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Lower Back Pain Help


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#11 maineman

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Posted 07 March 2006 - 10:50 PM

Point: everyone has a back. Point: everyone bends over, picks something up, lives on a planet with gravity. Point: everyone gets some back back pain during their lifetime. Hence: "management" of low back pain is one of the greatest areas of hucksterism around. Let the buyer beware. I reported a few weeks ago on the result of the massive controlled trial on back pain and I'll review it here. Briefly, once it was determined that there was no emergency (nerve roots at risk, "slipped disk", radiculopathy, cancer in the verterba...)patients were assigned to one of several treatment arms. The patients were also matched across the allocation (i.e. a 6 ft 200 lb man was assigned to each of the treatments, etc.) This study was designed cooperatively with neurosurgeons, chiropractors, accupunturists, orthopods, osteopaths, physical therapists general practitioners, etc. to avoid any complaints. Treatment options included: traditional bed rest and heat followed by back exercise. Chiropractic manipulation. Physical therapy. Accupuncture. Massage. Nothing. The outcome? Outcomes in back studies are determined by subjective reporting of pain relief by the patients and objective measurement of time to full function, i.e. days missed from work and time it takes to be back in the game. Patients who recieved "passive care", (Physical therapy, chiropractic, massage, accupuncture, etc) all reported less discomfort at 30 days and reported being "pleased" with the care they were getting. Patients who rested or did nothing were less pleased. At 6 months there was no significant difference noted between groups. At one year the groups who did independent back exercises had fewer missed days at work. The chiropractic, massage and accupuncture groups had the highest recurrence of missed days. By the way, this was a massive study, with 1000s of patients enrolled. Finally there was a study on back pain around 5 years ago in Finland that was similar except that they had a group who was told to go right back to work and not spend some time on bed rest (bed rest and heat has been the mainstay of acute low back pain therapy for over 5 decades). The back to work group had the best ultimate outcome. The theory raised (and currently being researched) is whether bed rest may lead to atrophy (or weakness) of the back muscles which subsequently interferes with recovery. (they can't repeat this study in the USA because the Unions won't allow workers with new onset back pain to be sent back to work without "sick leave" and bed rest). Anyway, the current standard of care is: 1. make sure your back pain is not a medical emergency. 2. If its not, then its muscular, therefore 3. Heat, massage, stretching, etc. are used for comfort. 4. Pain relief by whatever floats your boat (tylenol, ibuprofen, nothing, etc. etc....) 5. As soon as the acute pain has passed then daily targeted exercise to strengthen the muscles of the lower back (these are easy to do and widely available). 6. Avoid smoking as this exacerbates low back pain 7. lifestyle and work place modification in order to "be nice to your back". maineman
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#12 pistol_pete

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Posted 08 March 2006 - 03:23 AM

Guys/Gals, This is one of the conditions I take care of day in and day out. A N.U.C.C.A doctor has the best chance to help in the shortest period of time. Go to www.nucca.com, click locate a doc and have at it. Roughly 150 docs on the planet, with the utmost integrity and love for their patients and their work. PP BTW, all the previous suggestions can be of help....some more than others....depending on the situation.

#13 OEXCHAOS

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Posted 08 March 2006 - 10:24 AM

Thanks guys. Right now, we're not yet at the acute phase and we're trying to avoid that, heal up, and avoid the problem in the future (as much as possible). As such, I'm leaning that way rather than more aggressive measures like accupucture and chiropractic. And BTW, Holly is only occasionally taking Ibuprophen (though I wonder if she should take more to reduce inflammation and speed healing?) for her discomfort.

I'm thinking yoga and stretches are the way to go. I've found some stuff, but if anyone wants to fine tune it I'm all eyes.

Oh, for the archives, this is one of many articles that I found on yoga and back pain.

Yoga More Effective for Lower Back Pain than Aerobic Exercise
http://www.medpageto...ackPain/tb/2358

By Katrina Woznicki, MedPage Today Staff Writer
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
December 20, 2005


* Inform patients with chronic back pain that yoga may be beneficial in alleviating symptoms. However, interested patients should be advised that not all forms of yoga are the same and that some styles may be too challenging for patients with back pain who are new to yoga.

Review
SEATTLE, Dec. 20 - The ancient practice of yoga proved to be more effective in reducing chronic back pain than either aerobic exercise or a self-help book.

So says a study in the Dec. 20 issue of Annals of Internal Medicine in which investigators compared three types of treatment among 101 chronic back pain patients.

They found a gentle form of yoga called viniyoga proved to be more beneficial in alleviating back pain symptoms and improving function. The benefits also lingered weeks after the study was over.

Twelve weeks after baseline, back-related function was superior in the yoga group when compared with both those who received only a self-help book (mean difference, -3.4 [95% confidence interval, -5.1 to -1.6]; P<0.001) and also when compared with those who did the aerobic exercise (mean difference, -1.8 [95% CI, -3.5 to -0.1]; P=0.034).

Fourteen weeks after the study had ended, the yoga participants still showed greater improvement than the self-help book patients (mean difference, -3.6 [95% CI, -5.4 to -1.8]; P<0.001).

