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Back Pain

Your Backpack Is Putting Major Stress on Your Spine

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When we think about who wears a backpack, we often think first of students and members of the military. But these days, backpack wearers increasingly transcend age and occupational categories. Who wears a backpack? The businessman who wants to avoid checking a bag at the airport. The mom preparing for a family day at the park. The senior staying active by hiking. The list goes on and on…

Backpacks serve a valuable purpose, but they’re also risky when worn incorrectly or overpacked – particularly risky to the spine. In fact, according to recent research, a backpack can exert stress forces on the spine ranging from seven to 11-plus times the weight of the backpack, depending on whether the backpack is worn with the spine in a neutral position or 20 degrees of forward flexion (tilted-forward posture, as is often the case when carrying a heavy backpack – otherwise you would fall backward).

According to the study, published in Surgical Technology International, adding 1-100 lbs to backpacks in 25-lb increments revealed that with incremental weight increases, stress forces on the spine increased incrementally as well (again, from seven to 11-plus times the additional weight). Total stress forces were identical whether wearing the backpack with one or two straps, although it is important to note that using a single strap will distribute the force unequally to one side of the body, potentially causing postural and other compensations / injuries.

Previous research links backpack use to back pain, spinal disc compression, neck pain, altered posture and walking mechanics, and even foot pressure. It’s easy to understand why, considering the magnitude of force delivered to the spine and the fact that spinal health – for better or worse – influences the health of the entire body. Your doctor can tell you more about spinal health, backpack safety, and the appropriate weight and position (e.g., single- vs. double-strap, etc.) that will minimize injury risk when wearing a backpack.

Time to Visit Your Chiropractor – Even When You’re Not in Pain

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Why visit your doctor of chiropractic periodically – even when you’re not experiencing pain or other symptoms? Here’s why. The latest study on maintenance care for low back health suggests receiving chiropractic care periodically dramatically reduces the number of days you’ll experience “bothersome” low back pain over the course of a year.

Published in the multidisciplinary open-access journal PLOS One, the study included 328 patients ages 18-65 with nonspecific low back pain who experienced a favorable response to chiropractic care during their initial course of treatment. Patients were then randomly allocated to one of two groups for one year: a maintenance care group that received periodic chiropractic care or a control group that returned to their chiropractor only when LBP symptoms were present. Every week, researchers assessed subjects’ low back pain with a single question: “On how many days during the past week were you bothered by your lower back (i.e., it affected your daily activities or routines)?”

During the 12-month tracking period, members of the maintenance care (MC) group made an average of 6.7 visits to the chiropractor, compared with 4.8 visits by members of the control group. Those additional visits correlated with 12.8 fewer days of bothersome low back pain, on average, for the MC group compared to the control group.

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How important is 12.8 fewer days of bothersome LBP a year? We’re sure you agree it’s worth a few additional visits to your chiropractor! And that’s the beauty of chiropractic care – it helps minimize the chances your pain will occur / recur, rather than treating it with medication once you’re already in pain. If you’re smart, you don’t wait until your car breaks down to take it to the mechanic, and you don’t wait until your teeth fall out to visit the dentist; so why wait until you’re in pain before going to your chiropractor?

As we mentioned at the beginning, this isn’t the first study – and likely won’t be the last – to suggest maintenance chiropractic care is more effective than symptom-guided care for low back pain. Click here to read our summary of a study published in 2017.

Raise Your Hand If You Have Back Pain

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As adults, we get used to a variety of daily or near-daily aches and pains, particularly as we age. But what about our children? Don’t they seem immune to many, if not all, of the pain complaints we have – despite the fact that for the most part, they’re exponentially more active?

Maybe not. A study of schoolchildren ages 12-15 revealed a startling statistic: More than half (57 percent) reported experiencing back pain in the past year. As you might expect, “remaining seated at school” was a primary pain trigger, particularly for back pain lasting up to seven days.

