Incidence Of Low Back Pain
- 79.2% of Australians Suffer Low Back Pain at some point in their life. (J Manipulative Physiol Ther. 2004 May;27(4):238-44.)
- 67.6% suffer mild low back pain in any 12 month period
- In any 6 month period around 10% suffer significant disability from low back pain
- Most frequently seen musculoskeletal condition in general practice.
WHAT IS THE COST TO SOCIETY
- Low back pain is the 3rd largest drain on the public health purse in Australia
- Only heart disease and Cancer cost more.
- Multi- billion dollar per year problem for taxpayers and the government
- 55% of sufferers do not seek care, independent of social status and economics. (J Manipulative Physiol Ther. 2004 Jun;27(5):327-35.)
- Multifactorial and not well defined
- Most patients don't really know!!
- Factors include (to name a few)
- Poor posture
- Lack of exercise
- Poor work habits
- Congenital anomalies
- Poor diet
- Lack of education
- Heavy drinking
MACRO VERSUS MICRO - TRAUMA
- Most people believe back pain is a result of macro-trauma (MVA, falls, etc)
- 95% of low back pain cases are non-specific in origin, generally associated with repetitive micro-trauma.
- Obesity was previously believed to be a causative factor however, this has been refuted by Stuart McGill.
- Recent anthropometric testing appears to show that those with greater upper body segment (long trunk) have more LBP.
- (J Manipulative Physiol Ther. 1994 Jun;17(5):296-301.)
- CT scans are good for validation but not diagnosis.
- Breathing and incontinence are more important than obesity and physical activity (Aust J Physiother. 2006;52(1):11-6.)
WHAT CAUSES THE PAIN?
- The pain generating structures are often not well identified but may include; disc, facet joints, ligaments, tendons, other connective tissue, muscles, local nerves, nerve root, sacroiliac joints and visceral referral from internal organs.
EFFECTIVE PAIN RELIEF IS A HUMAN RIGHT(NHMRC 1999a)
- Unrelieved severe pain has adveres psychological & physiological effects.
- Consumers shoulder be involved in the assessment and management of their pain
- To be effective, treatment should be flexible and tailored to individual needs.
- It should be possible to reduce pain to a comfortable and tolerable level.
- Pain should be treated early, as established, severe pain is more difficult to treat.
Quality of primary care guidelines for acute low back pain
- The quality and transparency of the development process and the consistency in the reporting of primary care guidelines for low back pain need to be improved. (Spine. 2004 Sep 1;29(17):E357-62)
- Majority of cases are of short duration and recover within 3 months, mild symptoms may persist
- Recurrences are not uncommon
- Psychosocial and Occupational facts appear to be associated with progression from acute to chronic and need to be assessed and addressed early in the intervention.
- Conclusion from this Literature search: The problem with chronic back pain is weakness and loss of function not disease. 'Best stand alone/single practice for prevention and treatment of spinal/joint dysfunction is exercise and life style changes. Best combined interventions are specific spinal control exercises with a course of manual adjustments/mobilizations. (Spine 2004)
Why Choose Chiropractic?
- Chiropractic is a primary contact branch of health care specialising in the diagnosis, treatment and overall management of conditions which are due to mechanical dysfunction and injury of soft tissues.
- Early assessment and treatment gives the best possible outcome with less visits and less pain!
- Our Practitioners utilize a variety of techniques, with the overall goal to resolve symptoms, retrain altered movement patterns, and prevent recurrence. Treatment programs take into account the nature of the condition and the patient's own commitment to provide the best possible outcome.
WHAT CAN WE OFFER ?
- Diagnosis and differential list.
- Eliminate red and yellow flags
- As primary care professionals we can refer for spinal and pelvic x-rays at no charge, and peripheral x-rays for a small surcharge.
- Formulate a management plan and communicate with other professionals.
- Render effective, economical treatment.
- We are in the information age and although we use evidence based care we are not limited by it. Evidence based guidelines tell us what we can't do but don't tell us what we should do.
- The aim of rehabilitation is to help patients identify what is going wrong and assist them in putting steps in place to lessen the frequency and severity of recurrences.
- Effective management should see the probability of relapse to reduce to 20-25%.
- Key is too keep patients motivated after 6 weeks.