LOW BACK PAIN

Back pain affects almost everyone at some time, causing restricted movement and untold misery, stress and discomfort.  It also causes millions of people to take valuable time off work, costing companies enormous sums in sick pay and lost production. [i]

 In 1999 The Royal College of General Practitioners updated their guidelines for the treatment of acute low back pain. The main points from these guidelines relevant to chiropractors are:

· Not to recommend the use of bed rest as a treatment method, as it is not as effective as alternative treatments for pain relief and likely to make back pain worse.

· Early intervention is essential for effective management and full recovery.

· Spinal manipulation is recommended for patients who are failing to return to normal activities. 

A conclusion from a prospective study involving sufferers of low back pain in the British Medical Journal (2/05/98), also supports the need for active and early intervention for the treatment of low back pain. The study alsocontradicted the previous claim in the BMJ that back pain resolved itself naturally. A follow up found that 91% of those in the survey were still experiencing back pain 12 months later. GP's had presumed incorrectly that because their back pain patients had not returned they were better. A more likely explanation was they were dissatisfied with the level of care and saw no point in returning, or they had gone for alternative treatment. In April 1999 the Family Chiropractic Centre in Kingston surveyed all the GP's surgeries in the Kingston and Richmond Health Authority for clear advice on acute low back pain. Only one surgery provided advice in line with their own guidelines. These facts were presented to the Kingston Primary Care Group at two consecutive meetings. The Primary Care Group eventually circulated a reminder of the guidelines to all their GP's members. Few GP's will admit, as Dr Phil Hammond does in his book Trust Me I'm A Doctor that "they are not very good at treating back pain". Most GP's are reluctant to refer outside the NHS, even though chiropractors are specially trained to identify and advise on the specific cause of your spinal dysfunction (back pain). The bones of your spine protect the spinal cord, sometimes they lose their normal motion or position (vertebral subluxation complex - link to subluxation), this can irritate the nerves that branch off the spinal cord to all the tissues of your body, resulting in pain being experienced. After the subluxation has been corrected by a chiropractic adjustment (manipulation - link to adjustment and pain control) and the adjustments are holding for a longer time, the chiropractor should offer advice on rehabilitation and maintenance care plan to prevent reoccurrence.  In order for the spine to be flexible, the vertebrae are joined together by soft tissue structures known as discs.  Each disc is made up of two parts – a central soft core and outer rings of tough cartilage.  The discs allow movement and also help to absorb shock.  A slipped disc is the rather inaccurate term used to describe the condition, often in the lower back, where trauma or ‘wear and tear’ have caused damage to the outer rings of cartilage, so that the core is squeezed outwards.  This can eventually result in a bulge which can press on the spinal cord, the nerve root or the nerve itself.  It can cause excruciating pain, either in the back or referred elsewhere – for example in the lower leg or foot.  Chiropractic care can mobilise the spine to reduce any pressure around the spinal cord or nerves.

The standard medical approach to back pain varies depending on the severity of the condition. Muscle relaxers, painkillers, bedrest and physical therapy such as traction, diathermy, ultrasound, hot packs etc.  This approach has not been found very helpful however.[ii]  If the problem doesn’t improve or worsens, then surgery may be performed.  The medical approach is at times necessary – even back surgery has a place.  But according to some studies, most spinal surgery for acute lower back problems should be rarely performed.[iii]  Many people who have had back surgery report a recurrence of their symptoms within a year or two of the operation and may return to the operating table.  In some cases the surgery makes no difference whatsoever, and in some cases it does give long-term relief.

The Chiropractic Approach

Chiropractors have helped millions of people with low back problems, often saving them from pain, disability, drugs and surgery.  The chiropractor’s purpose is to make your spine and its nerves, discs ligaments and muscles healthier, stronger and more stable by correcting your vertebral subluxation. Anyone suffering from a back problem should see a chiropractor to make sure they have no subluxations and have them corrected with a chiropractic adjustment if necessary.  This may make the difference between a life of ease, health and comfort or a life of pain, disease and disability.

What did the Government Studies reveal?

Low back pain sufferers have received very good news lately.  Major government studies from the US, Canada and UK have reaffirmed what chiropractic patients have been telling their friends with back pain for years:  “Why don’t you see my chiropractor?  You’ll probably get better much faster than from drugs or surgery- and it’s safer too.

What the British Researchers found

In 1991 the Medical Research Council sent shockwaves through the health care system when a definite public pronouncement established chiropractic as one of the preferred and most effective methods of care for acute adult low back pain. "Chiropractic almost certainly confers worthwhile long term benefits in comparison with hospital out patient management". "If all these patients were referred for chiropractic instead of hospital treatment, the annual cost would be about four million pounds. Our results suggest that there might be a reduction of some 290,000 days in sickness absence during 2 years, saving about 13 million in output and 2.9 million in social security payments". British Medical Journal, June 2nd 1990

A panel of medical experts spent 2.5 years reviewing nearly 4,000 studies and reported that expensive tests (MRI, CAT scans) and therapies typically used to diagnose and treat acute lower back pain (ice, heat, massage, diathermy) are largely useless.  Instead the experts recommended the non-drug chiropractic approach:  “The therapeutic objectives of manipulation include symptomatic relief and functional improvement.”[iv]

 What Canadian Researchers Found

The Manga Report was commissioned by the government of Ontario in Canada.  Leading economists found that chiropractic care for patients with low back pain is superior to medical care in terms of safely, scientific evidence of effectiveness, cost and patient satisfaction.

 “The higher satisfaction levels expressed by patients of chiropractors…offers an overwhelming case in favour of much greater use of chiropractic services in the management of low-back pain.

 “There should be a shift in policy to encourage and prefer chiropractic services for most patients with low-back pain…a very good case can be made for making chiropractors the gatekeepers for management of low-back pain in the workers’ compensation system.”[v]

The Facts speak for themseleves

“Scientific studies that have been done by medical physicians comparing chiropractic care with medical care and physical therapy non-surgical care of the back and neck show that doctors of chiropractic relieve chronic and severe pain, both immediate and long term, in one half the time it takes medical physicians not trained in chiropractic procedures…controlled empirical studies can and have been conducted.  There are not in excess of 60 scientific studies  which demonstrate the value of manipulation…manipulation is a most effective and cost-effective from of treatment for dysfunctional problems in the cervical, thoracic, and lumbar spines.”

 “For patients with acute low back symptoms without radiculopathy, the scientific evidence suggests spinal manipulation is effective in reducing pain and perhaps speeding recovery within the first month of symptoms.”[vi]

Chiropractic is better for you ?

Studies have shown chiropractic works better, is safer and less costly than standard medicine for lower back complaints.

 Why are the results so overwhelmingly in favour of chiropractic?  Because painkillers, muscle relaxers, Valium^TM, braces, physical therapy and surgery are not designed to correct vertebral subluxation.  Chiropractic is!