These findings not only point to the universality of back pain – and the need for it to be addressed by qualified healthcare professionals such as doctors of chiropractic; but also the need to recognize and avoid situations that may increase the risk of experiencing an episode of back pain.

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For example, evidence implicates ergonomic flaws both in the school and workplace (desk / chair height, etc.) in back pain, not to mention carpal tunnel syndrome, neck pain, and other conditions. What’s more, the act of sitting alone creates undue stress on the spinal column and encourages poor posture whether at school, work or home, a major initiator of back pain and related conditions.

If anyone in your family is suffering from back pain, do something about it. Talk to your doctor about the potential causes and solutions.

Back to Basics: Understanding Back Pain

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Despite the amount of information available on the Internet these days, many people still do not have the proper facts on back pain. Perhaps it’s due to information overload or just misinformation.

Regardless of the reason, there are too many people suffering from back pain and not enough understanding of the causes and potential solutions. Let’s try and change that by looking at the basics of back pain.

First, understand that back pain is not due to one and only one cause. That would make everyone’s job so much easier. Just imagine going to your car mechanic and knowing anything and everything that might be wrong with your car had only one cause. Life would be so much easier that way, but it’s just not the case. Back pain is no different. It can be caused by a multitude of things involving bones, muscles, nerves or even psychological factors.

Second, many people with chronic pain think their back pain will never go away. Considering that chronic low back pain costs society up to $100 billion a year in health care utilization, workers’ compensation, etc., it’s hard to imagine that most of the back pain out there actually gets better, but surprisingly, it usually does. But if that’s the case, then why is low back pain such an epidemic?

For a long time (and in some cases even today), patients and health professionals alike had similar views regarding back pain. When you came into the office, the priorities were to find out what was wrong, where the pain was coming from, and then address the structure (part of your body) that needed addressing. That’s it. Sounds straightforward, but this is actually the wrong way to look at back pain.

For example, a person with leg numbness may go get an MRI done, and it may show that they have a “disc bulge” at L5 (the fifth lumbar vertebra in the back). Believing that L5 is causing the person’s leg numbness, more often than not, a surgeon would go in and operate on that L5. However, did you know that some people who have no back pain can also have a disc bulge at that level showing on the MRI? What this means is that what you see on an imaging test is not necessarily where the pain is coming from.

Let’s divide low back pain into two different conditions and discuss the general facts about how to deal with each one. We call low back pain that is quite recent acute low back pain. This can range from pain that is present for several minutes to several days. The second category of back pain is chronic low back pain. This pain persists for three months or more.

ACUTE LOW BACK PAIN: Early treatment leads to better outcomes

If you’ve suffered from low back pain over the past few days, or if you get back pain sometime in the future, the tendency will be to wait it out and see if it gets better. Sometimes we even decide to take time off and lie in bed, hoping we will eventually be feeling better and back to our usual activities or work. However, more and more research shows that lying in bed or waiting it out is the worst thing you can do for yourself. Remember, only 10 percent of people develop chronic low back pain, but those cases account for an estimated $100 billion a year in health care and other costs. It’s a safe bet that most of them have taken this incorrect “wait and see” approach.

Research suggests that when it comes to back pain, early intervention is best. There are many reasons for this concept, but here is a basic summary of what current guidelines are saying:

    1. Low back pain can sometimes be due to something more serious than a simple sprain. That’s why it’s important to see your chiropractor right away so they can evaluate you for anything more serious.

 

    1. Spinal manipulation is one of the only treatments that is consistently being recommended for those with acute low back pain – and yet far too many people don’t visit a chiropractor and choose to pop over-the-counter pain medication instead.

 

    1. Avoid bed rest as much as possible. Yes, I know that it feels good and frankly, when I had an episode of low back pain once, I was tempted to lie in bed all day, too. On a basic level, it’s the most “rational” thing to do. However, bed rest actually wastes away your muscles, and this effect lasts even for the lucky ones who improve with their low back pain. For those who are pain free, the bad news is that the muscles still waste away.What does this mean? It means that although you may be lucky enough to be out of pain, your muscles will have put you in a position where you will most likely suffer back pain again. That’s why trying to stay as active as possible in the early stages can go a long way not only to get over the back pain, but also to help prevent future back pain episodes from happening.

