Relief For Lower Back Pain

by: Dr. Mark Walter

Low back pain is a common health care and social problem associated with disability and absence from work. One 2005 medical study of chronic spinal pain stated that the “lifetime prevalence of spinal pain has been reported as 54 to 80 percent, with as many as 60 percent of patients continuing to have chronic pain five years or longer after the initial episode.” The long-term and disabling conditions of chronic and recurrent low back problems are of major concern, both from a cost perspective and in terms of morbidity.

Chiropractic care has been shown to compare favorably in many cases to medical care with respect to long-term pain and disability outcomes. However, any chiropractor should carefully consider the optimum treatment plan for each patient on an individual basis. For most cases of chronic low back pain, I recommend a three-step program of spinal adjustments, postural stabilization and rehabilitative exercise. Combining these three elements can make the difference between a successful care program and a lingering, recurring low back condition.

Spinal Adjustments

As far back as 1985, medical research was reporting that “a two- to three-week regimen of daily spinal manipulations by an experienced chiropractor” brought significant improvement in 81 percent of completely disabled patients with chronic low back and referred leg pain.³ The subjects in the study were from a university back pain clinic for patients who had failed to respond to previous conservative or surgical treatment. The researchers stated, “In our experience, anything less than two weeks of daily manipulation is inadequate for chronic back pain patients.” In addition, several chiropractic research studies published between 1979 and 1993 described various procedures that assisted patients in regaining lumbopelvic structural function and alignment.^4-6

Postural Stabilization

A significant factor in reducing excessive biomechanical forces on the lumbar spine is frequently overlooked- the use of external supports to decrease external forces. Positioning aids such as sitting postural supports (e.g., postural back rests or ischial lifts for chairs and car seats), standing postural supports (e.g., foot orthotics and heel lifts) and sleeping postural supports (e.g., mattresses and pillows) can all greatly assist in the long-term management of painful lumbar spine conditions.

Rehabilitative Exercises

Home corrective exercises to strengthen supporting muscles are recommended as an adjunct to chiropractic adjustments and postural stabilization. Active involvement of the chronic low back pain patient in an appropriate exercise program has been found to be very beneficial, even for patients with herniated discs. Flexibility and strength exercises can bring about rapid improvements in lumbar spinal function, as well as decreases in pain levels. Activity should focus on developing strength in the abdominals and supporting pelvic and low back muscles. This also can enhance the shock-absorbing properties of the tissues.

Specific exercises must develop “dynamic control of lumbar spine forces in order to eliminate repetitive injury to the intervertebral discs, facet joints, and related structures.” Recommending specific exercise(s) is not easy, as some research supports the need for abdominal strengthening, others advise pelvic tilts, and other reports focus on the importance of strengthening the lumbar extensor muscles. The bottom line is that patients’ needs vary, and exercises that work for one patient will not necessarily work for the next.  It is essential to make sure your provider has performed a complete structural and functional assessment before recommending any exercise program.

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