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Chiropractic is the Most Effective Treatment for Low Back Pain

McKinney Chiropractor Best Practices

Research Commentary;

Best Treatment for Low Back Pain 

Comparison of Spinal Manipulation Methods and Usual Medical Care for Acute and Subacute Low Back Pain

A Randomized Clinical Trial

Michael Schneider, DC, PhD, Mitchell Haas, DC, MA, Ronald Glick, MD, Joel Stevans, DC, and Doug Landsittel, PhD

Research Reviewed by Dr. Travis Downs

Best Treatment for Low Back Pain 

Summarized Review Conclusions

We all know that one person, in fact it’s probably many people that deal with low back pain on a daily basis. Most of those people take over the counter medications and just try to tough it out. This is because they have been to a medical doctor and what they prescribed didn’t work and they don’t know what else to do. This research once again shows that the best care for low back pain is from the manual thrust manipulation (MTM) that a chiropractor performs over usual medical care (UMC). When research involving chiropractic adjustments are done correctly the adjustment will always come out on top because of Hilton’s Law. If you put the proper motion into a joint it’s going to decrease the inflammation and pain is going to start to go away. Below you will find direct quotes of the referenced article along with my synopses of the research query, methodology and findings including references used by the research authors.

 

  • “Significantly more patients in the manual-thrust manipulation group achieved moderate (≥30%) or substantial (≥50%) reductions in self-reported disability and pain scores at 4 weeks.”
  • “These results contradict prior assumptions of therapeutic equivalence between manual thrust and mechanical-assisted types of manipulation.
  • “Manipulation is an effective treatment for short- term relief of acute and subacute LBP.”

 

Introduction to the Research

This research shows that the manual adjustment is better than the one click assisted adjustment and usual medical care. This is just one of many articles that has proven this time and time again. For anyone with low back pain chiropractic is the way to go. The interesting thing about this article is that when they did the follow ups with the patients in the study at 3 and 6 months, they were all about the same. This is not surprising because we know about Hilton’s Law and if you stop moving the joints properly then the pain will start to come back. Once you are out of pain you must keep up your adjustments or pain will return.

 

 

Research Methodology

A total of 107 adults with onset of LBP within the past 12 weeks were randomized to 1 of 3 treatment groups: MTM, MAM, or UMC. Outcome measures included the Oswestry LBP Disability Index (0–100 scale) and numeric pain rating (0–10 scale). Participants in the manipulation groups were treated twice weekly during 4 weeks; subjects in UMC were seen for 3 visits during this time. Outcome measures were captured at baseline, 4 weeks, 3 months, and 6 months.

 

 

Research Findings

MTM led to greater short-term reductions in self-reported pain and disability than MAM or UMC. These changes were both statistically significant and clinically meaningful. The benefit seen at end-of-intervention was no longer statisti- cally significant at 3 or 6 months. No adverse outcomes were reported. MTM should be considered an effective short-term treatment option for patients with acute and subacute LBP. MAM and UMC seem similar in effect; both lead to decreased pain and disability, but their value compared with natural his- tory was not evaluated in this study.

 

Research References

As always with these reviews, these are my takeaways from the article and I encourage you to read the article in its entirety.  The references used in this article by the authors of this article are listed here.

Our Message

Our Chiropractors in McKinney, located near the corner of Eldorado Pkwy. and Ridge Rd., take a natural approach to getting rid of soreness caused by low back pain, neck pain, shoulder pain, etc. We know how important getting the right amount of nutrients and movement is to your health. Through Chiropractic adjustments and education, we teach our patients the best ways to relieve pain with Chiropractic and without medicine.

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Many times foam rolling will help break up soft tissue adhesions but may not be pointed and intense enough. Lacrosse balls are a great way to up the intensity as you hit trigger points to create blood flow and muscle mobility while still being in control and using just your body weight and desired pressure. Lacrosse balls travel easy and are a great way to work through the knots and tight muscles you may experience as we work through your pain and move toward the return of function and health.

Many of the things that cause you to be in pain like sitting a lot, lack of exercise, poor nutrition can create inflammation and cause tight muscles as the body tries to protect itself. By teaching our patients how to use a foam roller in a way to mobilize tissue and break up adhesions, we can create more motion and induce healing. Using your own body weight and correct placement of the foam roller we can teach you to control the pressure and intensity giving you control in your soft tissue break up.   

