Exercise at work to prevent low back pain

More jobs now require prolonged sitting which has been associated with loss of the lumbar lordosis, intervertebral disc (IVD) compression, and height loss, possibly increasing the risk of lower back pain. There are numerous studies suggest that exercise can play an important role in preventing occupational and non-occupational low back pain. An innovative approach was published in the April issue of The Spine Journal that used an office chair exercise that is performed while seated. The exercise provides a brief decompression of the lumbar spine by moving forward on the chair seat, placing the hands on the seat of the chair, pressing downward with the arms to take pressure off the lumbar spine, and arching the back and shoulders backward at the same time. This decompression maneuver held for 5 seconds followed by 3 seconds of reloading (sitting normally) and was repeated 4 times. Sequential MRI demonstrated a marked increase in vertical height of the lumbar spine using this decompression strategy. The authors concluded that “Seated upright MRI and stadiometry, as performed in this study, appear to be feasible methods for detecting compressive and decompressive spinal changes associated with normal sitting and, alternately, seated unloading exercises. Larger studies are encouraged to determine normative values of our study measurements and to determine if morphological changes induced by seated unloading predict treatment response and/or reductions in the incidence of sitting-related LBP.”

There are numerous quality evidence that post-treatment exercise programs can prevent recurrences of back pain. There have been many studies published this past decade that support the value of exercise in primary, secondary as well as tertiary prevention of low back pain. These studies have been conducted with multiple age groups and multiple settings including sports venues and the workplace.

Source:
http://www.chiroaccess.com/Articles/Exercise-and-the-Prevention-of-Low-Back-Pain.aspx?id=0000162

Dr. David P. Chen
Chiropractor in Laurel, MD
Laurel Regional Chiropractic

Chronic Whiplash Pain Caused by Spinal Facet Injury

In an article published in late 2007 in the Journal of the American Academy of Orthopedic Surgeons revealed that a significant number of people suffering acute neck pain following a motor vehicle collision develop chronic pain that last for years. The most common source of the chronic pain is damage to the spinal facet joints, followed by disc pain. The authors reviewed the medical literature and published data concerning chronic whiplash pain. The review reveals that 15% to 40% of patients with acute neck pain following a motor vehicle collision develop chronic pain, and that 5% to 7% become permanently partially or totally disabled. The most common source of chronic whiplash neck pain: the facet joint (49% to 54%).

In the treatment of chronic neck pain, exercise is recommended as helpful to strengthening the weak muscle groups but exercise alone is rarely curative. Many studies have shown that spinal manipulation is one of the most effective treatments for whiplash injury. Early manipulation to the cervical spine will restore motion, decrease pain, and increase the speed of recovery. The early manipulation will also decrease the buildup of scar tissue and future chronic pain syndromes.

As you may know, Tiger Woods announced on his blog on Wednesday that an MRI determined he has inflammation in the facet joint of his neck which causes pain in the area along with headaches and difficulty rotating the head. Even though he denied that his neck injury is related to the Nov. 27 car accident, but it is possible that Tiger may not have been aware of the damage immediately. As the damage sometimes doesn't manifest itself until a physical activity that puts strain on the neck - things like lifting boxes or hitting golf balls in Tiger’s case.

Reference: Schofferman J, Bogduk N, and Slosar P. Chronic whiplash and whiplash-associated disorders: An evidence-based approach. J Am Acad Orthop Surg. 2007 Oct;15(10):596-606.

Dr. David P. Chen
Chiropractor in Laurel, Maryland
Laurel Regional Chiropractic

Study recommends conservative management of lumbar disc herniation before surgical discectomy

A recent article appeared in the Spine Journal examines the cost of previous conservative care for patients that ultimately elect to have spinal surgery. The study consisted of 30,709 patients. The average cost of conservative care in the 90 days period before surgery was $3,445 each. Magnetic resonance imaging and other diagnostic procedures represented a little over half of the total pre-surgery costs. Of the treatment costs, 16% were for injections, 5.7% physical therapy, and 1.2% chiropractic care. Despite the fact that these expenses were for failed back conservative care, the authors recognize the overall benefits of conservative care and recognize that many patients are able to avoid surgery. They conclude that “Although a large number of patients will ultimately require surgical intervention, given that many patients will improve with nonoperative therapy, a trial of conservative management is appropriate”.

Previous studies have examined conservative versus surgical treatment related to several common causes of low back pain. For spinal stenosis, “Among patients with lumbar spinal stenosis completing 8- to 10-year follow-up, low back pain relief, predominant symptom improvement, and satisfaction with the current state were similar in patients initially treated surgically or nonsurgically.” Another study of patients with disc herniation reported, “…with moderate or severe sciatica, surgical treatment was associated with greater improvement than nonsurgical treatment at 5 years. However, patients treated surgically were as likely to be receiving disability compensation, and the relative benefit of surgery decreased over time.”

Sources:
Daffner SD, Hymanson HJ, Wang JC. Cost and use of conservative management of lumbar disc herniation before surgical discectomy. Spine J. 2010 Mar 31.

http://www.chiroaccess.com/Articles/Studies-Recommend-Conservative-Care-for-Low-Back-Pain-before-Surgery.aspx?id=0000148

Dr. David Chen
Chiropractor in Laurel, MD
Laurel Regional Chiropractic