Back Pain: Number One Cause of Disability Worldwide

There is a worldwide effort being undertaken by the Global Burden of Disease 2010 Project to identify detrimental health conditions throughout the world. Seven of the studies undertaken by this group as well as accompanying commentaries have appeared in The Lancet, a British medical journal. The global disease burden is a computation of death and disability and its overall cost.

One of the most interesting studies involves a massive collaboration between the World Health Organization, the Institute for health Metrics and Evaluation which is the coordinating center of this endeavor, the University of Queensland School of Population Health, Harvard School of Public Health, Johns Hopkins Bloomberg School of Public Health, and the University of Tokyo, Imperial College London that delineates the extent of musculoskeletal conditions throughout the world.

The Global Burden of Disease 2010 Project found that neck and back pain are respectively the number four and number one causes of disability worldwide. The worldwide burden of disability from musculoskeletal conditions is much larger than they were only 20-30 years ago. The estimates of people suffering from musculoskeletal conditions worldwide is staggering with an estimated 632.045 million people suffering low back pain and another 332.049 suffering neck pain.

Additionally, people are living much longer which adds to the health burden because age is usually accompanied by pain, disability, and disease at levels not previously seen.

Dr. Scott Haldeman holds both a Doctor of Chiropractic degree and a degree in Medicine (meaning he is both a chiropractor and medical doctor) who chaired the 2000-2010 Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders of the Global Burden of Disease 2010 Project. Dr. Haldeman notes that musculoskeletal conditions such as back pain, neck pain, and arthritis affect more than 1.7 BILLION people throughout this world.

With over 1.7 billion people suffering from back pain, neck pain, and arthritis that makes musculoskeletal conditions a greater impact on people than HIV/AIDS, tropical diseases that includes malaria, disasters from nature, and all of the neurological conditions combined. And do not confuse the term “health burden” with deaths from these causes. It is the cost of long-term deleterious health problems.

When considering the costs of “years living with disability,” musculoskeletal conditions are only second to mental and behavioral disorders. Overall, musculoskeletal conditions are the sixth leading cause of death and disability with cardiovascular disease, neonatal diseases (newborn baby diseases in the first month of life), neoplasms (a new growth of tissue that serves no physiological function… think “tumor”), and mental or behavioral disorders being a greater threat to death and disability than musculoskeletal conditions.

Low back pain alone accounts for more of a global disease burden than malaria, preterm birth complications, COPD (Chronic Obstructive Pulmonary Disease such as emphysema or chronic bronchitis that is an irreversible obstruction in the airway causing impediments to the ability to exhale air from the lungs), tuberculosis, diabetes, or lung cancer.

When calculations are done to combine the global disease burden of low back pain with that of neck pain these two conditions account for more of a global disease burden than all other diseases and health depleting conditions except ischemic heart disease. This makes the combination of low back and neck pain a greater global disease burden than HIV/AIDS, malaria, lower respiratory infections, stroke, breast cancer and lung cancer combined, Alzheimer’s disease, diabetes, depression, or injuries from traffic accidents.

Your Choice: Chiropractic or Surgery?

Your idea of what healthcare should be or should not be may determine whether you can enjoy the benefits of conservative care or carry the scars of surgery.

One study shows that the healthier the personal habits are of a doctor the recommendations they make are more likely to be for lifestyle modifications than relying solely on medication or surgery. This concept leads us to a second study and the purpose of this article.

A separate study shows that if a patient with low back pain sees a surgeon as their first choice in doctors then that patient is more likely to have surgery for their low back complaints than if they had seen a Doctor of Chiropractic as their first choice in doctors. The figures are significant with 42.7% of the patients who saw a surgeon first being scheduled for surgery compared to only 1.5% of the patients who saw a Doctor of Chiropractic as their first choice in doctors.  Interestingly, these figures held true even when the severity of the injury and other factors were taken into consideration.

In other words, choose a Doctor of Chiropractic for your first contact when you are seeking relief from low back pain otherwise you may end up with less than satisfactory results and a permanent scar on your back. It is clear that the treatment philosophies of various doctors dictate the type of treatment they recommend for their patients.

An old saying goes, “Surgeons do what surgeons are taught to do.” Apparently, studies are proving the truthfulness of that old saying.