There are all types of orthotics for specific uses throughout the body when facing injuries. In our clinics we may use foot orthotics from time to time depending upon the patients presenting symptoms. In 10% – 25% of low back pain we may see a break in the “kinetic chain”, which simply means examining the proper alignment of skeletal function from the feet to the skull. In certain cases of fallen arches, supination or pronation of the feet it could benefit the patient to temporarily use orthotics while working through a corrective care program consisting of adjusting the spine and a focused rehabilitative exercise program to restore proper function.
Manual Therapy is very specific and isolated muscle work but it is much more than what you might think of when getting a massage. Many times injuries that occur or have been ignored can lead to muscle imbalances. Because of this, we have many patients who, on the front-end of care may benefit from isolated muscle stripping, trigger point therapies or breaking down adhesions. In our office we will use our hands and specific tools, such as those used in IASTM (Instrument Assisted Soft Tissue Mobilization), to mobilize the affected areas. This allows for more blood flow to the area of injury increasing your motion and recovery.
In a situation of acute pain of any joint or muscle, RockTape can be used on the skin to help restore some immediate function, which will reduce pain short term. RockTape works by stimulating proprioception and blood flow, which is to say it brings your brains attention (neuroreceptivity) to the area of application and encourages healing by allowing for an increase in motion. RockTape quickly alleviates front-end pain giving you more motion and leads to the beginning of your recovery.
Many patients come to the chiropractor in very acute pain. Analgesics, while not the answer to fixing the problem, can assist the doctor on the front end of care to provide temporary relief. This will allow for less pain in the beginning stages of care and allow for more movement, which will lead to healing and recovery.
It is important as chiropractors that we x-ray your spine and problem areas looking for alignment, curves of the spine, degeneration and arthritis, so that we can properly assess your symptoms and be safe and effective in our treatment. Unlike most chiropractors we will not only x-ray in the beginning but also at the post acute progress exam in order for you to see the changes that have been made and help you understand how to maintain these changes moving forward.
As a human being, you are born with 3 natural curves to your spine giving you the ability to be upright. Throughout life you can lose these curves either through injury or more commonly through poor posture, lack of exercise, and poor lifestyle habits. This decrease in proper function can lead to neck pain, back pain, and headaches. By restoring the curves of the spine you will see a return of proper daily function. As the old adage says, “Proper structure allows for proper function.” The Denneroll is a curve restoration device made from Styrofoam, which has been proven to use a patient’s body weight and gravity to reshape the curves of the spine and allow the ligaments and muscles to return to normal length. In our office you will see marked differences between your pre and post x-ray series during care.

The wellness and prevention program we use was developed by Dr. James Chestnut and the Wellness Practice.  It will email you daily for 90 days focusing on three major components of human health and immunity, which can all be completed at home. Each day you will receive instructions in three different aspects of daily living; including specific recipes for each meal and snack, personalized workouts for each day and stress management routines including a variety of positive thinking exercises. After completing your Lifestyle Health Risk Assessment we will use the individual results and your personal health score to create a 90-day lifestyle plan, (also developed by the Wellness Practice) which will help guide you in how to eat better, move better, and think better. When you have completed a 90-day program you will see a significant improvement in your overall health and wellness score. This program will give you the power and knowledge to be the healthiest and happiest version of yourself.

Decompression is exactly as it sounds, it decompresses the spine by way of mechanical traction and should always be used in conjunction with the chiropractic adjustment for the highest benefit to the patient. The spine can become compressed by injury or more commonly overtime by way of degeneration due to poor posture, too much sitting, improper motion and dehydration of discs. By using decompression in the office we can help to hydrate the discs and create greater motion in the joints to allow for the relief of back pain, neck pain and shooting or traveling pain. The decompression table works by having the patient lie in their most comfortable position on the table while a traction cable pulls and releases slowly and gently decompressing the spine.

It is not only our goal to help patients get out of pain but to also understand the lifestyle choices which caused the pain in the first place. Whereas the SHA focuses on functional improvement the LHRA was designed by Dr. James Chestnut and the Wellness Practice to help educate patients on how to live a healthier life by understanding all of our lifestyle decisions that impact overall health. The LHRA consists of 3 elements; a lifestyle questionnaire, a physical fitness test, and a blood work panel so that we can give you a personalized Health Score from 1-100. Your score will be outlined in a 13 page report that will fully explain the research behind your overall health and how it applies to you and your life.

