Surprise, surprise, but new research on lower back pain encourages exercise, non-pharmacological therapies and tell us that pain is a protective mechanism, not necessarily an indicator of tissue damage.
A recent Lancet journal series on lower back pain found that evidence for spinal surgery is weak at best.
ABC news reported that according to University of NSW professor of orthopaedic surgery Ian Harris, rates of surgery are roughly doubling every 10 years despite the poor outcomes.
Cheaper, more effective and less interventional ways of overcoming lower back pain are reported as:
1. Get moving: Once you have the all clear from your Chiropractor or other health professional, it’s essential to return to exercise as soon as possible. “When it comes to chronic pain, the brain is being overly cautious. Pain is increased by fear of re-injury and a whole host of other factors. Over time, our body creates a bigger than necessary pain buffer zone. Most back pain is recurrent, but exercise has an important preventative role.” Along with exercise, spinal manipulation (or spinal adjustment) were the only two therapies recommended by all three of the major, current guidelines (US, UK and Danish).
2. Which exercise?: No particular exercise was specified in the report, only that most exercise is beneficial. Generally speaking, which ever you are going to enjoy the most and is not going to exacerbate your condition is the best to go for. You won’t keep doing what you’re not enjoying! Saying that, after you get used to the endorphin hit following a good cardio session, you may find you have a new passion. Chat to us about which exercise may be the best for you and your body.
3. MRI/CT scans and X-rays: From the Lancet series, imaging of the spine was not encouraged, given that two people can have the same imaging findings, but only one of them will feel pain. At Live! Chiropractic Applecross, we look at the body system holistically and often use manual adjusting techniques to improve mobility in the areas of primary dysfunction, so for us X-rays can be helpful to assess biomechanics, plus determine what degree of degeneration may be present. This gives us an indicator of how long dysfunction has been present plus how long it might take to return the body to a more stable condition.
4. Cortisone injections: From Professor Hancock: “the best evidence we have from previous studies is that corticosteroid injections reduce sciatica by only 5 points on a 100-point scale compared with placebo in the short term, with no long-term benefit.” In other words, not much help at all, with no lasting effects.
5. So, no surgery… ever?: Surgery is rarely the best option for lower back pain. Once the body has been altered, it’s never the same again. From orthopaedic surgeon Professor Harris: “For patients with typical degenerative changes in the spine and chronic low back pain with out a significant neurological problem, I would not advise surgery in any situation’. Trauma, tumour or neurological deficit from instability are exceptions. Patients in the worker’s compensation system “had only 3 percent return to pre-injury duties and 89 percent still taking major narcotics for pain relief at 24 months post-surgery.” Not great outcomes there!
6. Stay off the drugs: First choice of therapy from the Lancet guidelines should be non-pharmacological. As per the ABC report, opioids should be avoided as much as possible.
7. Find the right clinician: We always recommend you to seek out a health professional who is up to date with the latest research, plus one that you personally resonate with. At Live! Chiropractic Applecross, we work closely with your body to help regain function, naturally. The philosophy of our approach is very important, and that is to stabilise the primary problem then strengthen to support the spine correctly.
Thanks to ABC News June 2018 for the report to which I've added my Chiropractic perspective and Lancet 2018; 391: 2368–83