Spinal Manipulation Therapy for Acute Low Back Pain

The October 2010 issue of The Spine Journal includes a new review of the scientific evidence supporting spinal manipulative therapy (SMT) for low back pain (LBP). The results were quite favorable and reflect a growing body of evidence supporting SMT over medications and other conservative options. SMT research demonstrates “equivalent or superior improvement in pain and function when compared with other commonly used interventions, such as physical modalities, medication, education, or exercise, for short, intermediate, and long-term follow-up.” The authors conclude by recommending that other health care providers consider SMT as a viable option if self care or education fails to provide pain relief.

METHODS: Literature was identified by searching MEDLINE using indexed and free text terms. Studies were included if they were randomized controlled trials (RCTs) published in English, and SMT was administered to a group of patients with LBP of less than 3 months. RCTs included in two previous SRs were also screened, as were reference lists of included studies. Combined search results were screened for relevance by two reviewers. Data related to methods, risk of bias, harms, and results were abstracted independently by two reviewers.

RESULTS: The MEDLINE search returned 699 studies, of which six were included; an additional eight studies were identified from two previous SRs. There were 2,027 participants in the 14 included RCTs, which combined SMT with education (n=5), mobilization (MOB) (n=4), exercise (n=3), modalities (n=3), or medication (n=2). The groups that received SMT were most commonly compared with those receiving physical modalities (n=7), education (n=6), medication (n=5), exercise (n=5), MOB (n=3), or sham SMT (n=2). Most studies (n=6) administered 5 to 10 sessions of SMT over 2 to 4 weeks for acute LBP. Outcomes measured included pain (n=10), function (n=10), health-care utilization (n=6), and global effect (n=5). Studies had a follow-up of less than 1 month (n=7), 3 months (n=1), 6 months (n=3), 1 year (n=2), or 2 years (n=1). When compared with various control groups, results for improvement in pain in the SMT groups were superior in three RCTs and equivalent in three RCTs in the short term, equivalent in four RCTs in the intermediate term, and equivalent in two RCTs in the long term. For improvement in function, results from the SMT groups were superior in one RCT and equivalent in four RCTs in the short term, superior in one RCT and equivalent in one RCT in the intermediate term, and equivalent in one RCT and inferior in one RCT in the long term. No harms related to SMT were reported in these RCTs.

CONCLUSIONS: Several RCTs have been conducted to assess the efficacy of SMT for acute LBP using various methods. Results from most studies suggest that 5 to 10 sessions of SMT administered over 2 to 4 weeks achieve equivalent or superior improvement in pain and function when compared with other commonly used interventions, such as physical modalities, medication, education, or exercise, for short, intermediate, and long-term follow-up.

Reference: Dagenais, S; Gay, RE; Tricco, AC; Freeman, MD; Mayer, JM (2010). "NASS Contemporary Concepts in Spine Care: spinal manipulation therapy for acute low back pain.". The spine journal. 10 (10): 918–40.

Dr. David P. Chen
Chiropractor in Laurel, MD 20708

4 "Snow Day" Treadmill Tricks

4 "Snow Day" Treadmill Tricks

The 'mill is a fine tool for staying fit when the mercury drops. But it's important to have a plan of action when you hit the machine. Not only will it make the time pass more quickly, but you'll get a greater fitness boost than you would if you did the same type of run every time you went inside. Here are four TM workouts to do on the days you'd rather not risk black ice—or blue toes.

How to avoid packing on pounds this off-season.

The "Fast 15"

Do this workout when you're pressed for time. Jog for three minutes. Then increase the speed to a faster pace and hold it for two minutes (it's okay if you're huffing and puffing a bit by the end). Walk for 30 seconds. Repeat the sequence. Next, extend the run portion to three minutes. Walk for 30 seconds. Repeat. Cool down with a short walk.

The Pace Booster

Warm up for six minutes by alternating 30 seconds jogging with 30 seconds walking. Then increase your speed slightly and run for 30 seconds. Walk for 30 seconds. Continue this 30/30 ratio. Increase your speed slightly with each successive run segment. Do as many cycles as you comfortably can.

Treadmill workouts that keep you focused—and fit.

The Distance Run

Increase your speed until you're running comfortably. Run for two minutes, then walk for one minute. Repeat this 2:1 ratio three times. Bump up the ratio: Run for three minutes, then walk for one minute. Repeat three times. End the workout by running two 2:1 segments, followed by two 1:1 segments.

Winter got you down? How to outrun the blues during the season of plunging temps and zero motivation.

The Hill Climb

Gradually increase your speed until you're at easy-run pace. Run for three minutes. Raise the incline to 2 percent for one minute, then to 4 for one minute. Lower the incline and rest for one minute. Raise to 4 percent and run for two minutes. Alternate running two minutes at an incline/jogging one minute on the flat for as long as you can.

Run stronger, longer, and faster with the latest science.