The SHA is a proprietary health software program developed by Dr. James Chestnut and the Wellness Practice and used by our office to assess the symptoms of our patients on a more functional level. It also helps us to examine your current lifestyle and the full range of contributing factors while diagnosing exactly what has caused your symptoms including any pain you may be experiencing. After completing the SHA testing you will be given a personalized Spinal Health score from 1-100 which will be used to create an individual care plan that gets you out of pain and helps you start rebuilding a healthy lifestyle.

Much like allopathic care, the goal of naturopathy is to address symptoms.  The difference is that instead of using drugs or surgery, naturopathic medicine uses “natural” cures.  Usually these are seen in the form of herbs, vitamins, supplements, and nutraceuticals.  The same issue that exists in allopathy occurs here.  That is, we are treating symptoms only and not focused on a return to homeostasis or eliminating the root problem.  This means we don’t address the cause of the symptoms, only the treatment of them. 

A proper balance of a human’s physical, chemical, and emotional state, are necessary for optimal life and health.  The goal of every human is to maintain the balance known as homeostasis within our daily environment (eating, moving, thinking).  When you are at homeostasis, the cells of your body are functioning optimally to achieve health, immunity and create an environment where you can function at your highest level of daily performance.

Probiotics are an essential nutrient for human health.  These are the “good bacteria” found in our digestive system, which make up our Gut Flora.  The bacteria support healthy digestion of the food we eat, maximum absorption of the nutrients we take in, and help support us in achieving and maintaining homeostasis. These bacteria are vital to our immune system and protecting us from bad bacteria, viruses, and fungi.  Lastly, probiotics reduce the inflammation we see systemically.   Modern man consumes 1/1,000,000 of the good bacteria we need to be healthy.

Vitamin D3 is an essential nutrient that is actually less of a vitamin and technically acts more as a hormone in the body.  In modern society almost everyone is now deficient in vitamin D3 and it is having profoundly negative effects on our immune system and ability to maintain health (homeostasis).  Humans naturally obtain vitamin D3 from the UVB rays of sunlight hitting our skin and causing a reaction to occur changing cholesterol eventually to Vitamin D3 by way of the liver. Due to our lack of sun exposure compared with that of our healthier stone-age ancestors, we must add this essential nutrient to our diet every day.  Always watch for an organically sourced carrier when choosing a Vitamin D3 supplement.

Omega 3 is an essential nutrient, which humans require around 2000mg per day to maintain health. This must be taken in through diet due to the fact we do not produce this in the body.  In today’s world, it is impossible to get enough Omega 3 through diet and must be supplemented.  Omega 3 is a polyunsaturated fatty acid consisting of DHA (Docosahexaenoic Acid), EPA (Eicosapentaenoic Acid), and DPA (Docosapentaenoic Acid).  The most common form is found in fish oil. Many of the forms we see as supplements are concentrates and the DPA has been removed in the refining process.  In nature DPA is present and must be in quality fish oil.

RCT stands for Randomized Controlled Trial.  It is a double blinded, placebo-controlled study.  This is recognized as the highest standard in research and what all health care should be predicated upon. Unfortunately, many physicians and pharmaceutical companies rely on lesser “studies” to support treatment protocols/pharmaceuticals over RCT researched outcomes.  For this reason, the care we provide in our office is based solely on the RCT literature in peer reviewed medical journals.

These examinations are performed as part of your initial intake assessment, as well as your ongoing progress examinations during care.  The purpose is to examine from the orthopedic tests, the integrity of your joints and surrounding structures regarding motion, disfunction, and pain.  Secondly, the Neurological tests allow us to see how your brain is communicating with your body and how that plays into your symptoms and disfunctions.  These tests go a long way in diagnosing and treating any conditions a patient is experiencing.

Our immune system is made up of special organs, cells and hormones that fight infection (microbes) throughout the body. The main parts of the immune system are: white blood cells, antibodies, the complement system, the lymphatic system, the spleen, the thymus, and the bone marrow.  There are two parts to the immune system, the innate or the front line that works to fight off microbes immediately and is non-specific, and the adaptive, which is the larger part that remembers microbes and builds long lasting defense.  Supporting the immune system correctly is essential in controlling its overall function and helping you heal and defend yourself from disease. 

“Thigh Bone connected to the hip bone…” this familiar song is the easiest way to explain the concept used to describe human movement.  Starting from the ground up, with every movement you make, many muscles, joints, tendons, and ligaments are involved.  When in balance and moving correctly, everything works in unison.  When you’re not in balance or they’re experiencing a breakdown in the kinetic chain, we create compensations, disfunction and eventually pain at different points throughout the body.  The kinetic chain working properly and in balance, is a part of resolving musculoskeletal conditions.