      Early exercise will help ensure that your muscles and bones will continue to move to prevent stiffness and pain. I often have patients tell me that they have Googled an exercise program for their back pain and are using it. Unfortunately, there is no-one-size-fits-all exercise program for low back pain. The type of exercises you do for a disc herniation can be totally different than the ones you do for a simple strain or sprain caused by playing a sport or lifting something at work. In fact, some exercises that you may see posted on the Internet may actually cause further damage or prolong your back pain. That’s why it’s so important to see your health professional to get an expert opinion on which exercises will be beneficial for your condition.

 

  1. There are ways to predict if acute pain will end up developing into chronic pain. One of the most frustrating things health professionals face is the fact that although some patients may have undergone treatments, they still develop chronic low back pain. The good news is that there are certain predictors that can identify someone who may end up developing chronic back pain. When you look at these, it becomes more apparent that seeking treatment and following all the above points is crucial to getting better. One of the biggest predictors is called “pain avoidance behavior.” Quite simply, it means once you get the pain, you will do everything you can to avoid anything that will cause pain.

What happens next? You guessed it. This type of person lies in bed as much as possible. This type of person will try to avoid any exercise that may cause the slightest discomfort. Essentially, they will avoid everything that could be helpful to their condition. That’s why I always take time with my patients to stress the importance of not letting the pain overtake their lives. Continue doing what you did before, no matter how small of an effort you put in. The back pain feels like your back is going to break in two. However, with proper supervision and the right recommendations for treatment, you will not be able to damage your back any more than the situation it is in.

So, the next time you experience back pain and feel like you can’t do anything, always remember that any movement or activity or treatment that keeps you moving is crucial for your recovery. Another factor is that you may be deconditioned and not fit enough. With back pain, you can become even more deconditioned. That’s why starting to move and then progressing to an exercise program is crucial to ensure not only that you get better, but also that you don’t get future bouts of low back pain.

CHRONIC LOW BACK PAIN: Focus on strengthening and endurance exercises

Chronic low back pain is pain that has been persistent for more than three months. Most of my patients have either tried different therapies with no results, or have decided to use the “wait and see” approach that we just discussed. Regardless of how you got here, there are several key things to remember about your back pain if it’s chronic:

Most back pain does not require surgery. Some of my patients with chronic pain are always looking for the surgical solution. Who wouldn’t? We all will believe that if someone just takes what is causing the pain “out,” everything will be fine. Unfortunately, surgery doesn’t have a stellar track record of finding a cure for your chronic back pain. Most surgeons I know and work with will tell me straight out that it’s the last option for the patient. For example, some of my disc herniation patients with nerve root problems may feel like surgery is the only option, but then are surprised when the surgeon holds off. One thing you have to realize is that surgeons will only do surgery if there is physical damage occurring to the nerves that are causing muscle wasting and will lead to irreversible damage. Pain is not a criteria for surgery!

Begin an exercise program to increase strength and endurance. Most of my patients will chronic low back pain tell me they have done exercises, but they haven’t worked. I then see what they’ve done and realize it isn’t enough.

To someone with chronic low back pain, it appears to be more than enough simply because any more will cause pain! However, you need to see yourself not as a crippled patient, but as an athlete coming back from injury. We are always mesmerized by how fast some athletes get back from surgery or get back from their injuries. That’s because they push themselves through appropriate exercises.

The body has a wonderful ability to get stronger when exercise stresses are placed on it. The body can bend, but usually doesn’t break. That’s why an effective exercise program should not be based on simple stretches alone. Exercises need to progress to strengthening and endurance exercises. Endurance is how long your back (or any area of the body) can sustain an activity before it gets tired and unable to function. Therefore, endurance exercises are the key to gradually work your back into shape. It’s also important to exercise your whole body, not just your back. Having strong legs will help you get up easier. Having a strong upper back and arms will allow you to carry things easier.