Karen J. Sherman, Ph.D., a researcher at the Group Health Cooperative Center for Health Studies here, said yoga's emphasis on toning muscles, flexibility, strength, relieving muscle tension, and also the mind-body connection may explain why this particular exercise is so effective.

An estimated 14 million Americans practice yoga, including more than one million who use yoga to minimize back pain, Dr. Sherman said.

"Yoga may be beneficial for back pain because it involves physical movement, but it may also exert benefits through its effects on mental focus," Dr. Sherman and her colleagues wrote. "We do not know whether a different yoga regimen would have reaped similar benefits."

It's also possible that different instructors could have yielded different results, the authors noted. A single instructor led the yoga group. The exercise class was designed by a physical therapist and also taught by an individual instructor.

The researchers randomly assigned 101 patients to one of the three treatment groups between June and December 2003. The yoga and exercise groups attended 12 weekly 75-minute sessions. The self-help care group received by mail a copy of The Back Pain Helpbook by Jim Moore (Perseus Books; 1999). All patients were allowed to take medications as needed, including anti-inflammatory agents like acetaminophen.

The average participant was a gainfully employed, college-educated white woman between the ages of 40 and 50. Most participants had experienced back pain for more than one year prior to the study.

The interviewers were blinded to the patient's treatment. The participants were interviewed at baseline, and then again at six, 12, and 26 weeks.

During the 12-week treatment period, 11% of the yoga patients reported visiting healthcare providers for back pain treatment compared with 23% in the aerobic exercise group and 10% in the self-help book group.

But over the course of the 12-week intervention, the yoga patients had some significant improvements. Using the Roland Disability Scale, a measurement of disability, the study results showed that at 12 weeks, 78% of the yoga participants had experienced at least a two-point reduction in their Roland score compared with just 63% in the exercise group and only 47% in the self-help book group.

At 26 weeks, but not 12 weeks, the yoga group was also significantly superior to the other two groups in symptom bothersomeness (p<0.001).

Medication use was similar between the groups at baseline, but dropped significantly for the yoga patients. Only 21% of the yoga participants reported using medication to treat their back pain one week before the 26-week interview compared with 50% in the exercise group and 59% in the self-help book group.

Dr. Sherman said while yoga appears to be promising, not all forms of yoga are the same.

"Some styles, such as Bikram and vinyasa, may be too vigorous for patients with back pain who are unfamiliar with yoga whereas other styles (for example Iyengar) may need modification from normal practice to be appropriate for patients with back pain," she wrote.

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#14 emkay

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Posted 08 March 2006 - 09:00 PM

hi MARK, sorry to hear about GD's health problem. hope it will heal sooner than you wish. my 2cents on healing life's ailments is to exercise in breathing. one of the oldest techniques from HINDU YOGA practice is BREATHING. here is one of the most effective breathing exercise. SIT ON A FLOOR WITH LEGS CROSSED (LIKE THE BUDDHA) AND CLOSE YOUR EYES. WITH RIGHT HAND (finger) COVER THE LEFT NOSTRIL OF YOUR NOSE AND BREATH IN THE AIR DEEPLY THROUGH THE RIGHT NOSTRIL AND THEN COVER THE RIGHT NOSTRIL, LET OUT YOUR BREATH THROUGH THE LEFT NOSTRIL. NOW REPEAT. BREATH THROUGH THE LEFT AND LET IT OUT THROUGH THE RIGHT NOSTRIL. KEEP REPEATING, EACH TIME CHANGING FROM RIGHT TO LEFT. LEFT TO RIGHT i.e. breath through one and breath out the other. repeat for about 5mins (or more) per session. EYES CLOSED ALL THE TIME. DO THIS EVERYDAY THREE/FOUR TIMES A DAY 5mins (OR MORE) YOU'll FEEL SOME REAL CHANGES IN YOUR HEALTH. best wishes rgds mani

#15 EntropyModel

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Posted 27 March 2006 - 01:50 PM

Mark...I hope you've sorted this problem by now...but I will add 2cents in case you haven't. I suffered a severe injury to my lower back at 14, what's called a hyper extension injury...due to sports..For 10 years I couldn't bend down and straighten up without a major lower back spasm. Went to all the specialists, and the best one's tell the truth..which is mangement is best...but it took along time for me to believe it, which means - 1. Learning correct posture - which most people don't have. This will require developing supporting mucles, yoga as you mentioned will help. 2. Avoiding stress and cold/damp - which will tend to be a trigger[ I also could always tell why rain was coming...and seasonal allergies made it marginallly worse]. It took along time, but once I corrected my posture..and that was extremely difficult because we subconsiously 'slouch' etc ..especually if we sit at computers, and avoided triggers long enough, recovery set in and now I have no back problems at all, which is quite amazing really....I never thought that possible, so I'm now convinced most lower back pain can be managed and doesn't require endless visits to chiropractors[which never helped me]. BTW - What definitely did NOT work, was trying to 'protect' my back and avoid using it...that just weakened the muscles and exeragerates the problems, but is a natural reaction of course. Hope you sort out your problems. Mark.

Edited by entropy, 27 March 2006 - 01:52 PM.

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