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 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...
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.
A debate has been published today in the British Medical Journal (8 June 2012), questioning the safety of neck manipulation. The story has been picked up by a number of national newspapers, and has been discussed on live radio and television programmes. Regrettably, many of these focus on the negative, so often the case with sensationalist journalism. I hope that I will be able to provide a more realistic, accurate and balanced view.
Neck manipulation has been shown to be safe and effective and benefits thousands of people suffering from neck pain and headaches. In fact, the risk of a stroke after treatment is the same whether you see a GP and get a prescription, or see a chiropractor and get your neck adjusted. (http://www.ncbi.nlm.nih.gov/pubmed/18204390)
Manipulation of the neck is at least as effective as other medical treatments and is safer than many of the drugs used to treat similar conditions. (http://www.ncbi.nlm.nih.gov/pubmed/17258728)
The term chiropractic is often mis-used for treatment carried out by non-chiropractors. This leads to over-reporting of incidents blamed on chiropractors, including in the BMJ. In one report of 24 cases attributed to chiropractors, not one was shown to be a chiropractor. (http://chiromt.com/content/14/1/16#B21)
Chiropractors are highly trained in spinal care and manipulation. In one UK study undertaken in 2007, of 50,000 neck treatments reviewed, not one single adverse event was reported. (http://www.ncbi.nlm.nih.gov/pubmed/17906581)
The cherry-picking of poor quality research needlessly raises alarm in patients and does little to help people suffering from neck pain and headaches to choose the most appropriate treatment.
I hope that this has allayed any fears or worries about the safety and efficacy of spinal manipulation when carried out by a trained, professional pair of hands. However, should you have any further concerns or queries - please, just ask!
Having spent much of the bank holiday weekend traipsing around furniture stores, I know that buying a bed can be a costly and time consuming exercise! However, since a poor night's rest can cost you precious sleep and precipitate back pain, it's important to get it right.
So, what's the best mattress?
The best mattress is a supportive one - this will differ for each person, depending on their size and shape. What's right for a 10 stone lady might not be right for her 16 stone husband.
And, how do I find the right one?
Ideally, your spine should be straight when you are lying, either on your side or your back. If your mattress sags or bows so will your spine, and this may cause aches and pains. Your neck is a continuation of your spine - and you should aim to keep this straight too when sleeping, so choose a supportive pillow that isn't too high or low (more on pillows at a later date...!)
There are several types of mattress, and again, it comes down to personal preference...
_ A couple of years ago I was invited to take part in a small research project that a University colleague was running. My role was to collect some of the clinical data, and to help (a little!) with the write-up of the paper which has recently been published in the 'Archives of Physical Medicine and Rehabilitation' (Parkin-Smith et al, Arch Phys Med Rehabil Vol 93, Jan 2012 pp.11-20).
The study was designed to investigate the most effective form of treatment for acute low back pain. Normal, 'everyday' patients who presented at the Llangefni clinic were asked to complete a pain questionnaire at the start, middle and end of a course of treatment for low back pain. Comparison was made between 'usual' chiropractic care (including manipulation, soft tissue work, rehabilitation, exercise and postural advice) and a set 'structured protocol' (following specific written guidelines, specific exercise and rehabilitative advice, and specific treatment interventions). The results showed that both treatment methods resulted in a significant improvement in the patient's low back pain, and levels of patient satisfaction were high in both groups. The 'structured protocol', that ensured that advice regarding specific exercises and rehabilitation was given (and followed!) produced a slightly faster outcome.
Whilst only a small one, it is great to have been involved in such a study - and a big thank you to all the patients that took part!
Eich Ceiropractydd yng Nghlinig Ceiropracteg Llangefnii