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Virtually all human beings suffer from back pain at some point in their adult life. According to the American Pain Foundation, more than 26 million Americans between the ages of 20-64 suffer from some or the other form of back pain. In fact, in a survey provided by the National Institute of Health Statistics, low back pain is the most common ailment (27%), followed by severe headache or migraine pain (15%), neck pain (15%), and facial pain (4%). [1]
Various factors are responsible for back pain. Lifting heavy objects, prolonged standing or sitting, or even sitting in front of the computer for long hours at a stretch, are the most common causes of back ache. Age and gender, too, are the causal factors of back pain. Pain increases as people get older, and women, ,more specifically pregnant women, are found to be at a higher risk than men. [2] Alcohol, heavy smoking, and drug abuse increase the risk of back pain. So do obesity and poor posture. These cause undue stress on certain areas of the back causing back pain. Some psychological factors like anxiety, depression, lack of inner peace, and death of a loved one, are known to contribute to back pain. Sports such as wrestling, rugby, and skiing, increase the chances of back pain due to injuries. Last but not the least, certain spinal conditions like osteoporosis, spondylosis, and discogenic diseases, can cause back pain. [3]
Dr Chao Sun and his team, from the University of Health Sciences College of Osteopathic Medicine, Kansas City, reveal that treating back pain using conventional methods is sometimes difficult since the anatomic cause for the pain cannot be defined with specificity, as only a small percentage of patients with low back pain have an identifiable underlying cause. So, the back pain treatment is restricted to simple bed rest and use of analgesic tablets, and it is then followed by intensive therapy if the pain continues. [9]
A survey done conducted by the Kaiser Family Foundation in 2004 shows that nearly half of American population is concerned about the safety of the medical care they receive and would like to opt for safer non-drug, non-surgical treatments whenever possible. [4] According to the American Chiropractic Association, chiropractic care is one of the safest health care options available today. It boasts high patient satisfaction ratings and is more effective than medication in the treatment of back pain conditions. Unlike conventional medicine, chiropractic therapy does not directly treat disease, but facilitates the body's own restorative powers. [5] In a research study performed by Drs. Shekelle, Markovich, and Louie, from West Los Angeles VAMC, USA, concluded that chiropractors were the choice for about 33 percent of patients who sought back pain care. Geographic location, education, income, and gender were independent patient factors determining chiropractic use. [10] Chiropractic therapy is based on the theory that the improper alignment of one or more of the twenty-four vertebrae that make up the spinal column and the spinal cord they protect is the cause of diseases and disorders. Daniel Palmer, founder of modern chiropractic theory in 1895, and other chiropractors believe that that the human body has an innate self-healing ability and always seeks a balance this is scientifically termed as homeostasis.
Chiropractic treatment involves applying pressure in a specific manner to allow the vertebrae in the spinal column to realign. However, chiropracty is not just a matter of manipulating the spinal column, rather it takes into consideration factors such as nutrition, stress management, and exercise routine. [6] Today's chiropractic treatment involves a mix of traditional methods which claim that subluxations are the root cause of disease and manipulation is the best form of treatment, and modern methods, which believes in treatment using progressive techniques.
A randomized, double-blind clinical trial was conducted on 102 ambulatory patients by Dr. Santilli and his team at the University of Rome, Italy, in 2005-2006, to assess the short-term and long-term effects of spinal manipulations on acute back pain and sciatica with disc protrusion. Sixty-four men and thirty-eight women aged 19-63 years were randomized to manipulations (53) or simulated manipulations (49). It was found that active manipulations were more effective as compared to simulated manipulations on pain relief for acute back pain and sciatica with disc protrusion. [11]
According to Dr. Ron Grassi, a chiropractic therapist with Grassi Chiropractic Orthopedics & Forensics of Jupiter, Florida, differential diagnosis of neuro-musculoskeletal disorders of the back is made on the basis of following tests: [7] - Gait examination that may reveal inconsistencies between the pelvis and spine.Bending in different directions to aid in the evaluation of stiffness and abnormal curvature of the spine.
