Low Back Pain and Chiropractic Care


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Low Back Pain and Chiropractic Care

  1. 1. Low Back Pain Jamie H. Bassel, DC
  2. 2. Introduction <ul><li>What is the Low Back? </li></ul><ul><li>What is Low Back Pain? </li></ul><ul><li>Who is likely to suffer with Low Back Pain? </li></ul><ul><li>Common Diseases causing Low Back Pain </li></ul><ul><li>What Can a Chiropractor do for Low Back Pain? </li></ul>
  3. 3. The Spine <ul><li>Consists of three regions </li></ul><ul><li>Cervical Spine- 7 Vertebrae </li></ul><ul><li>Thoracic Spine- 12 Vertebrae </li></ul><ul><li>Lumbar Spine- 5 Vertebrae </li></ul>
  4. 4. Parts of the Lumbar Spine <ul><li>consists of five vertebral bodies.  </li></ul><ul><li>sits on top of the sacrum, above the coccyx (tailbone).  </li></ul><ul><li>supports the thoracic spine.  </li></ul><ul><li>the lumbar spine supports most of the weight of the body.  The bodies are the largest of the spine, because of the large amount of weight they must bear. </li></ul>
  5. 5. <ul><li>the vertebral body - an oval segment of bone.  </li></ul><ul><li>support the bulk of the weight of the body.  </li></ul><ul><li>between the vertebral bodies lie the intervertebral disks, = shock absorbers when healthy </li></ul><ul><li>triangular space = the spinal canal.  </li></ul><ul><li>spinous process = is often palpable of thin people.  </li></ul>Anatomy
  6. 6. Did You Know? <ul><li>80% of the population will experience LBP* </li></ul><ul><li>* Extrapolated from industrial statistics, medical records and insurance figures </li></ul>
  7. 7. Types of Low Back Pain <ul><li>Organic or Disease Related </li></ul><ul><li>Traumatic </li></ul><ul><li>Mechanical </li></ul><ul><li>Spinal Subluxations </li></ul>
  8. 8. 06/07/09 Organic Causes of Low Back Pain <ul><li>Disease coming from the Kidney, Stomach, Pancreas, Bowel </li></ul><ul><li>Malignancies/Cancer </li></ul><ul><li>Bone Diseases </li></ul><ul><li>Systemic Disorders </li></ul>
  9. 9. PLEASE NOTE!!!!! <ul><li>It is extremely important to match the symptoms a patient experiences, with the symptoms one would expect based on the physical exam, and other tests.  </li></ul>
  10. 10. Traumatic Low Back Pain <ul><li>Examples include: </li></ul><ul><li>Motor Vehicle Accidents </li></ul><ul><li>Work Injuries </li></ul><ul><li>Slip & Fall Accidents </li></ul>
  11. 11. Mechanical Causes of Low Back Pain <ul><li>Most commonly treated by Chiropractors & Physical Therapists </li></ul><ul><li>Spine= Mechanical structure supporting individual throughout life </li></ul><ul><li>Allows individual to bend, stoop, squat, twist & turn </li></ul>
  12. 12. Mechanical Causes of Low Back Pain <ul><li>Spinal structures such as discs, ligaments and tendons are used in aiding movement </li></ul><ul><li>These structures can be irritated, stressed, abused, injured when used improperly </li></ul>
  13. 13. Vertebral Subluxations <ul><li>Day to day stress can cause the spine and its associated parts to deteriorate. </li></ul><ul><li>Stress can cause the vertebrae to shift from their proper place </li></ul><ul><li>Causes irritation of the surrounding nerves, bones, discs, ligaments and other soft tissues </li></ul>
  14. 14. Spine & Disc Degeneration <ul><li>Spinal Degeneration is like tooth decay (often painless), by the time pain is felt, the process has been going on for many years. </li></ul>
  15. 15. Spinal Degeneration <ul><li>Occurs in Phases </li></ul><ul><li>4 Phases in total </li></ul><ul><li>Caused by years of longstanding stress placed on your spine </li></ul><ul><li>Prevention can be accomplished through several approaches </li></ul>
  16. 16. Phase I - Degeneration <ul><li>Loss of Normal Spinal Curves </li></ul><ul><li>Joints become more stressed and age more rapidly </li></ul><ul><li>No pain associated </li></ul><ul><li>Response to spinal care is generally good </li></ul>
  17. 17. Phase II- Degeneration <ul><li>Much greater degree of decay, disc narrowing and bone spur formation </li></ul><ul><li>By Age 40 (80% of males and 76% of females exhibit moderate disc degeneration)* </li></ul><ul><li>Pain and fatigue commonly seen at this stage </li></ul>
  18. 18. Phase III-Degeneration <ul><li>Postural Imbalances, increased nerve damage, advanced bone deformation </li></ul><ul><li>With care, some reversal is possible </li></ul><ul><li>Loss of disc height is appreciated </li></ul>
  19. 19. Phase IV- Degeneration <ul><li>Advanced stage of subluxation degeneration. </li></ul><ul><li>Postural imbalance is severe and motion is limited. </li></ul><ul><li>Bones begin to fuse </li></ul><ul><li>Chiropractic may provide some symptomatic relief </li></ul>
