By: Dawn Basciani, DC
Brighton Hill Chiropractic
Prevalence of Back Pain:
 According to the Spine Journal, 80% of Americans
experience low back pain (LBP) in their lifetime
 2-8% have chronic back pain (CBP) lasting more than
3 months
 3-4% of the population is temporarily disabled due to
back pain
 1 % of the working-age population is disabled
completely and permanently as a result of LBP
(Martin et al., 2009)
Main cause of disability among civilian
noninstitutionalized U.S.adults aged ≥18 years with
self-reported disabilities, estimated affected
population, and percentages, in the US, 2005
Condition:
Estimated
Population:
Weighted numbers
in 1,000s
Percentage (%)
Arthritis or rheumatism
8,552
19.0
Back or spine problems
7,589
16.8
Heart trouble
2,988
6.6
U.S. Census Bureau, Survey of Income and Program Participation, 2004
Panel, Wave 5, June--September 2005.
Chronic back pain (CBP) is common, costly,
and disabling according to Spine Journal:
 LBP is the 2nd leading cause of lost
work time
 LBP is the 3rd most common reason to
undergo a surgical procedure
 LBP is the 5th most frequent cause of
hospitalization
(Martin, B.I., Turner, J.A., Mirza, S.K., et al., 2009)
Tips for Back Pain Prevention:
 Maintain a healthy diet and weight
 Remain active
 Avoid prolonged inactivity or bed rest
 Warm up or stretch before exercising
 Maintain proper posture
 Wear comfortable, low-heeled shoes
 Sleep on a mattress of medium firmness to minimize any curve in your
spine
 Use proper lifting technique
 Ergonomically correct workstation
(American Chiropractic Association, 2013)
Workplace Ergonomics: The Desk
 Choose a desk that is the proper height
 Feet should be touching the floor, with the legs and body forming an
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angle of 90-110 degrees
Body should be straight with the head and neck upright and looking
forward, avoiding slouching
The eyes are should be at the same height as the top of the monitor
Wrists should be straight when typing, shoulders perpendicular to
floor, and forearms parallel to the floor
Headset should be used when talking on the phone
Stand up and stretch with a short walk and/or simple stretches every
20-30 min
(American Chiropractic Association, 2013)
(http://wikieducator.org/Ergonomics_posture)
Proper Lifting Techniques:
 keep the weight as close to the body as possible
 bend at the knees, using the stronger leg muscles to do
the lifting
 provide balance to the back by tightening the
abdominal muscles and tucking in the pelvis
 when bending and lifting, the trunk should not twist,
but should be erect with the knees bent so that muscle
coordination takes place
(Potter & Perry, 2009)
(http://what-when-how.com/nursing/body-mechanics-and-positioning-client-carenursing-part-1/)
Posture Problems:
(http://www.swolept.com/posts/posture-tricks-to-make-your-butt-and-gut-smaller-addressing-anterior-pelvictilt#.UbhYlJwfJdY)
Pelvic Tilt Exercises:
 Lie on your back with your
knees bent
 "Brace" your stomachtighten your muscles by
pulling in and imagining
your belly button moving
toward your spine. Your
back should be pressing to
the floor and your hips and
pelvis are rocking back
 Hold for about 6 seconds
 Repeat 8-12 times
(Healthwise, 2010)
Low Back Stretching:
(Why I Exercise, 2012)
Low Back Stretching:
(Why I Exercise, 2012)
Low Back Stretching:
(Why I Exercise, 2012)
Low Back Stretching:
(Why I Exercise, 2012)
Low Back Stretching:
(Why I Exercise, 2012)
Low Back Strengthening:
(Why I Exercise, 2012)
Low Back Strengthening:
(Why I Exercise, 2012)
Low Back Strengthening:
(Why I Exercise, 2012)
Low Back Strengthening:
(Why I Exercise, 2012)
Low Back Strengthening:
(Why I Exercise, 2012)
The Truth about Fish Oil
OMEGA-3 FATTY ACIDS
 A study published in the New England Journal of Medicine
noted that prescription NSAIDs for rheumatoid and
degenerative arthritis alone conservatively accounted for a
minimum of 16,500 fatal bleeding deaths per year in the
US, which is the 15th leading cause of death in the US
 Most cox-enzyme inhibiting pain drugs known as nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit both
cox-1 and cox-2 enzymes.
 blocking the cox-1 enzyme resulted in significant bleeding
problems
 blocking of the cox-2 enzyme is what was responsible
for pain reduction
(New England Journal of Medicine, 1999)
Non-drug alternative to the treatment of chronic spine
pain was recommended at the 73rd meeting of the
American Association of Neurological Surgeons:
 Omega-3 fatty acids were recommended as they block the cox-2
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enzyme responsible for pain
Omega-3 fatty acids (fish oil) is an safe and effective antiinflammatory alternative to NSAIDs for discogenic pain
NSAIDs are associated with “extreme complications, including
gastric ulcers, bleeding, myocardial infarction, and even deaths.”
