ve banged on about it enough to my patients and now, as always, I’ve been proved right.
Firstly, you have got to understand that you are built on the design brief of Palaeolithic Man. In this massive design brief slapped down by God (or what ever supreme deity you want, such as ‘The Force’) there was no chapter on sitting on your butt and peering into a computer for 8 hours on the trot and there was no annex that that covered ‘Future proofing’ the structure. No, the main pages would have covered: ‘Running fast for a short distance to avoid predation’ and ‘Walk/Running for a long distance to improve chances of killing mammoth’.
So, your work posture is a real challenge to your body as it is a demand that is wildly outside the design brief, similar to using your car to climb trees, so no wonder it hurts.
The next point is that no manner of fancy chair, desk height re-alignment is going to make THE difference – yes, it will be less-bad for you than a really crappy one but you’ll still be in the region of bad and it will never be the answer. (And the best would be a height changing desk that allows you to stand at the thing every now and then – search the web). So, get a decent desk, a decent chair (IKEA £50 is what I am using) and save the money on some of the ‘orthopaedic products’ out there.
Why do I say this? Well look at this bit of really solid recent research:
The paper is called:
High-quality trials on preventing episodes of back problems: systematic literature review in working-age adults
It was produced by Bigos SJ, Holland J, Holland C, et al. from Department of Orthopedic Surgery at the University of Washington and published in the serious Spine Journal in 2009; 9: 147-168.
The study looked at clinical or educational approaches (exercise or education), personal appliances (back supports or shoe inserts), ergonomic equipment (lift assists etc.), changes in physical activities or work duties and administrative or social interventions such as work policies or social changes. All trials included had high quality scores, 90% investigated workplace settings, and 50% involved health care workers and, eventually, 20 prospective controlled trials were included and evaluated. Of these 20 rigorous trails 5 measured objective outcomes and the remaining 15 measured only subjective outcomes.
At the end of the day Exercise was the only intervention found to be effective. 7 out of 8 exercise trials reported statistically significant reduction in back pain and 5 of the 7 successful exercise programs included 45-60 minutes of supervised exercise, twice per week for 3-12 months (most also encouraged additional exercise without supervision).
The exercise techniques included McKenzie (Google that one), active and passive back extensions, core stabilization, “Williams” exercises and Mensendieck trunk exercises (again, Google).
NO other intervention was found effective in reducing back pain.
And, negative results were found in all studies on ergonomic/back education, stress management, lumbar supports, shoe inserts, and programs for reducing lifting tasks.
So, the story is that the exercise that your Palaeolithic ancestor did is exactly the stuff you need to do to survive doing strange things with your back to prevent it going wrong. No wonder we advocate core stability, rehab and sports therapy at C1. We can get you right but you must keep yourself there.
So stop putting your faith in futuristic looking mesh back multi adjustable seats and desks made from dolphin-friendly ethically resourced wood and get some core stability into you and then go for a run.
Makes sense, yes?
‘Trapped nerve’: what sort of junk diagnosis is that?
Thursday, July 30th, 2009Agggghhhhh, so another utterly cod diagnosis arrives on my mat. A friend’s son is ‘diagnosed’ with a trapped nerve. He is 8 and has pain on extension, flexion and rotation but the pain is localised and really, really nasty and with some epic muscle tightness in his lumbar region.
After a bit of questioning it is bloody obvious that he’s got a posterior facet syndrome which with a bit of care and a load of ice will come good fast – which it does and he’s ready to climb a Welsh mountain a few days later.
But it got me fuming about ‘trapped nerves’ and what an utterly piss-poor diagnosis this is, it sits up there with lumbago and ague as a really lazy bit of work. Now, I admit a nerve entrapment is entirely possible – just google entrapment neuropathy and you’ll get some real spot-on diagnosis such as medial plantar neuritis and thoracic outlet syndrome. These nerve entrapments are crackers and really obvious and clear cut once you are thinking right. However, to achieve the same sort of thing in your lumbar region is a far, far trickier thing.
Consider the anatomy and what you’d have to do to pinch or trap a nerve. The most simple to imagine would be a classic disc herniation or prolapse, the bulge in lay-terms. Now this can compress the nerve root in the back but these are rare, have a raft of pretty convincing signs and symptoms, such as electric pain down the nerve, and you don’t recover from these at all quickly. The second thing you could do is have some soft tissue structure compress the nerve root (a lateral or central stenosis) or a space occupying lesion (far more scary) but, again, this is rare and usually very obvious with a raft of red flags to watch out for.
So, if you visit your doctor with low-back pain sometimes with pain running across the width of your back and possibly some referred pain down you legs to above your knee or knees and you are told you have a ‘trapped nerve’, like my friend’s son, raise a quizzical eyebrow and say the following:
“Which nerve and where can it be trapped or are you just fobbing me off because I’ve spent more than my allocated 5 minutes in your office?”
Because I bet you have a posterior facet syndrome with widespread muscle guarding which is chiropractic business.
Are Chiropractors spinal health experts?
Monday, July 13th, 2009Chronic low-back pain is the most expensive cause of pain and disability in working age adults. In the drug keen US of A in the eight years from 1997 – 2005 there was a 65% increase in spine care costs, with the biggest increase being in drugs which rose to a vast $19.8 billion – or an increase of 188%. In 2005 the total health bill for spine problems was over $85.9 billion or 9% of the total national US expenditure on health – only heart disease and stroke were more costly. However, at the same time as this increase in expenditure occurred the health status of the patients got worse with 1 in 4 patients with chronic low-back pain reporting physical limitations.
It is also pretty badly handled by the NHS, with the rush to surgery being far too fast and little to fill the gap between a fist full of pain-masking pills and a knife in your spine.
The great journal ‘The Spine Journal’ (Focus Issue on Chronic Low-back pain – 2008) suggested that “a reasonable approach to CLBP would include education strategies, simple analgesics, a brief course of manual therapy in the form of spinal manipulation, mobilization or massage, and possibly acupuncture”. All of this is provided by skilled practitioners in the clinic, C1 Chiropractic Health Centre.
The report also and adds, damningly, about the allopathic medicine providers: “there is clearly no consensus that commonly used diagnostic tests hold any value in the decision-making process before offering a treatment for CLBP” and this “brings into question the routine use of laboratory testing, x-rays, CT, MRI, discography, nerve conduction velocity and electromyography”.
All this is available on www.sciencedirect.com/science/journal/15299430 – vol 8 issue 1.
So, who’s got the answers – clearly not the medics but I’d suggest the spinal health experts such as those at the clinic.