The cost of surgery is much greater than the expense associated with conservative chiropractic care so politicians and bureaucrats involved with healthcare cost containment may become interested in making healthcare decisions based upon the overall cost of various treatment modalities and techniques. This is becoming more obvious as emerging studies become available and even the Mayo Clinic has recognized that back surgery is only indicated in a small percentage of cases.

The choice of expensive surgery or more moderately priced chiropractic care is significant because the direct cost of treating low back pain in the United States in the year 2004 was $193.9 BILLION dollars!

It is because of these factors that researchers delved into various forms of records such as medical bills, administrative claims, medical record review documents, and even performed telephone interviews with patients who had undergone low back surgery to determine the potential variables involved in learning how to predict who would have low back surgery and who would not.

In looking at low back injuries suffered on the job it became apparent that a worker’s initial score on the Roland-Morris Disability Questionnaire (RMDQ) proved to be one of the most striking predictors of who would have surgery or not. If a worker had an initial score on the RMDQ that was 17 or higher on the 0-24 scale then they were six times more likely to have surgery compared to workers whose initial score on the RMDQ was in the 0-8 range. Apparently, if they were in more pain or disabled to a greater degree it led them to believe that a much more radical treatment such as relatively expensive surgery was necessary. The end result being that conservative (and less expensive) chiropractic care was not initially considered and many more injured workers went to surgery instead of avoiding it by utilizing conservative chiropractic care. 

Increased Bone and Joint Injury from High Arches in Feet

It really is no surprise that flat feet can cause numerous problems not only in the feet but also throughout the entire axial skeleton up to the base of the skull. What is not as well known is that too much arch in the foot can be just as detrimental as fallen arches as far as spinal and body structural health is concerned.

A high arch can cause femoral (upper leg bone) stress fractures in athletically active people because a high arch allows the shock from the heel striking the ground to be transmitted directly up the axial skeleton instead of being absorbed as a normal arch would soak up the shock generated by heel strike.  

Having too much of an arch in your feet is just as bad as having flat feet so the “happy medium” is where you want to be to avid foot dysfunction and the musculoskeletal disorders and injuries foot dysfunction causes. One study clearly showed that less injury occurred in athletes whose feet were normal (i.e.; the “happy medium”) than occurred in athletes with either high arches or flat feet. The normal foot absorbs shock from heel strike more efficiently so less injury to the entire musculoskeletal system occurs.

The shock-wave force generated when your heel strikes the ground is so common that you do not notice it even if it is causing degenerative changes in your weight-bearing joints. One study showed that leather shoes transmit more shock from heel strike than shoes that have shock absorbing material imbedded in the heel and sole portion of the shoe.

Problems arise when there is too much or too little motion in the foot and ankle joint. A foot that has a higher than normal arch is much too rigid which leads to it being too inflexible to absorb shock from your heel striking the ground when you walk. The rigidity of a foot that has too high of an arch can result in stress fractures of the heel bone (calcaneus), leg bones (femur), and even the bones of the pelvis.  

The effects of a rigid foot caused by too high of an arch are amplified if the other foot has little or no arch. This is because of the increased asymmetry between the two feet which precipitates deleterious rotation of the lower extremity (the leg). Increased rotation of the lower extremity occurs more in cases of foot asymmetry than if the arches in both feet were equal.

How much of a difference does having a rigid foot caused by too high of an arch make in the transference of the shock wave from heel strike up the axial skeleton? Researchers found that in people with symmetrical feet a .5 g impact can be measured at the skull while walking. This is equal to being hit in the head by 80 pounds with each step. A rigid foot caused by too high of an arch will transmit even more of the shock wave up the skeleton.

Researchers estimate that running multiplies the impact of a heel strike induced shock wave by three times thereby causing a greater incidence of symptoms and pathologies in athletes with high arches in their feet. Additionally, researchers were able to identify that athletes with high arches in their feet have different injury patterns than athletes with low arches due to the differences in stresses introduced into their body by the different ways their feet hit the ground while running.

To help alleviate injuries and reduce wear and tear on your body see your Doctor of Chiropractic to be fit for corrective orthotics regardless of whether  you are an athlete or not because preserving the health of your body is an important aspect to maintaining your happiness and well being. 

If you have more questions about our services, contact us at 410-256-9650 or sign-up at www.phcpt.com for a free consultation! 