“An alternative treatment with fewer side effects that also
reduces the inflammatory response and thereby reduces pain is
believed to be omega-3 EFAs found in fish oil”
At an average of 75 days on fish oil, 59% discontinued taking
their prescription NSAIDs for pain
“fish oil supplements appear to be a safer alternative to NSAIDs
for treatment of nonsurgical neck or back pain.”
(Surgical Neurology, 2006)
Omega-3 fatty acids (fish oil) Dose
Recommendations:
Children:
 The DHA should be greater than the EPA (2.6/1)
 900 mg of EPA + DHA per day
Adults:
 Has an ideal ratio of ALA, EPA, DHA, and GLA; EPA should
be double DHA
 3,000 mg of EPA + DHA per day
(Nutri-West, n.d.)
Non-pharmacologic Therapies to benefit and
improve pain or function in CBP:
 spinal manipulation
 acupuncture
 exercise therapy
 stretching, and strengthening
 massage therapy
 yoga
 behavioral therapy
(American Chronic Pain Association, 2008, p.10)
What is Chiropractic?
 “Health care profession that focuses on disorders of the
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musculoskeletal system and the nervous system, and the effects of
these disorders on general health”
Hands-on approach including patient examination, diagnosis, and
treatment
Most common therapeutic procedure performed by Chiropractors spinal manipulation
Purpose of manipulation – to restore joint mobility by manually
applying a controlled force into joints that have become restricted in
their movement as a result of a tissue injury
Injured tissues undergo physical and chemical changes that can cause
inflammation, pain, and diminished function
Spinal manipulation helps to alleviate pain and muscle tightness,
allowing tissues to heal
(American Chiropractic Association, 2013)
A retrospective analysis of 70,274 member-months in a 7-year period
within an IPA, comparing medical management to chiropractic
management, demonstrated decreases of:
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60.2% in-hospital admissions,
59.0% hospital days,
62.0% outpatient surgeries and procedures,
and 83% pharmaceutical costs
when compared with conventional medicine IPA performance.
This clearly demonstrates that chiropractic nonsurgical
nonpharmaceutical approaches generates reductions in both clinical
and cost utilization when compared with PCPs using conventional
medicine alone.
(Journal of
Manipulative and Physiological Therapeutics, 2007)
Consumer Reports April 2009
The Consumer Reports Health Ratings Center
recently surveyed more than 14,000 subscribers who
experienced lower-back pain in the past year but never had
back surgery. Hands-on treatments were rated by lowerback-pain sufferers as very helpful.
