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FOCUS: Don't turn your back on chiropractic2009/10/18More Malaysians are suffering from lower back pain, not only causing discomfortbut losing productivity at work as well. MICHAEL HANELINE describes thechiropractic options available for a patient to seek relief.LOWER back pain is a very common problem that affects about 80 per cent of allpeople at some point in their lives.In developed countries, back pain is the second most common reason people visittheir doctors, the fifth most common reason people are hospitalised and the thirdmost common reason for surgery.Malaysia is no exception. A recent survey found that about 12 per cent ofrespondents had existing lower back pain.Many people think that lower back pain will usually get better on its own in a fewweeks. However, recent research has shown that about half of lower back painsufferers continue to have pain for up to one year following its onset and thatsome people never recover.Lower back pain that has been present for more than a few months is considered c hr o n i c.The pain can sometimes be quite severe and disabling; thus, lower back pain is oneof the most common reasons people have to miss work caused by illness.In Britain for instance, 175 million working days were lost in 2006 because oflower back pain, at a cost of more than £100 billion (RM550 billion).Treating the condition is also very costly, with US$85.9 billion (RM290 billion)being spent by Americans seeking relief from back and neck pain in 2005.One study reported that the average annual medical costs to treat people with backproblems wa s US$6,096 per person in 2005, about 76 per cent more than peoplewithout back problems.Lower back pain can be caused by falls, sports injuries, and heavy lifting,although sometimes the pain appears for no apparent reason.It also commonly occurs during pregnancy. The origin of a person’s lower back painis often, difficult to determine because there are several possible sources ofpain, including muscles, ligaments, facets, sacroiliac joints and intervertebral di s c s.When any of these areas are irritated, they typically cause pain in the same areaof the body — the lower back.There are subtle differences, however, that a trained expert can usually diagnosefor optimal treatment.COMMON TREATMENTS FOR LOWER BACK PAINA healthcare professional will first examine a patient before making a diagnosis.Based on the diagnosis and various factors about the patient, a suitable treatmentcan be recommended.There are numerous treatment choices available to lower back pain suffers,
 
including medication, acupuncture, massage, chiropractic and many others.There are pros and cons to each type of care and a particular type of treatmentmay be appropriate for one person but not another person who appears to have asimilar problem.Over-the-counter pain relievers may be viable as a short-term solution for lowerback pain, but prolonged use may cause problems.For instance, non-steroidal antiinflammatory drugs, which include ibuprofen andaspirin, are commonly used for lower back pain.These medications increase the risk of serious adverse reactions involving thestomach lining, kidneys and cardiovascular system.Another commonly used pain reliever is acetaminophen (the active ingredient inPanadol) which, according to the US Food and Drug Administration, is the leadingcause of liver failure in the West.Surgery is generally not recommended for people with lower back pain unless theyhave pain or numbness extending from the back into the leg and/or foot that doesnot respond to other forms of treatment.There are other indications for surgery in lower back pain patients, but only asmall percentage of cases ever require it.Massage, acupuncture and physical therapy are other treatments that are sometimesbeneficial.These types of care are considered to be noninvasive because no surgery isinvolved.One positive feature of these types of care is that they are unlikely to causesevere adverse reactions.Chiropractic is another noninvasive type of care that increasing numbers ofMalaysians are choosing and one that a great deal of research has shown to behelpful for people with lower back pain.While still a developing profession in Malaysia, chiropractic is one of the mostpopular treatment options among Americans.In fact, it has been estimated that 22 million Americans visit chiropractors everyyear and the major complaint of about 35 per cent of them is lower back pain.Severe adverse reactions to chiropractic care for lower back pain are extremelyunlikely.CHIROPRACTIC CARE FOR LOWER BACK PAINThe main focus of chiropractic is the diagnosis and treatment of disorders of thebones and muscles of the body, especially involving the back and neck.Doctors of chiropractic (also referred to as chiropractors) commonly treat avariety of conditions, including back and neck pain, headaches, pain in the armsor legs, and many others.Chiropractors are trained to locate back disorders that involve restrictedmovement and/or abnormal position between adjoining vertebrae (back bones).This condition is known as a “subluxation,” which chiropractors correct using
 
“chiropractic adjustments”.During this procedure, the chiropractor applies specific forces to the restrictedand/or misaligned areas using their hands or an adjusting instrument.Chiropractic adjustments restore the movement and/or position of the affectedjoints, which reduces the strain on the surrounding tissues and relieves pain.In addition to providing adjustments, chiropractors also use ancillary proceduresto assist the healing process, such as rehabilitative exercise, dietary advice,physical therapy modalities, and others.If the chiropractor determines that a patient’s condition will not likely respondto chiropractic care, the patient will be referred to an appropriate healthcareprovider.Other types of doctors and therapists use manipulation in their practices too, butchiropractors provide the t majority of this service.For example, in the US, 94 per cent of all manipulation is provided bychiropractors. No other healthcare provider is better equipped to provide thistype of service than a chiropractor because manipulation (adjustment) of the backand neck is the central focus of a chiropractor’s four years of education and thebasis of their daily practice.RESEARCH SUPPORTS CHIROPRACTIC CAREThe use of manipulation (adjustment) in the treatment of low back pain has beenextensively studied by researchers throughout the world, probably more than anyother treatment option.The findings of this research have been used to produce guidelines for healthcareproviders about the best way they should treat their lower back pain patients.Some examples of the recommendations in these guidelines are:• The Agency for Health Care Policy and Research, a US research organisation,carried out an extensive study of all research until 1993 on the care for lowerback probl e m s.The agency recommended spinal manipulation as the only safe and effective form ofinitial professional treatment for adults with acute lower back problems.• Another lower back pain treatment guideline was developed by the AmericanCollege of Physicians and the American Pain Society in 2007.After reviewing all of the research that had been carried out on treatments forlower back pain in general, their recommendations were reported in an article thatappeared in the Annals of Internal Medicine.Spinal manipulation was the only recommended active treatment for patients withsub-acute or chronic lower back pain.Another option that the authors of the article recommended was rehabilitativeexercise to help stabilise the back, which is something that chiropractorsroutinely recommend to their patients.• Earlier this year, the National Institute for Health and Clinical Excellence inBritain released guidelines that were prepared for doctors who treat patients withlower back pain.Spinal manipulation (adjustment), mainly done by chiropractors, was one of only a
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