- Posture of the patient while standing or sitting. It is interesting to note that poor posture is the leading cause of back pain.
- The Piriformis Test to check the flexibility of the piriformis muscle. The patient is asked to flex and bend the knee and hip while lying down.
- Straight Leg Raise (SLR) to check the flexibility of the hamstring muscle and tension and irritation to the sciatic nerve.
- The Psoas Muscle Test to assess pain or imbalance of the joints between the vertebrae.
- The Yeoman's Test to assess if the patient's sacroiliac joints are sprained or strained.
- Other tests include hand strength (grip), bilateral assessment of body weight, muscle trigger point analysis, reflexes and sensation, and muscle testing.
- An x-ray or MRI studies, blood tests, and a urinalysis, if necessary.
After the chiropractic doctor has determined what the problem is, the diagnosis, the possible causes of the disorder, and treatment options are explained elaborately to the patient. In addition, information is also given on how the treatment is performed, the number of visits necessary to complete the treatment, cost of treatment, and expected outcomes of the therapy.
It is important to remember that all manipulations involve a certain degree of risk and may not suit all patients. Since self treatment is not possible through chiropractic manipulation, it is vital to choose a good and experienced chiropractic practitioner. Dr. Kelly Andrews, an experienced chiropractor, suggests that the following questions should be asked when trying to find a competent and trustworthy chiropractor. [8]
1. Which techniques does the chiropractor use and why?
2. Does the chiropractor use his or her hands or an instrument for the manipulation?
3. How much experience does the chiropractor have treating similar types of problems as the patient?
4. What is the chiropractor's typical treatment program or pattern?
5. Does the chiropractor offer services such as massage, exercise instruction, rehabilitation and strength training, and nutritional counseling?
6. What is the chiropractor's recommendation if the treatment doesn't seem to help? Does he recommend another practitioner or another method of treatment?
7. From which chiropractic school did the chiropractor graduate? Does the chiropractor have a post-graduate specialty?
8. How many years has the chiropractor been in practice?
9. Is the chiropractor covered under the patient's insurance plan?
10. What are the chiropractor's fees?
11. What kind of discounts does the chiropractor offer?
12. Is the chiropractor friendly and courteous?
13. Does the chiropractor fully answer all questions and listen to the patient's complete explanation of symptoms?
14. Does the patient feel comfortable talking with the chiropractor?
As a measure to prevent back pain, the American Chiropractic Association suggests maintaining a healthy diet and weight, and remaining active. Physical activities such as gardening, warming up before exercising, and maintaining proper posture helps in preventing back pain. Furthermore, wearing low-heeled, comfortable shoes and sleeping on a mattress reduce strain on the spine and thus reduce the onset of back pain. It is important to quit smoking since smoking impairs blood flow, resulting in oxygen and nutrient deprivation to the spine. [5] References: 1. www.nlm.nih.gov/medlineplus/backpain.html
2. www.spine.org/articles/backpain_pregnancy.cfm
3. www.healingchronicpain.org/content/backpain/diag_home_med.asp
4. www.news-medical.net/?id=6407
5. www.acatoday.com/
6. www.amerchiro.org
7. www.spineuniverse.com
8. www.spine-health.com
9. Chao Sun, MD, MPH; Gautam J. Desai, DO; David S. Pucci, MSIV; Sherman Jew, JD, MSIII: Musculoskeletal Disorders: Does the Osteopathic Medical Profession Demonstrate Its Unique and Distinctive Characteristics? JAOA Vol 104 No 4 April 2004 149-155
10. Shekelle PG, Markovich M, Louie R.: Factors associated with choosing a chiropractor for episodes of back pain care. Med Care. 1995 Aug; 33(8):842-50.
11. Santilli V, Beghi E, Finucci S.: Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J. 2006 Mar-Apr; 6(2):131-7. Epub 2006 Feb 3.
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