Today’s episode is all about chronic low back pain and some great, brand new research. By now, as I’ve said in the past, even traditional Chiropractor-hating, torch-wielding, quasi-scholastic chiropractic detractors are admitting that, yes, Chiropractic is indeed helpful for low back pain.
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For now though, it’s time for bumper music!
We will dive into the research in a few minutes but first, I have to introduce my guest this week. His name is Dr. Craig Benton. Dr. Benton is the owner/operator of Benton Chiropractic down in Lampassas, Texas but that’s not where the intro stops. Dr. Benton is the chair of Scientific Affairs for the Texas Chiropractic Association. He is where I have found a healthy percentage of the material that I have covered over the years for my blog, my YouTube videos, and now for the Chiropractic Forward podcast. Dr. Benton has been unknowingly instrumental in keeping me in business and making my life easier.
Welcome to the show Dr. Benton, how is life in Lampassas this week? My first question today is, have you been playing any guitar lately?
Dr. Benton and I are both in active practice. In fact, there’s a chance we may both have a patient show up at any time. That’s how actively we are practicing. I think that’s incredibly important to note because, so many times, you hear podcasts and attend seminars where the guys and gals speaking don’t really know a thing about actively practicing for 20 plus years. I’ve always felt that experience matters. Even when I was young and green. I was well-aware that I didn’t know it all and I’m even more aware of that today than ever.
So Dr. Benton, I’m looking forward to hearing your opinions and insight today.
Since the podcast today is about chronic pain, I think we should begin with a definition of what Chronic really is. When we define “chronic” in the context of neuromusculoskeletal complaints, we define it as being a complaint that is greater than 12 weeks in duration. Right at 3 months. Some patients will come into the office having had a condition for 15-20 years. I tell them that they are more than a little stubborn to have put up with something for so long.
It is common sense that a condition that is chronic will be more difficult to treat. Also, most chronic conditions can be traced back to a biomechanical, neuromusculoskeletal origin. One of my favorite quotes is from Dr. Lee Green, Professor of Family Medicine at the University of Michigan. He said, “Neck pain is a mechanical problem, and it makes sense that mechanical treatment works better than a chemical one.” Although Dr. Green is referring to neck pain in this instance, “low back pain” can easily be substituted. What he says could not make more sense. It’s an easy and very concise way to understand why Chiropractic, manipulation, mobilization is so incredibly effective above and beyond anything else for this sort or issue, including medication.
Do you have a quote or quotes that you love sharing that make sense to you and that help you boil down what it is we chiropractors are doing to help our patients?
I have overhead medical doctors (more than once) talking about having back pain and just injecting themselves with something to try to get over it. If they asked me, I’d tell them that they’re just covering up an underlying trigger or cause and ignoring it is to their detriment.
A good metaphor I came across for using medication for neuromusculoskeletal complaints is that it’s like unplugging a smoke alarm because you don’t like the noise. But, the fire is still slowly growing. What have they done to treat anything in a responsible and effective way? Nothing at all. We tend to live in a society that wants a pill for this and a potion for that so they can get over it and get on with life. But it doesn’t work that way.
Dr. Benton, has this been your experience as well?
Dr. Benton, don’t you treat soldiers through the VA program? Can you tell us all a little bit about that?
Let’s go over some low back pain statistics just we can try to stress the importance of what we’re talking about here. Dr. Benton, please feel free to jump in with anything you’d like to add:
- Low back pain is the single leading cause of disability worldwide.
- 8 out of every ten people will experience back pain. I will admit that I have never met anyone in 45 years of life on this Earth that fit’s into the 20% that apparently never suffers from any low back pain. Dr. Benton….have you ever met anyone that has never had back pain? Is it just me?
- Back pain is the second most common reason for visits to the doctor’s office right behind upper-respiratory infections.
- With such gains and leaps in the medical industry as far as treatment goes, low back pain is stubbornly on the rise.
- More than half of Americans who experience low back pain spend the majority of the work day sitting. 54% to be exact. It’s good to be a chiropractor I guess. Our patients keep us up and moving most of the day.
- Dr. Benton, did you know that….now…an equal number of patients seek help with a chiropractor first as seek help with a medical practitioner first for back pain? That’s new information to me that I found interesting.
- Back pain in general costs $100 billion dollars every year when you factor in lost wages, productivity as well as legal and insurance overheads.
Now that we all know more about low back pain, let’s go through some things that may put you at greater risk of suffering from the condition. Dr. Benton, with your experience on the research, stop me if you have anything to add to any of these:
- Age: as the spine and supporting structures begin to age and decline, the rate of low back pain will understandably increase.