Remember, one of the best predictors of low back pain becoming chronic is pain avoidance behavior. By committing yourself to a life of avoiding things that give you pain, you are going to go into that vicious cycle of pain and disability. That’s why following your health professional’s advice on the right exercises is crucial to ensuring you get your life back instead of losing it to back pain.

As you can tell, the back is a complex structure and back pain can be just as complex, but at the same time, there are straightforward ways to reduce your risk of experiencing acute or chronic episodes. Talk to your doctor for more information.

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THE GOOD NEWS:
90% of people with low back pain will recover in four to six weeks.

THE BAD NEWS:
10% of people develop chronic low back pain, an epidemic that costs society up to $100 billion a year.

spine - Copyright – Stock Photo / Register Mark

THE GOOD NEWS:
Spinal manipulation is one of the only treatments consistently recommended for dealing with acute low back pain.

THE BAD NEWS:
Far too many people don’t visit a chiropractor for their pain and instead choose to pop over-the-counter pain medication at alarming rates.

exercise bike - Copyright – Stock Photo / Register Mark

THE GOOD NEWS:
While bed rest may seem like the rational thing to do when in pain, evidence suggests proper exercises to increase mobility and reduce loss of muscle strength are key to recovery.

THE BAD NEWS:
One of the biggest predictors of chronic back pain is called “pain avoidance behavior,” which means once you get the pain, you do everything you can to avoid anything that will cause pain.

A Great Exercise to Erase Low Back Pain

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Watch a toddler pick up a ball and then ask an adult to do the same task. What’s the most obvious difference you notice? The toddler hinges at the hips, sitting back and down into a deep squat to grasp the ball, pulling it close to the body.

The toddler powers through the hips, glutes, and thighs in returning to the starting position. It’s all in the hips!

The adult flexes forward at the waist and lumbar spine with little to no involvement of the hips, glutes, and thighs. The altered mechanics of bending at the waist, as opposed to the hips, place extreme vector loads on the lumbar spine, leading to microtrauma, dysfunctional movement patterning, and eventually pain.

Optimal movement patterning and proper lifting techniques never had to be taught to the toddler. They simply lifted without thinking. Functional movement is innate to the nervous system in pre-programmed stages of development. So, what happens during the time frame from toddler to adulthood that contributes to lifting technique going horribly wrong? Quite simply: We forget how to move. Add to that the laziness factor and countless hours people spend sitting in our culture, and you have a recipe for inefficient movement. Essentially, our rear-ends have now become our feet!

Toddlers have to yet experience these outside contributors to movement dysfunction, otherwise known as life, and therefore more efficiently. The problem is adults don’t’ know they move wrong! They have crossed over to subconscious dysfunction; their brain perceives the abnormal movement patterning as normal. This inefficient movement leads to microtrauma, pain, and injury.

The Hip Hinge

The hip hinge is a fundamental part of this reprogramming. The hip hinge, generally speaking, is any flexion/extension movement originating at the hips where there is a posterior weight shift. The hip hinge allows a person to maintain a neutral spine by moving at their hips instead of their low back.

Most people will find it difficult to do the hip hinge correctly. Using a dowel rod for neural feedback during the hinge allows you to “feel” the movement and re-establish proper patterning without overloading the nervous system. Here’s how to do it:

  • Stand with feet shoulder-width apart and a dowel running along the spine.
  • One hand should be holding the dowel on the neck while the other hand holds the opposite end on the low back. (Alternate hand positions between sets.)
  • Flex forward at the hip with slight knee bend. The dowel must remain in contact with the head, thoracic spine, and sacrum.
  • Stretch should be felt in the hamstrings. Stop movement as soon as the rod leaves contact with the head, thoracic spine or sacrum.
  • Assistance may be added to “regress” the movement by placing a 1-2-inch block under the heels. This forces forward weight shift of the body so the client must sit back into the hips to prevent falling. Ankle support also removes the barrier of possible mobility issues in ankle dorsiflexion, which may prevent the squat patterning.

