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...
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!
It was a pleasure and a privilege to attend the grand opening of the new Peter Maddison Rheumatology Unit at Llandudno General Hospital yesterday afternoon. Opened by the eminent Professor Maddison himself, together with his team of consultant rheumatologists, researchers and healthcare specialists, it was a great opportunity to see around the new unit.
The new centre has been specifically designed to meet the needs of the multidisciplinary team and its patients. Housed in a fully-refurbished wing of the Llandudno General Hospital, emphasis is placed on a patient-centred, evidence-based multidisciplinary approach to aid the complex management of rheumatological disorders - lupus, rheumatoid arthritis, scleroderma, Sjogren's syndrome - and many others. The unit has specific purpose-built rooms that can be used by research staff, clinicians, administrative staff and patient-focus groups.
The unit will be staffed by a team of healthcare professionals - rheumatologists, specialist nurses, researchers, physiotherapists, occupational therapists - so that rheumatology patients will be able to receive appropriate specialist care for their complaint all in the one location. This centralised hub will receive patients from across North Wales, covering the North Wales coast line, and the area encircled by Holyhead, Bangor, Caernarfon in the west, down the coast to Pwlheli, Portmadog, Barmouth and Dolgellau, inland to Machynlleth and Welshpool, and as far east as Wrexham. This will be ideal as patients will be able to see all the different specialists in one place, rather than having to attend for many different appointments with different people at different locations. It is one of the first multi-disciplinary rheumatology centres in the UK and it is hoped that similar units might be rolled out across the country.
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.
I wasn't surprised by the research findings that the so typically British 'stiff upper lip' may deter patients from seeing their doctor, as they are too embarrassed to disclose their symptoms or fear that they may be 'wasting the doctor's time'. These findings, part of a more lengthy study published in the British Journal of Cancer, may go some way to explain the surprisingly lower than expected cancer survival rates in the UK, when compared with other developed nations, despite access to highly trained medical staff and cutting-edge treatment interventions.
A survey of nearly 20,000 people in the developed countries of UK, Canada, Australia, Denmark, Norway and Sweden revealed that one sixth of British men and women over the age of 50 were embarrassed to share their symptoms with their doctor, and a third were reluctant to visit for fear of being 'time wasters'. This could delay diagnosis and hence commencement of treatment - and early intervention is often the most critical factor in a successful outcome for the treatment of many cancers.
Fortunately, since we chiropractors primarily deal with problems affecting the musculoskeletal system, rarely do people present with cancers, or symptoms that might lead me to suspect anything more sinister. However, I am all too familiar with people's reluctance to disclose potentially important information that might help me to make the correct diagnosis and hence establish an appropriate treatment plan. All too often they might think that something in their history isn't relevant to their particular, current problem, or they might feel a little embarrassed or awkward about discussing things with me. However, I would urge all patients to provide me with as much information as possible - every consultation is totally confidential and we aim to provide you with a comfortable, relaxed, private environment. There isn't much that shocks me, and chances are, I've probably heard or seen similar before!
Whilst we chiropractors mainly treat the joints, muscles, nerves and soft tissues, we spend many years at University studying all the medical sciences, so we are trained to recognise and diagnose all sorts of illnesses and problems, not just those affecting the musculoskeletal system. So, if I were to pick up on something that I thought wasn't within my scope of practice, I would refer you on to your GP, or appropriate healthcare professional for further investigation (obviously with your permission).
Personally, I'm just like everybody else; I still squirm with embarrassment and sit there, on my clammy hands, giggling like a nervous schoolgirl, when having to discuss even the most minor of ailments with my GP. I even worry that I'm wearing 'sensible' clothing when seeing my own chiropractor! I faff around, delay making the appointment, fidget in the waiting room - and then feel so much better once it's done!
So, be brave and grab the bull by the horns. If you're worried about something it is far better to deal with it sooner rather than later, and if it is something serious, the sooner you get help the better! At least you'll have a definite answer to what the problem is - and this has got to be preferable to the sleepless nights, worrying and wondering and imagining the worst...
I enjoyed reading this article written by GB triathlete, Helen Russell. She writes about how chiropractic was available at the London Olympics, the first time that chiropractic was included as part of the mainstream core medical services within the Olympic village. It is estimated that nearly 90% of elite athletes use chiropractic treatment on a regular basis!
You can read the full article here...
I enjoyed the article, particularly the bit when Helen described her own beneficial experience of chiropractic treatment; she was treated by chiropractor, Stuart Herbert, at the Bromsgrove Chiropractic Clinic - I worked with Stuart many years ago when I had just qualified as a chiropractor!
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...!
What better way to spend a wet, windy weekend than catching up on paperwork? And that's precisely what I've been doing - wrapped up in a snuggly jumper and armed with a large mug of tea.
People always wonder what I'm up to when I'm not in clinic seeing patients, easing their back ache, stiff neck and sore muscles. Much as I would dearly love to be at home, pottering about the garden, playing with Twiglet (our rabbit) or running on the beach, the job of being a chiropractor and running the Llangefni Chiropractic Clinic seems to be somewhat never ending! Or maybe I'm just inefficient, or perhaps a workaholic?!
One of the more time consuming activities is letter-writing. I like to communicate with each and every patient's GP (with the patient's permission, of course), to ensure that the GP is kept up to date with their chiropractic care. Obviously, there are also occasions when patients will require referral on to another healthcare professional for a second opinion. This letter writing also helps to build inter-professional relationships, and maintain the profile of chiropractic within the wider medical world.
In addition to this there is the work involved with my position on the British Chiropractic Association Council, and the 'business' side of running a chiropractic clinic. Then the ongoing reading to keep up with latest research findings and catching up with old colleagues to discuss useful techniques - or just to have a gossip!
So, that's probably why I'm finally getting around to writing this blog at 11pm, at the end of a productive rainy day. And yes, I did make sure I got up regularly for a wriggle and had a couple of walks, between the showers, for a bit of fresh air and exercise!
Eich Ceiropractydd yng Nghlinig Ceiropracteg Llangefnii