Chiro.org - Chiropractic Resource Organization.     Support Chiropractic Research!

Low Back Pain

Home/Low Back Pain

Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain

By |April 12, 2018|Guidelines, Low Back Pain|

Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain:

A Guideline From the Canadian Chiropractic Guideline Initiative

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2018 (Mar 29) [Epub]

André E. Bussières, DC, FCCS(C), PhD, Gregory Stewart, DC, Fadi Al-Zoubi, PT, MSc, Philip Decina, DC, Martin Descarreaux, DC, PhD, Danielle Haskett, BSc, Cesar Hincapié, DC, PhD, Isabelle Pagé, DC, MSc, Steven Passmore, DC, PhD, John Srbely, DC, PhD, Maja Stupar, DC, PhD, Joel Weisberg, DC, Joseph Ornelas, DC, PhD

School of Physical and Occupational Therapy,
Faculty of Medicine, McGill University,
Montreal, Québec, Canada


OBJECTIVE: &nbsp The objective of this study was to develop a clinical practice guideline on the management of acute and chronic low back pain (LBP) in adults. The aim was to develop a guideline to provide best practice recommendations on the initial assessment and monitoring of people with low back pain and address the use of spinal manipulation therapy (SMT) compared with other commonly used conservative treatments.

METHODS: &nbsp The topic areas were chosen based on an Agency for Healthcare Research and Quality comparative effectiveness review, specific to spinal manipulation as a nonpharmacological intervention. The panel updated the search strategies in Medline. We assessed admissible systematic reviews and randomized controlled trials for each question using A Measurement Tool to Assess Systematic Reviews and Cochrane Back Review Group criteria. Evidence profiles were used to summarize judgments of the evidence quality and link recommendations to the supporting evidence. Using the Evidence to Decision Framework, the guideline panel determined the certainty of evidence and strength of the recommendations. Consensus was achieved using a modified Delphi technique. The guideline was peer reviewed by an 8-member multidisciplinary external committee.

RESULTS: &nbsp For patients with acute (0-3 months) back pain, we suggest offering advice (posture, staying active), reassurance, education and self-management strategies in addition to SMT, usual medical care when deemed beneficial, or a combination of SMT and usual medical care to improve pain and disability. For patients with chronic (>3 months) back pain, we suggest offering advice and education, SMT or SMT as part of a multimodal therapy (exercise, myofascial therapy or usual medical care when deemed beneficial). For patients with chronic back-related leg pain, we suggest offering advice and education along with SMT and home exercise (positioning and stabilization exercises).

There are more articles like this @ our:

Low Back Pain Guidelines Page

(more…)

Prognostic Implications of the Quebec Task Force Classification of Back-related Leg Pain

By |April 9, 2018|Low Back Pain, Sciatica|

Prognostic Implications of the Quebec Task Force Classification of Back-related Leg Pain:
An Analysis of Longitudinal Routine Clinical Data

The Chiro.Org Blog


SOURCE:   BMC Musculoskelet Disord. 2013 (May 24); 14: 171

Alice Kongsted, Peter Kent, Tue Secher Jensen, Hanne Albert and Claus Manniche

Research Department,
The Spine Centre of Southern Denmark,
Middelfart, Hospital Lillebaelt,
Institute of Regional Health Services Research,
University of Southern Denmark,
Middelfart, Denmark


BACKGROUND:   Low back pain (LBP) patients with related leg pain have a more severe profile than those with local LBP and a worse prognosis. Pain location above or below the knee and the presence of neurological signs differentiate patients with different profiles, but knowledge about the prognostic value of these subgroups is sparse. The objectives of this study were (1) to investigate whether subgroups consisting of patients with Local LBP only, LBP + leg pain above the knee, LBP + leg pain below the knee, and LBP + leg pain and neurological signs had different prognoses, and (2) to determine if this was explained by measured baseline factors.

METHODS:   Routine clinical data were collected during the first visit to an outpatient department and follow-ups were performed after 3 and 12 months. Patients were divided into the four subgroups and associations between subgroups and the outcomes of activity limitation, global perceived effect (GPE) after 3 months, and sick leave after 3 months were tested by means of generalised estimating equations. Models were univariate (I), adjusted for duration (II), and adjusted for all baseline differences (III).