Perry Hall Chiropractic and Physical Therapy

8817 Belair Road 

Perry Hall, MD 21236

410-256-9650

www.phcpt.com

      

The Functional Movement Screening and Mid Back Mobility

An interesting concept is being developed that helps explain and monitor the functional loss of body movements that are becoming more frequent in the United States due to our sedentary lifestyle and industrialized work habits. The defining use for the Functional Movement Screen as developed by Gray Cook is as an assessment instrument for identifying then monitoring the loss of body functionality.

As early as the 1980s it became obvious that Americans are not moving as well as they used to in regards to fitness and body function. The U. S. Army noted this trend in the physical abilities of new recruits whose bodies were not able to move in an authentic, functional manner. People from less industrialized areas of the world are capable of moving their bodies in more authentic movement patterns demonstrating greater mobility and a more stable body foundation resulting in an overall improvement in body functioning.

One way to improve the functionality of your body is to increase the mobility of your thoracic spine (mid back area). Due to the types of activities most Americans engage in (computer work, sedentary television viewing, weight lifting at the gym, etc.) the thoracic spine becomes restricted in movement and functionality.

Common postural habits of Americans results in rounding of the spine in the mid back area, which is usually accompanied by a forward rounding of the shoulders resulting in the head being placed forward of the gravitational center line of the body. This posture results in tightness of the muscles and soft tissues on the front of the body and a concomitant weakening of the same tissues on the back of the body. It all makes sense since almost all of our work and activity takes place to the front of the body and very little to the back of the body.

Postural changes such as these result in micro-trauma to the joints, dysfunction of movement patterns, and the increased potential for repetitive motion injury all of which contributes to chronic musculoskeletal pain syndromes such as elbow tendonitis, shoulder impingement, neck pain, carpal tunnel syndrome, and hip area pain. You can alleviate some of the functionality problems you have developed over the years by performing the rib-roll stretch exercise daily.

To perform the rib-roll stretch lie on your side with your shoulders and hips in line and place enough pillows under your head to keep your head aligned with the midline of your body. Flex your upper leg to 90 degrees with enough pillows under that knee to keep your pelvis from rolling back and forth. These pillows will keep your hips from rolling so all the motion goes into your mid back area, which is what this entire procedure is about. Your bottom leg will remain straight with your lower hand resting on your upper thigh and your upper hand wrapped around your rib cage on the side down against the floor or bed you are lying on.

To begin this maneuver contract your gluteus muscles (squeeze your butt muscles) on the side you are lying on (that is the side with your straight lower leg) while lightly pressing your top leg into your lower leg to engage your core muscles. Turn your head to look at the ceiling then continue turning your head to look over your shoulder but only turn your head as far as it will comfortably go. Do not turn your head too far in an effort to “stretch” your neck. That will only cause problems. Remember, this is a stretching exercise for your mid back and not your neck.

After turning your head, follow with your upper shoulder as if you are trying to touch the back of your shoulder on the floor. After your upper shoulder has twisted backward as far as it comfortably can (remember that there should only be movement in your mid back area and not your low back… your low back should remain in the same straight up-and-down position it started in) you should use your bottom hand that is resting on your upper thigh to help pull your torso further into the mid back stretch.

Breathing: Exhale as you begin rotating your head backward and as your shoulders stretch backward then inhale another breath as you return to the starting position. Rest for four seconds at maximal stretch position and then between stretches after returning to the start position. Take your time to perform a controlled stretch of your mid back area and you will have better results.

Perform a total of eight repetitions on each side then do an additional eight repetitions on the side that is most restricted. Be careful not to strain your neck or pull too hard with your hand at the end of your mid back stretch.  You should be able to easily breathe throughout these maneuvers… do not hold your breath while performing this stretch.

If you want to see how this stretch is performed correctly you can view it at:   http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=56380. Once you get the general idea of how to perform this stretch by viewing the video you can follow the written directions above to assure you are tightening the correct muscles and performing the movements in the proper sequence.

The functional loss of body movements can be improved with the correct exercises and a good place to start is my improving your thoracic mobility with the rib-roll stretch as explained above.

If you have more questions about our services, contact us at 410-256-9650 or sign-up at www.phcpt.com for a free consultation! 

Perry Hall Chiropractic and Physical Therapy

8817 Belair Road 

Perry Hall, MD 21236

410-256-9650

www.phcpt.com