Research has shown that the previous injury is the number-one risk factor for future injury. Motor control limitations such as balance, stabilization and basic coordination, right-to-left asymmetries in muscle activity and flexibility are the next highest indicators associated with risk of future injury. Since the previous injury is unavoidable, we should focus on motor-control limitations and asymmetries as priorities for prevention or reduction of risk factors. Assume you move poorly and take steps to help master fundamental movements like the hip hinge; then watch the magic start to happen.

Back Falls & Pain: How To Get Back on Your Feet

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Gravity-(noun) the force of attraction by which terrestrial bodies tend to fall toward the center of the earth.

This textbook dictionary definition eloquently explains what falling means. Gravity is constantly pulling us towards the ground with a profound effect on posture and overall health. Throw the likelihood of traumatic falls and you have unlimited potential to cause bodily harm. It’s safe to assume that each of us will experience some type of fall in our lifetime. Every fall impacts body function, movement, mechanics, and efficiency. Even a minimal fall transfers energy from the ground through the body potentially causing severe injury. Energy is never lost or gained, it is simply transferred. If a body’s ability to absorb that energy is compromised dysfunction, pain, and injury will occur.

Different types of falls injure the body in distinct ways. Once you understand the mechanism behind a fall you can predict what areas of the body will typically be prone to pain. Forward falls onto an outstretched hand can cause injury to your wrist, elbow, and shoulder. However, the impact force travels up the arm and exits in the cervical spine (neck) and thoracic spine (upper back) similar to a whiplash type injury. Residual delayed symptoms may appear, which include headaches, neck pain, muscle spasm, tingling or numbness in the arm, and pain between the shoulder blades. Backward falls on the buttocks cause trauma to the spine, pelvis, hips, and head. Concussions are extremely common in backward types of falls due to the sudden whipping motion of the head. The tailbone portion of the spine is often bruised or fractured from impact velocity of the backward fall. The energy transfer through the spine exits at the top of the head leading many people to complain of severe headaches and neck pain. Severe symptoms might not appear for several days or weeks following the fall. Falls from a height landing on the feet may injure the ankles, knees, hips, pelvis, and spine. Hairline fractures are often a side effect of foot landing falls, particularly in the shin bone and pelvis. Lower back pain is the most common spinal complaint after a foot landing fall due to the compressive forces of the impact.

All falls cause mechanical and functional damage to the body leading to inefficient movement and compensations. These neurological compensations are part of your nervous systems hardwired survival mechanism to avoid pain at all cost by taking the path of least resistance. This mechanism involves adaptation of muscles, connective tissue (fascia), bones, joints, ligaments, and nerves. Postural changes are ingrained in your movement patterns to protect and guard you against future injury. Common chronic side effects from traumatic falls include; arthritis, muscle spasm and tightness, soreness, spinal disc degeneration, disc herniations, and visual postural distortions. You may notice one shoulder becomes higher than another, rounded shoulders, neck far out over the shoulders, hips become tight and you walk with a foot flare. These dysfunctional movement patterns manifest into pain and injury years after the trauma. Everything in your health history contributes to the possibility of future injury. Even that fall you had off the swing on the playground when you were a kid. Everything is connected and everything matters.

