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This has to be one of the most comprehensive explanations of simple low back pain. It explains the different types of low back pain, how we chiropractors and health care professionals classify it, what sort of nasties we're ruling out when we assess you, and most importantly, what YOU can be doing to help yourself! Definitely worth watching...
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 Patients are always asking me if their problem is common. Have I seen anything like it before? Why them? Why has their back gone? Why have they been affected? I try to reassure them that they're not alone - low back pain, is unfortunately, a very common problem and, the majority of people will suffer from it at some point during their lives. However, it is difficult to find reliable evidence that answers this question - just how many people suffer with low back pain? It is easy to know how many people we see with back pain in a clinic, or how many people go to their doctor with a sore back, or even how many people take time off work with a back injury, but we don't know just how many people are walking around with low back pain on a daily basis.
Or, at least, we didn't - until recently. A reliable study,* published recently in a well-respected journal, has looked at just this question - what is the prevalence of low back pain in the general population? This study, conducted by the eminent Professor Charlotte Lebeouf-Yde over a one-year period, found an interesting pattern of low back pain in a random population of 50 year olds, revealing three distinct, but virtually equally-sized groups: 1) those who mainly do not have LBP (35%), 2) those who have it at times (30%), and 3) those who have it more or less always (35%). *Chiropractic & Manual Therapies 2013, 21:30 "35% of people have low back pain more or less always" This is one of the few studies that is truly representative of the occurrence of low back pain the general population; participants were randomly selected, not chosen in response to a particular advert or from a particular place of work or a treatment clinic. They came from all walks of life, were from different socioeconomic backgrounds, had different levels of education and did all sorts of different jobs - so truly represented the 'normal, average Joe'. The participants were sent a text message every fortnight, asking them how many days their low back had bothered them, and how many days (if any) they'd had to take off work because of it. These regular text messages meant that the participants didn't have to rely on their memory and recall their pain over a long period, thus further enhancing the reliability of the data. Whilst there was some dropout from the study, the majority participated in the study for the whole year, giving a very valuable pool of data. "3% had low back pain every day for a year!" Further detailed analysis of the data revealed more - a lucky 19% of the sample did not experience any low back pain at all, whilst an unlucky 3% had low back pain every day for the entire year! 9% experienced some low back pain for several days every fortnight (but not every day) but the majority experienced episodes of low back pain lasting anything from a few days to a few weeks. So, what does this study mean? It shows just how common low back pain is within the general population. Whilst a fortunate third of people didn't experience any low back pain at all in an entire year, the remainder experienced some intermittent or constant low back pain. From studies like this which show just how common low back pain is, we can also anticipate the knock-on effect that low back pain has at an individual and societal level - the impact on a person's everyday life with ongoing pain and disability, the number of days off work, the potential loss of income and the resulting cost to society, not to mention the burden on our already stretched NHS. It highlights the necessity to provide a solution to this enormous problem - like chiropractic treatment which hopefully will one day be widely accessible and freely available to all those who are suffering!  The end of the school holidays and the start of term needn't be such a pain in the neck - or the back.
I walked with my niece to her school the other day and was amazed at the weight of her school bag - not to mention her hockey stick, PE kit, packed lunch - and all the other stuff that she needed for the day. It's not surprising then that back pain is on the increase in our youngsters, but a few simple tips can make the start of term a bit less painful... • Bag it up - a rucksack really is the best option, as long as your child carries it over both shoulders, with the straps are adjusted so that the bag is held close to their back and heavier items are placed at the top of the rucksack. They'll probably hate you for it now, making them look like a nerdy swot, but they'll thank you for it later in life when they haven't got such a sore back! • Keep it light - your child should avoid carrying any excess weight in their bag – check it every day to make sure they aren’t carrying any unnecessary items. Encourage the school to provide lockers so that they don't have to carry all their heavy books around all the time. • Best foot forward - wearing good, soft-soled shoes that are supportive and have a good grip on the ground will make carrying a heavy bag much easier. Ensure shoes laces are tied up properly for support (again, much cooler to have them undone, socks around the ankles - but just remind them that it's much less cool to have a broken ankle!). • Move around - staying still for a long time is bad for the spine. Limit your child to 40 minutes on their phone, laptop, tablet, and computer or in front of the TV then encourage them to get up and do something else for a while. Hint - Hide the remote control so they have to get up to change channel. • Keep fit - Regular and frequent exercise is best - the fitter they are, the less likely they are to injure themselves. Drag them out at the weekends or make the most of this late summer sunshine and head out after school. Encourage them to take up a new sport or active hobby. Exercise is good for us grown-ups too - set a good example and get out there! Ditch the car and walk or cycle them to school - and then carry on to work. These few simple tips can help to make things more comfortable and reduce the risk of back and neck pain. Ultimately, this'll hopefully make for a happier, healthier child (certainly less whingy!).  Many of you are heading to the 50th Royal Welsh Show in Llanelwedd, Builth Wells this week. With over 50,000 people attending each day it's sure to be a bustling affair, showing off the best that Wales has to offer - livestock, food, produce, crafts and entertainment - there's something there for everyone!