RESULTS:   A total of 1,752 patients were included, with a 76% 3-month and 70% 12-month follow-up. Subgroups were associated with activity limitation in all models (p < 0.001). Local LBP had the least and LBP + neurological signs the most severe limitations at all time-points, although patients with neurological signs improved the most. Associations with GPE after 3 months were only significant in Model I. Subgroups were associated with sick leave after 3 months in model I and II, with sick leave being most frequent in the subgroup with neurological signs. No significant differences were found in any pairwise comparisons of patients with leg pain above or below the knee.

There are more articles like this @ our:

Chiropractic and Sciatica Page and the:

Low Back Pain and Chiropractic Page

(more…)

What Low Back Pain Is and Why We Need to Pay Attention

By |April 7, 2018|Low Back Pain|

What Low Back Pain Is and Why We Need to Pay Attention

The Chiro.Org Blog


SOURCE:   Lancet. 2018 (Mar 20) [Epub]

Prof Jan Hartvigsen, PhD, Mark J Hancock, PhD, Alice Kongsted, PhD, Prof Quinette Louw, PhD, Manuela L Ferreira, PhD, Stéphane Genevay, MD, Damian Hoy, PhD, Prof Jaro Karppinen, PhD, Glenn Pransky, MD, Prof Joachim Sieper, MD, Prof Rob J Smeets, PhD, Prof Martin Underwood, MD

Department of Sports Science and Clinical Biomechanics,
University of Southern Denmark,
Odense, Denmark;
Nordic Institute of Chiropractic and Clinical Biomechanics,
Odense, Denmark.


Low back pain is a very common symptom. It occurs in high-income, middle-income, and low-income countries and all age groups from children to the elderly population. Globally, years lived with disability caused by low back pain increased by 54% between 1990 and 2015, mainly because of population increase and ageing, with the biggest increase seen in low-income and middle-income countries. Low back pain is now the leading cause of disability worldwide.

For nearly all people with low back pain, it is not possible to identify a specific nociceptive cause. Only a small proportion of people have a well understood pathological cause – eg, a vertebral fracture, malignancy, or infection. People with physically demanding jobs, physical and mental comorbidities, smokers, and obese individuals are at greatest risk of reporting low back pain. Disabling low back pain is over-represented among people with low socioeconomic status. Most people with new episodes of low back pain recover quickly; however, recurrence is common and in a small proportion of people, low back pain becomes persistent and disabling.

Initial high pain intensity, psychological distress, and accompanying pain at multiple body sites increases the risk of persistent disabling low back pain. Increasing evidence shows that central pain-modulating mechanisms and pain cognitions have important roles in the development of persistent disabling low back pain. Cost, health-care use, and disability from low back pain vary substantially between countries and are influenced by local culture and social systems, as well as by beliefs about cause and effect.

Disability and costs attributed to low back pain are projected to increase in coming decades, in particular in low-income and middle-income countries, where health and other systems are often fragile and not equipped to cope with this growing burden. Intensified research efforts and global initiatives are clearly needed to address the burden of low back pain as a public health problem.


From the FULL TEXT Article:

Introduction

Low back pain is an extremely common symptom experienced by people of all ages. [1–3] In 2015, the global point prevalence of activity-limiting low back pain was 7.3%, implying that 540 million people were affected at any one time. Low back pain is now the number one cause of disability globally. [4] The largest increases in disability caused by low back pain in the past few decades have occurred in low-income and middle-income countries, including in Asia, Africa, and the Middle East, [5] where health and social systems are poorly equipped to deal with this growing burden in addition to other priorities such as infectious diseases.