So what can and should you do after a fall to help minimize injury? First and foremost is to determine the seriousness of the injury. If severe headaches, dizziness, nausea, slurred speech or sleepiness are present immediately seek emergency medical attention for these are a common sign of a concussion (impact injury to the brain). Anticipate the onset of symptoms in the next several days following a fall. For swelling, inflammation, and muscle spasm apply ice for the first 72 hours. Heat is best used for chronic injuries and over muscles. Ice tends to be a more effective alternative for the joint related pain to reduce swelling. A warm sitz bath is a very effective conservative treatment for post fall-related soreness. Consult your primary care health provider if symptoms do not show improvement or worsen after 72-hours. Pain is the warning signal from your body that something is wrong. Do not ignore the pain message and hope things resolve without professional intervention. It is essential to visit a skilled clinician in manual therapy such as a chiropractor to ensure proper alignment of the spine and joint systems of the body. A doctor of chiropractic is an expert in assessment and treatment of acute and chronic musculoskeletal injuries with programs of preventive medicine. They will do a complete evaluation including x-rays to rule out severe trauma to the body and diagnose any underlying problems that may manifest in the future. Chiropractors will work in conjunction with your primary healthcare provider to ensure you receive the most effective care program for your type of injury. Once pain symptoms have improved your chiropractor will put you on a corrective exercise program involving strengthening and stretching for balance. This will train your body with proprioception (balance) to help improve your chances of catching yourself before falling in the future.

Never underestimate the long-term deleterious effects of any fall. Every fall leaves its mark on your body. Play it safe and assume the fall had a negative impact on your health. Be proactive and take steps to ensure you have the maximum chance of full recovery. Little things mean a lot when it comes to your health. Make sure to speak to your chiropractor about effective ways to deal with falls that may occur.

Waking Up to the Right Way to Treat Lower Back Pain

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An important collection of papers published in research journal The Lancet highlight the global impact of low back pain, the ineffectiveness of current medical treatments, and the value of spinal manipulation and other nondrug options before turning to medication is receiving substantial media attention.

One of the brightest spotlights: a “Health Alert” segment on a recent episode of “Good Morning America” titled “New Research on Lower Back Pain: Are Millions of People Getting Ineffective Treatment?”

“GMA” anchor Robin Roberts opened the segment with this statement to the show’s estimated 4.5 million viewers regarding lower back pain: “As many as 540 million people suffer from it. According to new research, many treatments, [including surgery and pain medication] … could be all wrong.”

She then introduced Dr. Jennifer Ashton, chief health and medical editor for the show. Dr. Ashton, who described the papers as the “magnum opus on low back pain” and The Lancet as “very reputable,” said the material “[draws] attention to the massive gap between evidence-based medicine and what’s really going on” when it comes to the treatment of back pain.

According to Dr. Ashton, reporting on the papers, back pain is a “massive global public health burden.” First-line treatments include staying active (“the worst thing you can do is get in bed”) and education: learning “what works and doesn’t from reputable sources.” Second-line treatment options (Dr. Ashton urged viewers, “This is really what I want people to pay attention to”) include superficial heat, spinal manipulation, massage, and acupuncture. [Italics ours]

Dr. Ashton added that NSAID medication (nonsteroidal anti-inflammatory drugs, commonly available as over-the-counter pain meds such as Advil, Aleve, etc.) is also considered a second-line treatment according to The Lancet papers, but should be utilized “only if the other things are not working.”

The Lancet content on lower back pain, published online on March 21, features two “series” papers, a “viewpoint” and a “comment,” all of which are available in the full-text format free of charge on the journal’s website:

  • “What Low Back Pain Is and Why We Need to Pay Attention” (Series 1) (Hartvigsen J., et al.)
  • “Prevention and Treatment of Low Back Pain: Evidence, Challenges and Promising Directions” (Series 2) (Foster N.E., et al.)
  • “Low Back Pain: A Call for Action” (Viewpoint) (Buchbinder R., et al.)
  • “Low Back Pain: A Major Global Challenge” (Comment) (Clark S., et al.)

The “GMA Health Alert” on LBP is also available online in its entirety and can be accessed by clicking here. To access the Lancet content, click the links above. To learn more about the value of chiropractic spinal manipulation for low back pain and why pain medication isn’t your first option, talk to your doctor.

Three Reasons to Choose Chiropractic

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When you’re suffering low back pain, shoulder pain or any number of similar musculoskeletal conditions, who gets the call: your medical doctor or your doctor of chiropractic? Your choice of health care provider in those situations could make a big difference, and research is continuing to prove it.