However, whilst this glorious sunshine will help to attract people (particularly as there is no danger of cars getting stuck in the quagmire of parking as in previous years!) it can add to the overall exhaustion experienced by some people at this huge event. I'm hoping to get to it myself over the next couple of days and I'm planning a few things to help me enjoy it all the more...
It's sure to be a fantastic event and I'm looking forward to going - who knows, I might even bump into a few of you there (amongst the 49,999 other people!).  I recently read a fascinating article written by Richard Brown, chiropractor and President of the British Chiropractic Association, extolling the virtue of chiropractic treatment as a drug-free, non-surgical intervention for the management of spinal and musculoskeletal conditions. One of the core philosophical tenets of chiropractic is that it is a drug-free intervention. We chiropractors recognise the body's natural ability to heal and repair itself and the fact that, if looked after with appropriate diet and exercise, it will remain healthy and pain free. This key principal is neatly summarised in the New Zealand Commission of Inquiry's 1979 report:
"As we have seen, much is made by chiropractors of the drugless and non-surgical nature of their therapy. But modern chiropractors do not suggest that there is only one cause of disease; they admit there are limits to their expertise; and they acknowledge the need for medical intervention and medical monitoring. They do, however, place emphasis on the body's natural functioning and its natural recuperative powers. In these matters of emphasis we see some value in the contribution that the chiropractic outlook can make to healthcare generally. There cannot be any fundamental objection to an attitude to healthcare which restricts drugs to cases where they are shown to be a matter of necessity rather than a matter of mere convenience. Nor can it seriously be suggested that anyone is unreasonable to believe that it is better for the body's disorders to be relieved if possible, by natural rather than artificial or chemical means". Whilst more than 30 years old, this statement still holds validity today in our professional methodologies. Obviously, as spinal care experts, working in the modern, scientific world alongside other healthcare professionals, we chiropractors recognise the benefit and necessity for patients to sometimes take drugs and even undergo surgery. I am certainly not suggesting that anyone should stop taking any prescribed medications without appropriate medical advice, and indeed, at times I will refer my own patients to their GP to obtain appropriate pain relieving medication, understanding the fact that my patients' health and wellbeing is of paramount importance. However, I am mindful of the fact that increasingly it seems that patients are turning away from drugs and surgery and are looking for an effective, research-driven form of natural healthcare. Something that gets to the root of the problem, and not just something that eases the pain or masks the symptoms. Added to which, ongoing scientific research and the media seem to increasingly highlight the complications, side-effects and contraindications for a number of commonly prescribed painkillers and anti-inflammatories, often readily doled out for the management of spinal and musculoskeletal pain. It is not surprising then that people seek out a drug-free, but safe and effective alternative - like chiropractic.  A recent study, published in the European Spine Journal, investigated the link between levels of physical activity, physical fitness and the incidence of low back pain.
The study was conducted in the Netherlands and asked a population of police officers about their activity levels and episodes of low back pain over the preceding 12 months. In addition to questioning, their levels of physical fitness were actually measured objectively (hence minimising the problem that often arises with this sort of study where people inaccurately record their activity levels, often tending to over-report). Results were collected from nearly 2000 individuals and the findings were conclusive - moderate levels of physical fitness (both muscular and aerobic) correlated with a lower incidence of low back pain, whereas the occurrence of low back pain increased with lower levels of activity and physical fitness. So, the implications of this are clear - exercise regularly, improve your fitness levels and you should experience fewer episodes of low back pain! However, it is not quite that simple - it may be that people refrained from exercise due to their low back pain, hence their back pain worsened, hence they exercised less - something of a Catch22 situation! Additionally, the findings showed that excessive levels of exercise actually increased the episodes of low back pain - this was particularly true of highly strenuous, vigorous activities such as weight lifting or heavy gardening and was a problem that mainly affected the male cohort of the study. In conclusion, this study showed that physical activity, strenuous enough to improve physical fitness, was strongly associated with lower levels of low back pain. So, the message is clear - get moving, get fit and you should have less low back pain (but take it gently and sensibly as excessive exercise might cause more harm than good!).  Have you ever watched an animal as it prepares to settle down for a nap? Or seen what it does on waking? It stretches. OK, so it might have a bit of a wash too, or circle the ground a few times (apparently dogs do this from their 'wild days' when they would flat down a circle of grass to make a comfy bed), but it will always take time to stretch. This is one of the many things that we humans have forgotten to do as we've evolved, but stretching regularly is really useful - it eases out the joints, loosens the muscles and helps the circulation. One of my favourite stretches is the Cat Stretch; it's quick and easy to do and loosens up the entire back, stretching out all the long muscles that run parallel to the spine and mobilising all the little joints between each vertebra. I encourage most of my patients to do it every day, morning and evening - those that do generally feeler looser and easier with less stiffness and fewer aches and pains.  The Cat Stretch