- Fitness Level: physically active people do not suffer low back pain to at the rate inactive people suffer. A healthy exercise and core building protocol can help reduce symptoms or instances of low back pain.
- Weight Gain: Being overweight or obese and gaining weight quickly places increased strain on the low back.
- Pregnancy: This one goes without saying. Pelvic changes and weight gain both contribute.
- Genetics: Some forms of arthritis or other systemic conditions are genetic in nature
- Work: Jobs that include heavy labor and or twisting or expose people to vibration consistently can be problematic. Jobs that require long periods of sitting in a chair can be equally problematic.
- Mental health factors: Many people are able to deal with chronic pain but anxiety and depression are conditions that can cause a person to focus on the pain which tends to raise the perceived severity and significance for the person suffering from the condition. Dr. Benton, have you come across any patients that fit this description in your practice?
- Improper backpack use: Kids suffer back pain needlessly since they are not traditionally in an age range we would consider to be a risk factor. However, backpacks used improperly are a common culprit. A backpack should never be more than 15%-20% of a child’s weight and should be carried on both shoulders with the bottom being at or about waste level.
What does the research say?
As I’m sure Dr. Benton will agree…..the research says a lot, to be honest. In fact, I’d say that there’s more research for the effectiveness of manipulation/mobilization in low back pain than for any other conditions chiropractors commonly treat. Am I out of bounds here Dr. Benton?
The research shows Chiropractic beating general practitioners in effectiveness as well as cost. The research shows Chiropractic beating common medications prescribed for low back pain. The research shows Chiropractic beating physical therapy and exercise alone. The research shows Chiropractic beating epidural spinal injections for low back pain. And the two of us can point you to randomized controlled trials proving it. Basically, the research is clear.
In January of 2018, a brand new research paper dealing with manipulation and mobilization was published in Spine Journal by Ian Coulter, PhD et. al. titled “Manipulation and mobilization for treating chronic low back pain: a systematic review” and funded by the National Center for Complementary and Integrative Health.
Now, to be clear, Spine Journal sounds a little bit like it may be a Chiropractic publication for those of you that don’t commonly read research abstracts…… but it is not.
Dr. Benton, can you describe Spine Journal for us?
Here’s why the authors took this project on.
The authors of the paper stated that there remained questions about manipulation and mobilization efficacy, the proper dosing of the techniques, how safe they are, as well as how they compare to other treatment protocols commonly used for chronic low back pain.
I have to say that I had no remaining questions regarding really ANY of those topics but it seems that these authors did.
Dr. Benton, again, please feel free to jump in anywhere you’d like as we go through the hows, why’s and the what’s here.
Here’s How They Did It
- This paper was a systematic review and meta-analysis.
- They searched databases for relevant studies from January 2000-March 2017
- They chose randomized controlled trials that compared manipulation or mobilization to sham treatment, no treatment, other therapies, and multimodal therapeutic approaches.
- They assessed the risk of bias using the Scottish Intercollegiate Guidelines Network.
- Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was applied to determine the confidence in effect estimates.
- 51 trials were included
What They Found
- Within 7 of those trials on manipulation and/or mobilization there was reduction of disability when compared to other forms of therapy.
- Further analyses showed that manipulation specifically was responsible for significant reduction in pain and disability when put up against therapies such as exercise and physical therapy.
- Mobilization was also was significantly more effective when compared to exercise regimens for pain reduction but not for disability.
Wrap It Up
In the conclusion of the paper abstract, the authors say, “There is moderate-quality evidence that manipulation and mobilization are likely to reduce pain and improve function for patients with chronic low back pain; manipulation appears to produce a larger effect than mobilization. Both therapies appear safe.”
There is moderate-quality evidence that manipulation and mobilization are likely to reduce pain and improve function for patients with chronic low back pain; manipulation appears to produce a larger effect than mobilization.
As I’ve said many times, “a lot of research in your favor becomes fact.” Chiropractic has A LOT of research in its favor.
Dr. Benton, would you like to add any final thoughts?
I’d like to thank Dr. Benton for taking the time to be with us today. He really is one of the guys out here in the real world trying his best to help change things for Chiropractors in Texas and in the world.
I want to finish off by saying that when Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple.
Just another reason to call a chiropractor TODAY!
Research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good or excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically and do it with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health!
Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Please remember, we need your help to spread the word and grow this podcast. If you would help us out by sharing our podcast information, our website, and social media entities, we would greatly appreciate your help.
We cannot wait to connect again with you next week. From Creek Stone here in Amarillo, TX, home of the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Coulter I, et. al. “Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis” The Spine Journal, Volume 0 , Issue 0 ,