According to the latest study, chiropractic care is at least as effective as medical care for certain musculoskeletal conditions, while reducing health care costs and leaving patients more satisfied with the results.

The authors of the study, published in the Journal of Manipulative and Physiological Therapeutics(JMPT), went so far as to state that for certain musculoskeletal conditions, visiting an MD first instead of a DC may actually be a mistake:

“The findings of this study support first-contact care provided by DCs as an alternative to first-contact care provided by MDs for a select number of musculoskeletal conditions. Restrictive models of care in which patients are required to contact a medical provider before consulting a chiropractic provider may be counterproductive for patients experiencing the musculoskeletal conditions investigated and possibly others.”

The study sample included 403 patients who saw medical doctors and 316 patients who saw doctors of chiropractic as the initial health care providers for their spinal, hip or shoulder pain complaint. Four months following the care, all patients completed a questionnaire that evaluated pain on that day and four months earlier (11-point scale); satisfaction with care received and the results of that care (5-point scale from “very satisfied” to “very unsatisfied”); and other variables. The researchers evaluated related costs of care by reviewing an insurance claims database.

“Patients initially consulting MDs had significantly less reduction in their numerical pain rating score and were significantly less likely to be satisfied with the care received and the outcome of care.” What’re more average per-patient costs over the four-month period were significantly lower in patients who initially consulted DCs ($368 difference compared to MD care)?

JMPT Editor-in-Chief Claire Johnson, DC, MEd, emphasized the importance of the latest findings: “Comparative studies – in other words, research that compares the outcomes between two different providers or modalities – are rare for chiropractic care,” she said. “Thus, this study … is especially important if payers and policy-makers are to better understand the ‘triple aim’ as it relates to chiropractic. Specifically, this study helps us better understand what type of care provides better patient satisfaction, is more cost-effective, and improves population health.”

The answer, suggests an increasing body of research, is chiropractic care.

The Problem With Surgery for Low Back Pain

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If you’ve ever experienced back pain, whether acute or chronic, there are a few facts you should know. First, you’re not alone; studies suggest 80 percent of adults experience at least one episode of low back pain in their lifetime. Second, thousands of people undergo back surgery every year for back pain, putting their bodies at risk for surgical complications. Third, chiropractic and other conservative, nonsurgical treatment methods have been shown to be effective for uncomplicated cases of LBP.

And here’s one more important fact: Research suggests the big problem with surgery for back pain, particularly chronic back pain (recurrent pain over weeks or months), is that it doesn’t seem to work – at least not any better than conservative care. The latest evidence: study findings published in the research journal Spine that found: “After an average of 11 years follow-up, there was no difference in patient self-rated outcomes between fusion and multidisciplinary cognitive-behavioral and exercise rehabilitation for cLBP (chronic low-back pain).

The results suggest that, given the increased risks of surgery and the lack of deterioration in nonoperative outcomes over time, the use of lumbar fusion in cLBP patients should not be favored in health care systems where multidisciplinary cognitive-behavioral and exercise rehabilitation programs are available.”

This isn’t the first study to suggest surgery isn’t your best option when it comes to the back. And if you think you can go to any type of doctor, think again. Expertise aside, research indicates that the type of doctor you visit first – namely a surgeon vs. a doctor of chiropractic – can essentially determine whether you’ll eventually undergo surgery. So think surgery last and visit a chiropractor first. Your back will thank you for it.

Paying the Price for Going Mobile

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I just got back from a trip to the East Coast. On my trip, I spent a fair amount of time in airports, on planes and on trains (sounds like a good movie title). As is not uncommon for me (I’m still a bit old-school), I was amazed at how many people are working while “on the road.” From the individual who uses a cell phone to check email messages and Facebook, to the passenger on an aircraft who uses seat time to work on a presentation or proposal on a laptop or tablet, more and more people are working on the go. The problem is, any attempt at using good ergonomics and/or good posture is total fantasy.