Dr. Joshua Brooks
Chiropractic - Physiotherapy, Fairfax, Va

Chiropractic Maintenance Care for Chronic Lower Back Pain

A new single blinded placebo controlled study conducted by the faculty of medicine at Mansoura University, conclusively demonstrates that chiropractic maintenance care provides significant benefits for those with chronic low back pain.

BACKGROUND: Spinal adjustments is a common treatment option for low back pain (LBP). Numerous clinical trials have attempted to evaluate its effectiveness for different subgroups of acute and chronic LBP previously, but the efficacy of maintenance adjustments in chronic non-specific LBP has never been studied.

In this study, 60 patients with chronic, nonspecific LBP lasting at leas 6 months were randomized into 3 groups:

1. One third of them received 12 treatments of sham adjustments over a one-month.
2. One third of them received 12 treatments of adjustments during a one-month period, with no follow-up care during the next nine months.
3. One third of them received 12 Chiropractic adjustments during the first month, followed by “maintenance” adjustments every two weeks, for the next nine months.

To determine any difference among these 3 care groups, researchers measured pain and disability scores, generic health status, and back-specific patient satisfaction at baseline, and at 1-month, 4-months, 7-months, and at 10-months.

RESULTS: Patients in groups (groups 2 & 3) experienced significantly lower pain and disability scores than the sham group at the end of the first 1-month period.

At the 10-month follow-up, only the maintenance group maintained improvements in pain and disability, while the group that only received 1-months care had reverted to their pretreatment pain and disability levels.

CONCLUSIONS: This is the first medically managed trial that clearly demonstrates that maintenance chiropractic care provides significant benefits to those who suffer from chronic low back pain.

SOURCE: "Does Maintained Spinal Manipulation Therapy for Chronic Non-specific Low Back Pain Result in Better Long Term Outcome?" Spine (Phila Pa 1976). 2011 Jan 17.

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

One more reason to take breaks from sitting: a smaller waistline

Always wanted a smaller waist? Scientists have discovered that the answer could be something as simple as taking frequent small breaks from sitting.

A U.S. National Health and Nutrition Examination Survey published in the European Society of Cardiology’s European Heart Journal revealed that participants who took more small breaks from sitting had smaller waistlines than those who did not. This was true even for those who were spent up to 21.2 hours a day sedentary. For the 25% of participants who took the most breaks from sitting, the survey found that waistlines were on average 1.61 inches or 4.1 centimeters smaller than the 25% of participants who took the fewest breaks. The survey, led by University of Queensland researcher followed 4,757 people, all aged 20 and older. The survey lasted for seven days, during which participants wore an accelerometer on their right hips when they were awake. These accelerometers measured the intensity of the participants’ physical activity. Low levels of intensity were equated with sedentary periods.

Having a small waistline indicates less abdominal fat, which in turn is an indicator for better heart health. Larger waists, on the other hand, are linked to cardiovascular disease and high blood pressure as well as higher risk for type 2 diabetes. Another study published in the journal, Obesity, links increases in waistlines to increased chance of premature death.

Participants who took more frequent breaks from sitting also had lower levels of C-reactive protein (CRP). CRPs are produced by the liver. Production is correlated with the level of inflammation in the body. The study also found that taking breaks had a significant effect on lowering HDL-cholesterol, particularly in non-Hispanic whites. Conversely, those who were had higher sedentary times tended to have larger waists, higher HDL-cholesterol, CRPs, triglycerides and insulin.

The benefits of frequent breaks from sitting is linked to muscle activity in the legs and back. When sitting or reclining, these large muscles are largely inactive. However when standing, these muscles are forced to continually contract in order to maintain posture. This increased activity helps to clear plasma triglycerides, which is a risk factor for cardiovascular disease.

Still not convinced? By taking frequent breaks and doing some stretches while sitting at work will also save you from frequent neck and back pain.

Source: http://www.msnbc.msn.com/id/41028986/ns/health-diet_and_nutrition/

Dr. David P. Chen
Chiropractor in Laurel, MD 20708
Laurel Regional Chiropractic

Interferential Current Therapy for Musculoskeletal Pain

Effectiveness of Interferential Current Therapy in the Management of Musculoskeletal Pain: A Systematic Review and Meta-Analysisfrom Physical Therapy current issue by Fuentes, J. P., Armijo Olivo, S., Magee, D. J., Gross, D. P.

Background
Interferential current (IFC) is a common electrotherapeutic modality used to treat pain. Although IFC is widely used, the available information regarding its clinical efficacy is debatable.

Purpose
The aim of this systematic review and meta-analysis was to analyze the available information regarding the efficacy of IFC in the management of musculoskeletal pain.

Data Sources
Randomized controlled trials were obtained through a computerized search of bibliographic databases (ie, CINAHL, Cochrane Library, EMBASE, MEDLINE, PEDro, Scopus, and Web of Science) from 1950 to February 8, 2010.

