Have You Got Lower Back Pain?

Lower back pain is one of the leading financial burdens on the Australian public health purse. Costing the government and consumer billions of dollars per year. This problem creates a massive negative impact on peoples quality of life and their ability to participate in their normal daily routine. According to one of the leading journals, 79.2% of Australians Suffer Lower Back Pain at some point in their life. (J manipulative Physiol Ther. 2004 May;27(4):238-44.) We also know that 67.6% suffer from a mild incidence in any 12 month period. In any 6 month period around 10% suffer significant disability, leading to time off work and away from normal activities. It is the most frequently seen musculoskeletal condition in general practice.

WHAT IS THE COST TO SOCIETY?

Lower back pain is the 3rd largest drain on the public health purse in Australia Only heart disease and Cancer cost more. Multi- billion dollar per year problem for taxpayers and the government Research indicates that 55% of sufferers do not seek care, independent of social status and economics. (J Manipulative Physiol Ther. 2004 Jun;27(5):327-35.)

CAUSATIVE FACTORS

Most of the reasons that people get back pain are Multifactorial and not well defined. Most people don't really know!! Factors include (to name a few); Poor posture, Lack of exercise, Poor work habits, Congenital anomalies, Poor diet, Lack of education, Smoking, Heavy drinking.

MACRO VERSUS MICRO - TRAUMA

Most people believe that back pain is a result of macro-trauma (MVA, falls, etc) However, more than 95% of low back pain cases are non-specific in origin, generally associated with repetitive micro-trauma, which means that the general activities that you do on a day to day basis, often in poor postural positions or ergonomically incorrect, contribute to or cause the back pain. Simple activities such as sitting for a long period of time at a desk, slouching in a lounge chair whilst watching a movie.

OTHER FACTORS

Obesity was previously believed to be a causative factor however, this has been refuted by Stuart McGill, who is a leading north American researcher on lower back pain.. Recent anthropometric testing appears to show that those with a greater upper body segment (long trunk) compared to those who have long legs and a short trunk have more LBP. (J Manipulative Physiol Ther. 1994 Jun;17(5):296-301.) CT and MRI scans are good for validation of clinical findings but are not good for diagnosis, with almost 50% of people in society having disc bulges or prolapses identified on scans which do not relate to the pain they suffer. Breathing and incontinence are more important than obesity and physical activity as predictive factors for lower back pain. (Aust J Physiother. 2006;52(1):11-6.)

WHAT CAUSES THE PAIN?

The pain generating structures are often not well identified but may Include; disc, facet joints, ligaments, tendons, other connective tissue, muscles, local nerves, nerve root, sacroiliac joints and visceral referral from internal organs. This means that although the person may have pain, it is often difficult to identify where the pain is coming from, and honestly, is often not important in regards to treatment options.

EFFECTIVE PAIN RELIEF IS A HUMAN RIGHT (NHMRC 1999a)

Unrelieved severe pain has adverse psychological & physiological effects. Consumers shoulder be involved in the assessment and management of their pain. To be effective, treatment should be flexible and tailored to individual needs. It should be possible to reduce pain to a comfortable and tolerable level. Pain should be treated early, as established, severe pain is more difficult to treat.

PROGNOSIS

Majority of cases are of short duration and recover within 3 months, mild symptoms may persist Recurrences are not uncommon Psychosocial and Occupational facts appear to be associated with progression from acute to chronic and need to be assessed and addressed early in the intervention.

Why Choose Chiropractic?

Chiropractic is a primary contact branch of health care specialising in the diagnosis, treatment and overall management of conditions which are due to mechanical dysfunction and injury of soft tissues. Early assessment and treatment gives the best possible outcome with less visits and less pain! Practitioners utilize a variety of techniques, with the overall goal to resolve symptoms, retrain altered movement patterns, and prevent recurrence. Treatment programs take into account the nature of the condition and the patient's own commitment to provide the best possible outcome. Chiropractors who specialise in rehabilitation can offer a unique approach, integrating skills of assessment and clinical treatment along with effective exercise program development to strengthen and correct postural and core muscle dysfunction which leads to injury and pain.

WHAT CAN WE OFFER?

Diagnosis and differential list. Eliminate red and yellow flags As primary care professionals we can refer for spinal and pelvic x-rays at no charge, and peripheral x-rays for a small surcharge. Formulate a management plan and communicate with other professionals. Render effective, economical treatment. We are in the information age and although we use evidence based care we are not limited by it. Evidence based guidelines tell us what we can't do but don't tell us what we should do.

REHABILITATION

The aim of rehabilitation is to help patients identify what is going wrong and assist them in putting steps in place to lessen the frequency and severity of recurrences. Effective management should see the probability of relapse to reduce to 20-25%. The Key is too keep motivated after 6 weeks. Many people start to improve dramatically around this time and decide to discontinue exercises and care. This is the point at which dedication is rewarded. 3-6 months of home work and managed integration of rehabilitation and exercises creates better long term outcomes with fewer and less severe recurrences of pain and dysfunction.

CONCLUSION

The problem with chronic back pain is weakness and loss of function not disease. `Best stand alone/single practice for prevention and treatment of spinal/joint dysfunction is exercise and life style changes. Best combined interventions are specific spinal control exercises with a course of manual adjustments/mobilizations. (Spine 2004)