There are more articles like this @ our:
Low Back Pain and Chiropractic Page

(more…)

Prevention and Treatment of Low Back Pain

By |April 6, 2018|Low Back Pain|

Prevention and Treatment of Low Back Pain:
Evidence, Challenges, and Promising Directions

The Chiro.Org Blog


SOURCE:   Lancet. 2018 (Mar 20) [Epub]

Nadine E Foster, Johannes R Anema, Dan Cherkin, Roger Chou, Steven P Cohen, Douglas P Gross, Paulo H Ferreira, Julie M Fritz, Bart W Koes, Wilco Peul, Judith A Turner, Chris G Maher, on behalf of the Lancet Low Back Pain Series Working Group

Arthritis Research UK Primary Care Centre,
Research Institute for Primary Care and Health Sciences,
Keele University,
Staffordshire, UK.


Many clinical practice guidelines recommend similar approaches for the assessment and management of low back pain. Recommendations include use of a biopsychosocial framework to guide management with initial non-pharmacological treatment, including education that supports self-management and resumption of normal activities and exercise, and psychological programmes for those with persistent symptoms. Guidelines recommend prudent use of medication, imaging, and surgery. The recommendations are based on trials almost exclusively from high-income countries, focused mainly on treatments rather than on prevention, with limited data for cost-effectiveness. However, globally, gaps between evidence and practice exist, with limited use of recommended first-line treatments and inappropriately high use of imaging, rest, opioids, spinal injections, and surgery. Doing more of the same will not reduce back-related disability or its long-term consequences.

The advances with the greatest potential are arguably those that align practice with the evidence, reduce the focus on spinal abnormalities, and ensure promotion of activity and function, including work participation. We have identified effective, promising, or emerging solutions that could offer new directions, but that need greater attention and further research to determine if they are appropriate for large-scale implementation.

These potential solutions include focused strategies to implement best practice, the redesign of clinical pathways, integrated health and occupational interventions to reduce work disability, changes in compensation and disability claims policies, and public health and prevention strategies.


From the FULL TEXT Article:

Introduction

Despite the plethora of treatments and health-care resources devoted to low back pain, back-related disability and population burden have increased. [1, 2] The first paper [3] in this Series describes the global burden and effect of low back pain and provides an overview of the causes and course of low back pain. In this Series paper, we summarise the evidence for effectiveness of interventions for the prevention and treatment of low back pain and the recommendations from best practice guidelines. Despite generally consistent guideline recommendations around the world, clear evidence exists of substantial gaps between evidence and practice that are pervasive in low-income, middle-income, and high-income countries. Different response strategies are needed that prevent and minimise disability and promote participation in physical and social activities. Here we highlight examples of effective, promising, or emerging solutions from around the world and make recommendations to strengthen the vidence base for them.


Prevention


Table 1

By contrast with the large number of trials that assess treatments for low back pain, evidence about prevention, particularly primary prevention, is inadequate (table 1). Most of the widely promoted interventions to prevent low back pain (eg, work-place education, no-lift policies, ergonomic furniture, mattresses, back belts, lifting devices) do not have a firm evidence base. A 2016 systematic review [4] identified only 21 trials with 30,850 adults (one in a low-middle-income country [Thailand]), and a 2014 systematic review [5] analysed only 11 randomised controlled trials with 2,700 children (one in a low-middle income country [Brazil]).

There are more articles like this @ our:

Low Back Pain and Chiropractic Page

(more…)

A Systematic Review on the Effectiveness of Physical and Rehabilitation Interventions for Chronic Non-specific Low Back Pain

By |March 18, 2018|Low Back Pain|

A Systematic Review on the Effectiveness of Physical and Rehabilitation Interventions for Chronic Non-specific Low Back Pain

The Chiro.Org Blog


SOURCE:   Eur Spine J. 2011 (Jan); 20 (1): 19–39

Marienke van Middelkoop • Sidney M. Rubinstein • Ton Kuijpers • Arianne P. Verhagen • Raymond Ostelo •
Bart W. Koes • Maurits W. van Tulder

Department of General Practice,
Erasmus MC, University Medical Center,
Rotterdam, The Netherlands.


This study has been included for completeness sake. It provides a broad assessment of many of the treatments available in the Supermarket Approach to the Management of Chronic Low Back Pain

Strangely, it only mentions spinal manipulation in the Exercise therapy versus manual therapy/ manipulation section, and none of those studies included chiropractic (CMT) trials.

Perhaps they missed the numerous studies conducted by researchers at the Wolfe-Harris Center @ Northwestern Health Sciences University. They are certainly worth reviewing.

