Managing Low Back pain with Chiropractic care, collaboration and lifestyle modifications

William Brightman DC, MS, MEd

The statistics are pretty staggering. About 80% of all adults will suffer from low back pain. It is one of the  leading causes of disability globally. It not only prevents people from doing their job but also limits other activities of daily living. This single handedly impacts overall health and can lead to long term disabilities. Back pain accounts for more than 264 million lost work days in one year and it does not discriminate against age or gender. It strikes kids, adults, and the elderly.  Low back pain is not only crippling to the one suffering but also can be damaging to the economy with upwards of 100 billion in lost wages and decreased productivity. Moreover, it will play an emotional toll on the sufferer and their family. 
As overwhelming as the statistics are these numbers can be greatly reduced with conservative care, collaboration with other specialists,  and lifestyle modifications. There are so many types of low back pain, hundreds of causes, and many approaches to managing the different types of pain. From medications to injections, physical therapy, chiropractic care, weight loss, acupuncture, counseling, nutrition  and of course, surgery, it is no wonder why a patient might be confused as to what path to take. 
As a sports chiropractor I generally get a large variety of musculoskeletal complaints in my office. I have patients who present with injuries from the bottom of the kinetic chain (foot/ankle) to the top of the chain (neck). The injuries may be sport related,from repetitive stress, or from inactivity. Even though I manage different conditions throughout the body,  I am still bombarded with the number one complaint by patients- low back pain. 
It is always important to do a complete physical exam to rule out any underlying condition. Most low back pain is mechanical in nature- meaning that it arises from muscles, tendons, ligaments, disc, or nerve. Some of it is local to the low back only and others are radiating to the lower extremity. With radicular symptoms I will often order an MRI or consult with a spine specialist who might perform an EMG/ NCV (electromyography nerve conduction velocity) test. While I typically manage most of my patients who suffer from low back pain  in the office, I will collaborate with other medical specialists when I feel that the patient needs a multi disciplined approach. 
Mechanical back pain is usually the result of a sprain/ strain with some kind of joint dysfunction (i.e. facet syndrome), but it may also be related to a disc displacement. The latter is more severe and takes considerably longer to heal with the right treatments in place. 
The causes of low back pain can be obvious like an athletic injury,  motor vehicle accident or lifting a very heavy object. But it can also occur from just moving the wrong way. Poor posture, desk workers, obesity, and arthritis are other factors that can set you up for low back pain. Sometimes low back pain can arise from internal structures such as ovaries, kidneys, and prostate problems as well as focalized cancers, bone disease,  and infections to the area. This is why diagnosis is always first and foremost. Thankfully, these internal problems are not common. 
 Most mechanical causes of low back pain can be managed nicely with chiropractic care including spinal manipulation,  muscle work, and corrective exercise. There is a growing emphasis on quality care, clinical outcomes and cost effectiveness as well as non drug approaches to managing low back pain. Chiropractic care fits nicely into this need, especially in light of the abuses from prescription opioid use. 
There is overwhelming evidence reported from the following prestigious journals recommending chiropractic care as a first defense in the treatment of low back pain. Agency for Health Care Research and Quality; Annals of Internal Medicine; Medical Journal Spine; and Journal of American Medical Association to name just a few. This is  in addition to countless other journals and thousands of clinical studies that have all recommended chiropractic care in the treatment of acute and chronic low back pain. 

 Most patients with mechanical back pain start feeling better within the first few visits. This combined with therapeutic exercises and lifestyle modifications the patient will continue to function better during their normal activities with less pain. Chiropractic care may have to be utilized with high frequency the first few weeks for long term sufferers, but after that initial phase, only maintenance may be needed to manage chronic low back pain. This beats the alternative of chronic pain and/or drug use! Some cases of acute low back pain resolve within 1-5 treatments and do not need additional chiropractic care. 
The spinal manipulation improves joint mobility and range of motion while reducing pain. This combined with a home stretching and strengthening program of 10 minutes 3-5 days a week will enhance the results. Stretching and Physical therapy alone can be beneficial to certain types of low back pain- but when combined with specific chiropractic manipulation the results are superior. Pain relief within 24-48 hours with improved mobility is the outcome. 
The following is a list of other recommendations in addition to chiropractic manipulation and home exercise for the treatment and management of low back pain. They are as follows:

• Maintain proper posture when standing and especially seated. Be aware of slouching- just like your mother always told you. 
  
• Wear supportive footwear- good walking shoes like new balance, asics, or brooks; avoid high heels
  
• Avoid long periods of sitting- if you have a desk job try to get up every ½ hour to move and stretch your spine out.
  
• Avoid prolonged bed rest- this stiffens the low back up when you are inactive for a long period of time. 
  
•  Maintain a healthy body weight- simply put, extra weight puts extra stress on the low back. Keep it in check. 
  
• Be aware of certain foods that may trigger inflammatory processes in the body. A diet high in sugar and processed food increases inflammation and contributes to low back pain. 
  
• Walk and do light aerobics. In addition to your low back stretches you should get some light cardio in as this helps with low back pain. 
  
• Stop smoking- smoking increases low back pain along with every other possible disease including heart disease and all forms of cancer. 
  
• Ergonomic workstation- . Make sure the computer is the right height and the chair has lumbar support for the low back. 
  
• Make sure your mattress is firm or extra firm to provide good spinal support during the night. You may benefit from a pillow between or under the knees and head having good support. 
  
• Lift with the hips and knees and NOT the low back
  
• Regular adjustments and communication with your chiropractor will raise your awareness about your low back and help you to manage the pain much more effectively.
  

Spinal manipulation that incorporates flexion distraction or decompression (left) combined with high velocity adjustments are very effective in managing acute and chronic low back pain. 

An overcorrection with posture to increase awareness to all postural muscles. (A plumb line can be drawn through the ear, shoulder, hip and ankle)

Correct seated posture is important in preventing back and neck pain. Slumped position on the left increases strain on spine while correct posture with lumbar support decreases load throughout the spine (low back and neck)

Below are some helpful stretches and strengthening exercises for the low back. 

Foam rolling to loosen soft tissue “tightness” (L): hip extension to activate gluteus maximus which is beneficial to low back (R)
​

Lumbar spine extension exercises off a physioball combined with bridges are excellent at strengthening the deep core spinal muscles. 
​

Knee to chest with a cross over stretch to help lengthen lumbar muscles: Exercises like this can be done very early in care for relief. 
​

Spinal extension and flexion exercises (Cow-cat exercises)

Opening up the hips helps to unload the low back

                                                                Variations of spinal extension stretches and strengthening exercise

There are an assortment of different strengthening and stretching exercises that when combined with hands on manipulation,  physical therapy, and different modes or aerobic exercise can be very effective at managing both acute and chronic low back problems. 



                            William Brightman DC, MS, MEd
                            Private Practice, Mahopac NY 
                            [email protected]