The facet joints are small, cartilage-lined points of contact where each individual vertebra meets the one above and below it. They both enable your spine to flex during movement and also limit its range of motion. These joints being correctly positioned allows for proper range of motion in the spine.

The care continuum is the period of time and actions taken when a patient is searching to alleviate an acute (pain) condition and return to homeostasis or a sense of wellness.

“The wear and tear on the body” which accumulates as an individual is exposed to environmental stressors. The term Allostatic load was coined by Dr. McEwen and Dr. Stellar, during their research, while at Yale University in 1993.  Essentially, your allostatic load increases whenever you have a stress to your system.  This could be from poor food or nutrition choices, not enough movement or incorrect movement, and lastly due to emotional stress or a lack of positive thought.  Your allostatic load can be decreased, by doing the right things for your body.

Many times the supplements/vitamins we find on the shelves at our local health-foods store or grocery store, are made in a lab and are not truly natural in spite of labeling. These products are known as “synthetics” due to their synthetic make up or their genetically engineered concentrated form.  The issue is that our bodies cannot fully absorb synthetic products and they can become highly inflammatory giving us zero benefit and can actually be harmful with prolonged use.

Biologics are drugs or vaccines that contain living organisms, and work by down regulating (suppressing) the immune system or by attempting to manipulate the body into activating parts of the immune system.  As you may have guessed though, there is an extremely negative side to down regulating your immune system and these drugs typically have many side effects. 

Drugs used in an allopathic model to over ride the immune system and kill the harmful bacteria presumed to be causing an illness.  The issue here becomes that an antibiotic does not recognize the difference between bacteria beneficial to humans and therefore depletes all types of positive gut bacteria while trying to eliminate the bad.  This can take a huge toll on the immune system, in fact in research cited by Dr. Martin Glaser, while he was chair of the Department of Medicine, New York University Langone Medical Center, suggested that even a short course of antibiotics may cause permanent changes to the community of friendly flora in the gut.

“Testing” performed by the physician used to identify markers and symptoms that are out of the ordinary.  Rarely does diagnostic testing look at homeostasis or the basis of overall health but when the information derived from proper diagnostics is examined in search of the root cause of a problem it can be extremely helpful to the patients treatment. 

The Allopathic model to health care is defined as: the treatment of disease through intervention most often using drugs or surgery to counter the effects of the presenting symptoms (symptomatic care).  The basis of allopathic care is that your body or immune system isn’t doing what it needs to and must be chemically over ridden by a prescription or synthetic remedy.  When you visit a medical doctor they will assess the symptoms and prescribe a treatment using drugs or surgery in an attempt to alleviate your symptom. The challenging theory of allopathic care (modern medicine) is the absence of addressing what lifestyle choices were made by the patient, which caused the symptom to occur. Causal based care takes into account the symptom and the basis of what lifestyle choices need to change in order to alleviate the main issue along with the symptom.

The neo-cortex is the largest part of the cerebral cortex, the outer layer of the cerebrum, and is made up of and maintained by Omega-3 fatty acids. The neo-cortex is made of six layers and is involved in higher-order brain functions such as sensory perception, cognition, generation of motor commands, spatial reasoning and language. 

Gut flora or gut microbiota are the microorganisms including bacteria, archaea and fungi that live in the digestive tracts of humans. The diversity and quantity of the gut bacteria is responsible for the health of our gastrointestinal tract.  These bacteria and their host have a symbiotic relationship where they are mutually beneficial to one another and the absence or proper levels can lead to illness and disease. 

An essential nutrient by definition is a nutrient required by a species for survival that our bodies are unable to always create.  The difference between a species living at optimal health vs. survival at lesser health is the quantity and sourcing of essential nutrients.  Essential nutrients must be obtained through food, proper organic supplementation or a healthy environment.  Modern day food sources make it almost impossible to obtain enough essential nutrients to be healthy.  Beware of synthetic supplements and vitamins masking as essential nutrients.

Spinal Manipulative Therapy, also known as the chiropractic adjustment is a technique that treats back pain, neck pain, joint pain and other musculoskeletal conditions via the application of a high speed, low amplitude force to the joints. Restoring proper joint motion and maintaining it will reduce pain, slow degeneration, and insure proper function, which initiate the body’s natural healing processes.