Start off on all fours, hands below your shoulders, knees below your hips. Make sure you're evenly balanced, keep your arms straight and strong and draw your belly button in towards you spine so your tummy doesn't 'sag' down to the floor. Gently arch your back, pushing your rib cage up to the ceiling, tucking your chin to your chest and your bottom underneath you (think of a dog tucking its tail between its legs!). Hold for a count of three, then gently lower back down to the starting position. Don't be tempted to arch the other way, sagging in the middle and sticking your bottom and head out, as this can over-arch the lower back and jam all the joints together - keep your back flat with your tummy muscles gently supporting your spine. Repeat this whole sequence 10 times or so, and do it every morning when you're getting up and last thing before bed. It only takes a couple of minutes and will really help to keep the spine healthy - a bit like cleaning your teeth twice a day keeps your teeth healthy! Sore knees? You can easily do this kneeling on your bed or on a couple of cushions. If it's still too much for your knees then you can do a 'half cat' - stand facing a wall, place your hands on the wall at shoulder height with your knees slightly bent and gently arch your back. Repeat 10 times, morning and evening. Obviously, if you find this stretch uncomfortable, painful or difficult to do, please be sensible and don't do it! Email me, or give me a call and we can work out what the problem is.  Things are hotting up at the London 2012 Olympics. Only a few more days until the Opening Ceremony... This week, the doors of the Athletes Village will open. Athletes and their support teams from 204 countries will start arriving. And, for the first time, chiropractors will be there! Within the Athletes Village is the state of the art Polyclinic. Open 24 hours a day this multidisciplinary clinic is kitted out with some of the most sophisticated equipment in the country and staffed by highly skilled specialists - including, for the first time ever, chiropractors. It is expected that a high proportion of the anticipated 200 competitors visiting the polyclinic each day will be suffering from musculoskeletal injuries - sprains, strains, muscle injuries and joint pains - exactly the sort of problems that we chiropractors excel in treating. So, it is expected that the team of chiropractors are going to be kept busy, providing care from 7am - 11pm every day, with 24 hour emergency 'on-call' cover as well!  The state of the art Polyclinic in the Olympic Village The team of chiropractors will be working alongside other musculoskeletal healthcare specialists - orthopaedic surgeons, neurologists, sports injury physicians - as well as other core services like dentistry, optometry, and physiotherapy. Together, this team of medical specialists will help to ensure that athletes are in their peak condition for this most important time in their sporting careers.  Richard Brown meets Lord Coe Richard Brown, chiropractor and President of the British Chiropractic Association is one of the chiropractors who has taken time out of his busy practice and professional schedule to be treating the athletes. He had the opportunity to meet Lord Coe, Chairman of LOCOG, who voiced his support at the presence of chiropractors at the Olympics, and who said that his own career would have been far shorter, had it not been chiropractors.
Hopefully, Richard and the other chiropractors in the Polyclinic will be able to keep the competitors in tip top condition; here's hoping that they enable Jessica Ennis and a few of her fellow competitors to bring home some shiny medals...!  One of the things I love about my job is the great diversity of people that I see on a daily basis. Not only is it hugely satisfying to have the skills to be able to relieve someone's back or neck pain and watch them put their socks and shoes on and walk out of clinic when they have hobbled in, but I love the contact that I have with so many people from so many different walks of life.
In just one clinic I have had conversations about: holidays to Corfu; walking around Mont Blanc; the political and military situation in Afghanistan and Syria; sheep farming and the lambing season; the possibility of an extra silage harvest this soggy summer; the weather (where would we be without it?!); bereavement; Wimbledon (will Murray get to the finals this year?!); the unflattering cut of the Olympic Torch bearers' outfits; the risk of flying fast jets; the economy and whether Bob Diamond was right to resign; the bitter battle with cancer; diet, lifestyle and exercise regimes; gardening (including a great recipe for Raspberry Vodka!); the horrors and joys of childbirth; scuba diving; local crime and the Police's endeavours to deal with it; fishing; motor bikes and track days; and finally, nuclear fission (honestly!). It is this interaction with my patients that keeps me going every day. It is my motivation for going to work each morning; not only do I have a responsibility to care for and treat my patients but I look forward to talking with them. It makes me a richer, more balanced person, and for that, I am grateful.  Taller than average? Wonder if tall people really suffer more with their backs? A recent study, published in the journal Spine* shows that tall people are at far greater risk of being hospitalised due to low back problems affecting the intervertebral discs.
*Wahlstrom et al. Risk factors for hospitalisation due to lumbar disc disease. Spine 2012 July 1;37(15):1334-1339 The study compared the incidence of back pain in over 260,000 construction workers over a period of 20 years. They found that taller people (190-199 cm; 6'3"-6'6") were 1.5 times more likely to be hospitalised due to lumbar disc disease than their shorter colleagues (170-179 cm; 5'7"-5'10"). These results are hardly surprising; tools and equipment are typically designed for those of 'average' height and build. Those at either end of the height spectrum find themselves having to use equipment that is not the ideal size for them which can cause extra strain on the spine. Ideally, people should take time to find equipment that is the right size for them. Longer handled tools, raised worktops, properly adjusted seats and desks can help to prevent back pain. We chiropractors recognise that 'prevention is better than cure' and much of chiropractic care is about giving advice to help prevent back pain in the first place, as well as treating it. |
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