Data Extraction
Two independent reviewers screened the abstracts found in the databases. Methodological quality was assessed using a compilation of items included in different scales related to rehabilitation research. The mean difference, with 95% confidence interval, was used to quantify the pooled effect. A chi-square test for heterogeneity was performed.

Data Synthesis
A total of 2,235 articles were found. Twenty studies fulfilled the inclusion criteria. Seven articles assessed the use of IFC on joint pain; 9 articles evaluated the use of IFC on muscle pain; 3 articles evaluated its use on soft tissue shoulder pain; and 1 article examined its use on postoperative pain. Three of the 20 studies were considered to be of high methodological quality, 14 studies were considered to be of moderate methodological quality, and 3 studies were considered to be of poor methodological quality. Fourteen studies were included in the meta-analysis.

Conclusion
Interferential current as a supplement to another intervention seems to be more effective for reducing pain than a control treatment at discharge and more effective than a placebo treatment at the 3-month follow-up. However, it is unknown whether the analgesic effect of IFC is superior to that of the concomitant interventions. Interferential current alone was not significantly better than placebo or other therapy at discharge or follow-up. Results must be considered with caution due to the low number of studies that used IFC alone. In addition, the heterogeneity across studies and methodological limitations prevent conclusive statements regarding analgesic efficacy.

Neck Injury in a Motor Vehicle Collision and Future Neck Pain

Neck Injury in a Motor Vehicle Collision and Future Neck Pain

The objective of this population-based cohort study was to investigate the association between a lifetime history of neck injury from a motor vehicle collision and the development of troublesome neck pain. The current evidence suggests that individuals with a history of neck injury in a traffic collision are more likely to experience future neck pain. However, these results may suffer from residual confounding. Therefore, there is a need to test this association in a large population-based cohort with adequate control of known confounders.

A cohort of 919 randomly sampled Saskatchewan adults with no or mild neck pain in September 1995 were formed. At baseline, participants were asked if they ever injured their neck in a motor vehicle collision. Six and twelve months later, we asked about the presence of troublesome neck pain (grade II–IV) on the chronic pain grade questionnaire. Multivariable Cox regression was used to estimate the association between a lifetime history of neck injury in a motor vehicle collision and the onset of troublesome neck pain while controlling for known confounders. The follow-up rate was 73.5% (676/919) at 6 months and 63.1% (580/919) at 1 year.

A positive association between a history of neck injury in a motor vehicle collision and the onset of troublesome neck pain after controlling for bodily pain and body mass index was found. The analysis suggests that a history of neck injury in a motor vehicle collision is a risk factor for developing future troublesome neck pain. The consequences of a neck injury in a motor vehicle collision can have long lasting effects and predispose individuals to experience recurrent episodes of neck pain.

A study published in the British Journal of Orthopaedic Medicine (1999)22(1):22-25 reported that chiropractic is the only proven effective treatment in chronic cases of whiplash injury. The study was prompted by a previous article in the journal Injury which demonstrated that chiropractic treatment had benefited 26 out of 28 patients suffering from chronic whiplash syndrome.

Reference: Nolet P.S., Côté P., Cassidy J.D., Carroll L.J. The association between a lifetime history of a neck injury in a motor vehicle collision and future neck pain: a population-based cohort study. European spine journal 2010(MAR 7).

Dr. Louis S. Crivelli II
Chiropractor
Greenbelt, MD

Manual therapy and exercise for neck pain: a systematic review

Manual therapy and exercise for neck pain: a systematic review.

Miller J, Gross A, D'Sylva J, Burnie SJ, Goldsmith CH, Graham N, Haines T, Brønfort G, Hoving JL

Manual therapy is often used with exercise to treat neck pain. This cervical overview group systematic review update assesses if manual therapy, including manipulation or mobilisation, combined with exercise improves pain, function/disability, quality of life, global perceived effect, and patient satisfaction for adults with neck pain with or without cervicogenic headache or radiculopathy. Computerized searches were performed to July 2009. Two or more authors independently selected studies, abstracted data, and assessed methodological quality. Pooled relative risk (pRR) and standardized mean differences (pSMD) were calculated. Of 17 randomized controlled trials included, 29% had a low risk of bias. Low quality evidence suggests clinically important long-term improvements in pain (pSMD-0.87(95% CI: -1.69, -0.06)), function/disability, and global perceived effect when manual therapy and exercise are compared to no treatment. High quality evidence suggestsgreater short-term pain relief [pSMD-0.50(95% CI: -0.76, -0.24)] than exercise alone, but no long-term differences across multiple outcomes for (sub)acute/chronic neck pain with or without cervicogenic headache. Moderate quality evidence supports this treatment combination for pain reduction and improved quality of life over manual therapy alone for chronic neck pain; and suggests greater short-term pain reduction when compared to traditional care for acute whiplash. Evidence regarding radiculopathy was sparse. Specific research recommendations are made.

Dr. Paul S. Tetro
Takoma Park/Silver Spring, MD