Fact 4- Low Back Pain, Global Crisis. Why Doesn’t Evidence inform Practice?

Low back pain is SO COMMON in our society. Recent global studies showed that at any given time, approximately 540 MILLION people are affected. This is crazy!!  Despite medical and societal advances, the experts have gotten WORSE at treating low back pain and its resulting disability. Research suggests this is because low back pain is multifactorial, complicated, and often has no major tissue damage cause (only around 1% in higher- income countries). Instead, the causes include a combination of biomechanical, psychological, and societal factors.  The most important of these appear to be: smoking, obesity, low levels of physical activity, and life stress.

Research has been changing rapidly as to what the best prevention and treatment modalities are for low back pain. What are the worst and least supported? Surgery, pharmacological medications, and rest. Which treatments are the MOST SUPPORTED by research? SELF-MANAGEMENT, PHYSCIAL AND PSYCHOLOGICAL THERAPIES, AND SOME COMPLEMENTARY MEDICINE. Yet there is a disconnect and less than 50% of those with chronic low back pain receive any information on exercise as a treatment. It is my hope that myself and other chiropractors, physical therapists, and primary care physicians can start to utilize the guidelines, minimize passive therapies and begin to move the population toward a more healthy, active lifestyle and, almost by accident, reduce the overwhelming impact of low back pain on our population.

All of the above mentioned facts were found in papers from the Lancet 2018 series on low back pain. Both papers are relatively easy to read and have AMAZING, RECENT INFORMATION for those interested. Reach out for more information!

1. What low back pain is and why we need to pay attention
2. Prevention and treatment of low back pain: evidence, challenges, and promising directions

Fact 3-Guidelines for neck and whiplash pain- manipulate and mobilize away!

How many people out there have been in a car accident or just a bad fall and felt…neck pain? Almost everyone of us at some point. Whiplash and neck pain are so common that hundreds of studies have been done in order to find the best clinical guidelines for treatment. One of the most recent reviews from 2016 found that neck and whiplash pain is best treated with a multi-treatment approach. After looking at hundreds of studies, they found that manipulation is best in the acute phase. This should be paired with range-of-motion work at home.

For more chronic injuries, the manipulation and home exercise is still applicable, but also with stress management, soft tissue work, high dose massage and yoga. There is a lot of variability in the way to apply these techniques, how much exercise or movement, and how much supervision from exercises and training. These guidelines support chiropractic treatment for these common injuries (YAY) and I cannot wait to apply them in the future.

Source: The Treatment of Neck Pain–Associated Disorders and Whiplash-Associated Disorders: A Clinical Practice Guideline- 2016

Fact 2- The doctor you visit = your care for back pain. WHAT?!

Imagine for a second that you have had back pain for 3 months and decide you are FINALLY going to a visit a doctor. So where do you go? Well if you go to your primary care physician you will probably get a pain medication. If you go to a physical therapist, you will get rehabilitation. If you go to a surgeon, you will get an injection or surgery. If you go to a chiropractor, you will get adjusted. If you go to a massage therapist, you will get a massage. Do you see a problem here? I DO!!!

Dr. Donald Murphy spent 30 years practicing as a physician and realized early on in practice that back pain was complex. There are hundreds of potential problems, patients can have more than one of these at a time and there are emotional, social, and psychological factors as well! So when you go to any of the above doctors, do they ask enough questions to cover all of the potential issues?  Usually not. Research has shown that patients with low back pain must follow a “supermarket approach” and visit many doctors and “shop” for a solution. One or two types of physicians may not provide a solution and therefore the patient must spend time and expenses to find the proper treatment or help. Dr. Murphy realized this was a problem and with others agreed that the world needed a primary spine care physician to deal with back pain. He and others wrote plenty of research articles and books describing how to approach low back pain.

These patients need a system in place so current doctors (and future ones like myself!) can help as many patients with low back pain as possible with what THEY need, NOT what the doctor has in their skill tool box. Dr. Murphy and others have done the research and have inspired me to put their work into practice in the future for those patients who need the new, modern, specific, diagnosis-based approach.

Fact 1- Chiropractic and Stroke

Why is my first fact going to be about stroke? I have been asked multiple times “wait, but can’t chiropractic adjustments cause a stroke?” Now personally, I never wondered or worried about this, thinking no that cannot be possible. But as I progress through school, I see more and more patients and people who are terrified of having their neck adjusted or of chiropractic in general. So I wish to tell you what the literature says about chiropractic and stroke.

So a stroke is a lack of blood supply due to a clot or a leak in the body’s blood vessels. What causes most strokes? High blood pressure, diabetes, tobacco use, and medications. There are also hundreds of different types of strokes that can occur. The ONE type of stroke that causes the controversy with chiropractic is the vertebrobasilar stroke (because the vertebral and basilar arteries are the ones on the back of the neck where adjustments take place). Now what do you feel when these strokes are starting to occur: head and neck pain. Where do you go for this? You either ignore it, go to your primary care physician, or your chiropractor!! That is what a large 2008 study found. When this very rare stroke type occured (818 out of 109 MILLION strokes over 9 years, 0.00075%!) the patients were just as likely to visit the primary doctor as the chiropractor for that pain (Cassidy et. al, 2008). In a recent 2015 study, even patients aged 66-99 (those who experience the most strokes), there was low incidence of VBS and again, no more chiropractic visits than medical visits in those cases (Whedon, J, 2015, JMPT).

Though there are many other research studies out there showing this same conclusion (that you are more likely to see a chiropractor for the symptoms you are expereincing RATHER than the chiropractor causing your symptoms), there remains controversy. If you go to the ER experiencing symptoms, the first question may be “have you seen a chiropractor?” Not have you fallen and hit your head? Do you have hypertension? Or diabetes? Or use tobacco? Which are thousands of times the more common causes. If you wish to continue this conversation, PLEASE DO! I love to talk about chiropractic and all the amazing things that it can do, but I understand that fear is prevalent and a 1 in a billion chance is still a chance. I’d love to tell you about the modifications that can be made to adjusting the necks of highly susceptible-to-stroke patients. Just remember, not everything you hear in the news or see on the internet is fact. This above is the real fact, according to research.