Low back pain (LBP) is a common and disabling disorder in western society. The management of LBP comprises a range of different intervention strategies including surgery, drug therapy, and non-medical interventions. The objective of the present study is to determine the effectiveness of physical and rehabilitation interventions (i.e. exercise therapy, back school, transcutaneous electrical nerve stimulation (TENS), low level laser therapy, education, massage, behavioural treatment, traction, multidisciplinary treatment, lumbar supports, and heat/cold therapy) for chronic LBP. The primary search was conducted in MEDLINE, EMBASE, CINAHL, CENTRAL, and PEDro up to 22 December 2008.

Existing Cochrane reviews for the individual interventions were screened for studies fulfilling the inclusion criteria. The search strategy outlined by the Cochrane Back Review Groups (CBRG) was followed. The following were included for selection criteria: (1) randomized controlled trials, (2) adult (≥ 18 years) population with chronic (≥ 12 weeks) non-specific LBP, and (3) evaluation of at least one of the main clinically relevant outcome measures (pain, functional status, perceived recovery, or return to work). Two reviewers independently selected studies and extracted data on study characteristics, risk of bias, and outcomes at short, intermediate, and long-term follow-up. The GRADE approach was used to determine the quality of evidence.

In total 83 randomized controlled trials met the inclusion criteria: exercise therapy (n = 37), back school (n = 5), TENS (n = 6), low level laser therapy (n = 3), behavioural treatment (n = 21), patient education (n = 1), traction (n = 1), and multidisciplinary treatment (n = 6).

Compared to usual care, exercise therapy improved post-treatment pain intensity and disability, and long-term function.

Behavioural treatment was found to be effective in reducing pain intensity at short-term follow-up compared to no treatment/waiting list controls.

Finally, multidisciplinary treatment was found to reduce pain intensity and disability at short-term follow-up compared to no treatment/waiting list controls.

There are more articles like this @ our:

Low Back Pain and Chiropractic Page

(more…)

Impact of Musculoskeletal Pain on Balance and Concerns of Falling in Mobility-limited, Community-dwelling Danes over 75 Years of Age

By |December 28, 2017|Low Back Pain|

Impact of Musculoskeletal Pain on Balance and Concerns of Falling in Mobility-limited, Community-dwelling Danes over 75 Years of Age: A Cross-sectional Study

The Chiro.Org Blog


SOURCE:   Aging Clin Exp Res. 2017 (Dec 11) [Epub]

Julie C. Kendall, Lars G. Hvid, Jan Hartvigsen,
Azharuddin Fazalbhoy, Michael F. Azari,
Mathias Skjødt, Stephen R. Robinson, Paolo Caserotti

School of Health and Biomedical Sciences,
RMIT University,
PO Box 71,
Bundoora, Melbourne, 3083, VIC, Australia.


BACKGROUND:   In older adults, musculoskeletal pain is associated with increased concerns of falling, reduced balance and increased occurrence of falls. In younger adults, the intensity of neck pain and low back pain is associated with increased postural sway. It is not known if pain further impairs balance and concerns of falling in mobility-limited older adults, and if so, whether this is associated with different intensities of pain.

OBJECTIVE:   This study examined whether mobility-limited older adults with mild or intense neck pain and/or low back pain have significantly increased postural sway as measured by centre of pressure (COP) changes and concerns of falling compared to those without pain.

METHODS:   48 older adults with a gait speed of < 0.9 m/s from Odense, Denmark were recruited through the public health service. Self-reported neck pain, low back pain, and concerns of falling were recorded on questionnaires. Sway range, velocity and area were recorded on a force plate in a comfortable standing stance. Pain intensity was rated on an 11 point numerical rating scale (0-10). Participants were sub-grouped into mild (0-4) and intense (> 5) neck pain or low back pain.

RESULTS:   Intense neck pain was associated with increased anterior-posterior sway range and area of sway. Intense low back pain was associated with increased concerns of falling.

There are more articles like this @ our:

Chiropractic and Senior Care Page

and the:

Low Back Pain and Chiropractic Page

(more…)