Professional
Chiropractor
Physical Therapist
Acupuncturist
Physician, specialist
Physician, PCP
Highly Satisfied
59%
55%
53%
44%
34%
Source: Consumer Reports Health Ratings Center
http://www.consumerreports.org/health/conditions-and-treatments/back-pain/overview/backpain.htm
Comparison of Competency test in
Musculoskeletal Medicine:
Journal of Bone and Joint Surgery 1998
Journal of the American Osteopathic Association 2006
Journal of Manipulative & Physiological Therapeutics 2007
Medications for CBP:
 Acetaminophen (Tylenol) - over-the-counter
 Non-selective Non-steroidal anti-inflammatory drugs (NSAIDS) - more effective
than acetaminophen, but have an increased risk of stomach ulcers. The FDA also
recently required warnings for all NSAIDS about potential risk of heart attacks
 COX-2s are a type of NSAIDS that are safer on the stomach, but there is a risk of heart
attack
 Opioids - powerful pain pills
 Muscle relaxants - short term relief, frequently associated with sedation and fatigue
 Antidepressants - benefits are likely small, not recommended as a first-line option
 Herbal therapies - willow bark, devil’s claw, and cayenne
 Gabapentin - anticonvulsant, short-term relief for patients with nerve pain
(radiculopathy), only been evaluated in a few small studies
 Corticosteroid pills and injections - not recommended for treatment of LBP because
they have not been shown to be effective
(American Chronic Pain Association, 2008, p.10)
Injections for CBP:
 For LBP related to sciatica due to a herniated disc, an
injection of corticosteroids into the epidural space (the
space around the spinal cord) may help decrease swelling
and relieve symptoms of back pain
 Benefits are generally short-term
 “none of these therapies have been proven to be beneficial
in well-conducted clinical trials and are not recommended
in most cases”
(American Chronic Pain Association, 2008, p. 11)
Surgery for CBP:
 “Surgery for non-specific low back pain should be considered
only after several noninvasive therapies have not worked”
 Back pain associated with a herniated disc or spinal stenosis
(presence of back pain and leg pain) surgery may be considered
when the symptoms are not getting better after 4-6 weeks
 Most of the benefits seen with surgery occur in the 1st year, after
which people treated with surgery and without surgery do about
the same
 Recommendation based on evidence – “surgery is not required
even when a herniated disc or spinal stenosis cause persistent
symptoms”
(American Chronic Pain Association, 2008, p. 11)
Chiropractic part of the team:
• Patient centric
• Team based care
• Optimizes skills &
competencies of the
care team
• Results oriented in
improving the health
and health care of the
individual
An integral team
member
Thank you to the CNY Chapter of
the American Society of Safety
Engineers for inviting me to
your holiday party to talk about
back prevention
Questions?
References:
 American Chronic Pain Association. (2013). Retrieved from http://www.theacpa.org/
 American Chronic Pain Association. (2008). Consumers’ Guide Practice Guidelines For
Low Back Pain Retrieved from
http://www.theacpa.org/uploads/documents/Consumer%20Guidelines%20for%20Low
%20Back%20PainFinal%202-6-08.pdf
 American Chiropractic Association. (2013). Workplace Erogonomics. Retrieved from
http://www.acatoday.org/content_css.cfm?CID=3130
 American Chiropractic Association. (2013). Chronic Pain and Depression. Retrieved from
http://www.acatoday.org/content_css.cfm?CID=2187
 American Chiropractic Association. (2013). Back Pain and Chiropractic. Retrieved from
http://www.acatoday.org/content_css.cfm?CID=1420
 Clinical Utilization and Cost Outcomes from an Integrative Medicine Independent
Physician Association: An Additional 3-year Update. Journal of Manipulative and
Physiological Therapeutics. 2007 (May); Vol:30 (4): pp.263–269.
 Keller, R.B. (2010). Pelvic Tilt Exercise. WebMD. Retrieved from
http://www.webmd.com/fitness-exercise/pelvic-tilt-exercise
 Maroon, J.C., Bost, J.W. (2006). Omega-3 fatty acids (fish oil) as an anti-inflammatory: an
alternative to nonsteroidal anti-inflammatory drugs for discogenic pain. Surgical
Neurology, 65(4). 326-31.
References:
 Martin, B.I., Turner, J.A., Mirza, S.K., et al. (2009). Trends in health care expenditures,
utilization, and health status among US adults with spine problems, 1997–2006. Spine,
1;34(19):2077-84. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19675510
 Potter, P., Perry, A., Stockert, P., & Hall, A. (2009). Fundamentals of nursing. (8th ed.). St.
Louis : Elsevier Mosby.
 U.S. Department of Health and Human Services. (n.d.). Arthritis, Osteoporosis, and
Chronic Back Conditions. Healthy People 2020. Retrieved April 26, 2013 from
http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=3
 U.S. Census Bureau, Survey of Income and Program Participation, 2004 Panel, Wave 5,
June--September 2005.
 Why I Exercise. (2012). [Photograph of Low Back Exercises]. Retrieved from
http://www.whyiexercise.com/
 Why I Exercise. (2012). [Photograph of Low Back Exercises]. Retrieved from
http://www.whyiexercise.com/
 University of Southern California Neurosurgery. (2010). [Photograph of Low Back Spine
Conditions]. Retrieved from http://www.uscneurosurgery.com/conditions/spinecenter/expertise/degenerative-spine-disease.php
 Wolfe M.M., Lichtenstein D.R., Singh G. (1999). Gastrointestinal Toxicity of Nonsteroidal
Antiinflammatory Drugs. New England Journal of Medicine, 340(24). 1888-1899.