  20. 20. What is a Disc? <ul><li>Acts as the Spine’s Shock Absorber </li></ul><ul><li>Allows the spine to move in many directions </li></ul><ul><li>A fluid filled structure that is surrounded by concentric rings </li></ul><ul><li>When the rings are disrupted, a Herniation can occur!!! </li></ul>
  21. 21. Disc Herniations <ul><li>Usually occur with mechanical stress that overload outer lining of the disc </li></ul><ul><li>Can compress the adjacent nerve root, causing irritation. </li></ul>
  22. 22. Differentiating the Pain <ul><li>Low back pain and lower extremity pain must be distinguished.    </li></ul><ul><li>Lower extremity pain = shoots down the leg, from the low back or buttock.  </li></ul><ul><li>results from the pinching of a nerve, and appears to radiate down the leg in the distribution of the nerve.  Ie. Sciatica </li></ul><ul><li>When mild, one may experience a numbness.  When it becomes more severe, pain may develop.  And, if it is quite severe, nerve damage will result, and weakness may also ensue.  </li></ul>
  23. 23. Posture <ul><li>Humans stand erect </li></ul><ul><li>Balance must be maintained against gravity </li></ul><ul><li>Ligaments and Muscles of the spine are essential for good posture </li></ul>
  24. 24. Good Posture <ul><li>Defined as: Energy-economical, cosmetically acceptable stance </li></ul><ul><li>Keeping the spine erect requires balance between ligaments and muscles. </li></ul><ul><li>Requires the pelvis and hips to work together to balance the body’s frame </li></ul>
  25. 25. Factors affecting Poor Posture <ul><li>Hereditary Factors – i.e. Kyphosis or excessive Lordosis </li></ul><ul><li>Structural Abnormalities - I.e. Acquired, Neurologic, Muscular, Skeletal </li></ul><ul><li>Postures of Habit </li></ul><ul><li>Training during developmental years </li></ul>
  26. 26. Cultural Aspects of Posture <ul><li>¼ of the worlds population take weight of their feet, legs and backs </li></ul><ul><li>Chairs, Stools and Benches began being used 5000 years ago </li></ul>
  27. 27. Cultural Aspects of Posture - cntd. <ul><li>The Chinese only started using chairs over the last 2000 years </li></ul><ul><li>In Asia, Africa and Latin America squatting was used for working </li></ul>
  28. 28. Cultural Aspects of Posture – cntd. <ul><li>Standing posture influenced by the use of footwear as well as by physiologic, psychological, social, sexual, occupational and environmental factors </li></ul>
  29. 29. Things are getting better!!!! <ul><li>Western Culture has become more aware of postural issues </li></ul><ul><li>Ergonomics - science concerned with designing and arranging things people use so that there is an efficient interaction between the two </li></ul>
  30. 30. How Can Chiropractic Help?* <ul><li>May reduce, halt and reverse spinal degeneration </li></ul><ul><li>Improve spinal balance </li></ul><ul><li>Restoration of normal joint function </li></ul><ul><li>Provide home and supervised exercise programs to strengthen the spine and prevent further degeneration. </li></ul><ul><ul><li>Gatterman, in the Journal of Manipulative Physiol Ther, Sept 2001, wrote &quot;The four conditions rated most amenable to chiropractic treatment were noncomplicated low back pain , sacroiliac joint dysfunction, posterior joint/subluxation, and low back pain with buttock or leg pain .&quot;  He concluded &quot; the ratings for the effectiveness of chiropractic technique procedures for the treatment of common low back conditions are not equal. Those procedures rated highest are supported by the highest quality of literature. Much more evidence is necessary for chiropractors to understand which procedures maximally benefit patients for which conditions </li></ul></ul>
  31. 31. Prevention of Recurrent Low Back Pain <ul><li>Those who recover from LBP are typically those who are at greatest RISK for recurrence!!!! </li></ul><ul><li>Some factors that predispose a patient to LBP are unavoidable </li></ul>
  32. 32. Risk Factors <ul><li>up to age 60 male = female women at a greater risk OSTEOPOROSIS </li></ul>
  33. 33.   Risk Factors Cntd <ul><li>size and shape of spinal canal AKA Spinal Stenosis </li></ul><ul><li>Smoking increases chances of low back pain.* </li></ul><ul><li>* Scott et al, in Spine  1999, learned &quot;that smokers have more frequent episodes of back pain may imply that smoking exacerbates back pain , and the observation that stronger associations between back pain and smoking were found in the scoliosis cohort suggests that smoking may have a greater impact on persons with damaged spines.&quot; </li></ul>
  34. 34. Ways to prevent low back pain   <ul><li>EXERCISE </li></ul><ul><li>DECREASE THE FAT IN YOUR DIET </li></ul><ul><li>WEIGHT MANAGEMENT </li></ul><ul><li>INCREASE &quot;SOLUBLE&quot; FIBER </li></ul><ul><li>MODERATE DIETARY CHOLESTEROL INTAKE </li></ul>
  35. 35. Questions and Answers