Telecommuting or telework is defined as an arrangement in which workers enjoy some flexibility in their working location and hours. It is generally used by workers who rely on the Internet, computers and cell phones. They don’t spend extended times working from a corporate office. Instead, they work from home offices, from their cars and while “on the road.”

I became interested in this topic because, for the most part, I am a telecommuter. I work much of the time from my home office. I also became interested because an increasing number of health problems seem to be associated with this rapidly expanding practice.

Of course, you don’t have to be working to use these devices. Everyone is using mobile technology these days, which means everyone is at risk of suffering the health consequences.

Not Enough Ergonomic Attention

Over the past few decades, there has been an increasing amount of attention paid to ergonomic principles in an effort to make the workplace safer and more efficient. This consideration has been particularly productive when it comes to workplace injuries. Partly due to the widespread adoption of ergonomic principles, many workplace injuries have been reduced. However, to date, the science of ergonomics hasn’t made much of a dent in the use of mobile technology, whether on or off the job.

Take, for example, the laptop computer. There are ample examples of ergonomically designed keyboards for desktop computers, but the keyboards on laptops are flat and force the wrists into awkward and compromising positions. It almost begs for problems. Combine this with the task of typing while using a laptop computer on an airplane seat-back tray, and you compound the ergonomic problems.

In addition, the keyboards on tablet devices are built into the screen. As such, they are anything but ergonomically designed. And everybody has a smartphone, most of which are able to send text messages. There are even contests to see who can send the fastest text message. But text messaging and ergonomics don’t go hand in hand, so to speak.

Paying the Price

One study by Harris International looked at more than 2,000 Americans ages 18 and over. The study indicated that 60 percent of Americans experience some form of health problem due to the use of technology during the day:

  • 36 percent had eye strain
  • 30 percent had back pain
  • 27 percent had neck pain
  • 24 percent had headaches
  • 21 percent had wrist pain
  • 11 percent had carpal tunnel syndrome
  • 9 percent had insomnia

There are even some “new” problems associated with the poor ergonomics reflective of today’s technology. The problems aren’t really new, but there is no doubt they are becoming more frequent. For example, “texter’s thumb” (aka “Blackberry thumb”) develops as a result of using the thumbs for sending text messages. It is a form of deQuervain’s tendinitis. “Texter’s neck” is the term used to describe neck pain that results from prolonged poor posture while using a smartphone.

(By the way, “earbud disease” is also becoming common. It is the result of ear infections due to the use of earbuds that are constantly placed in the ears when listening to music, watching video, etc., via mobile technology.)

According to a recent article published in the Journal of Occupational Safety and Ergonomics, 53 percent of smartphone users suffered from neck pain. A similar study stated that 84 percent of users had experienced pain in at least one body part.

It would appear that the culprit for “texter’s neck” is the prolonged forward head carriage that accompanies smartphone use. In addition to the forward head carriage, we’ve all seen individuals holding their cellphones against their ear by bending their neck. While this may allow the individual to use their hands, this posture undoubtedly creates problems.

Other Potential Health Issues

Poor posture and repetitive-stress issues are not the only problems encountered when using today’s mobile devices. Modern laptops generate a fair amount of heat. One study at State University of New York in Stony Brook showed that, when using a laptop actually on the lap, median temperature in the scrotum increased, leading to a reduction of normal sperm cells. Additionally, the heat from using a laptop on the lap may cause skin burns.

It is also worth noting that mobile devices use radio frequency (RF) waves. While no specific evidence exists linking exposure to RF waves to health problems, it is probably wise to minimize such exposure. After all, no one would dream of walking around with a microwave oven taped to their head.

Some authorities also feel used of mobile technology may be habit-forming, even addictive. I happen to agree. Given that so many of our patients present with a primary complaint of neck pain, recognizing the fact that mobile technology plays a role may make our treatments more effective.

What You Can Do

Our world has been made much more accessible by modern technology. It is now possible to stay in constant contact with others and work in places that were unimaginable just a few short years ago. However, the use of this technology comes at a cost. Many of the health problems we now suffer from are the result of inappropriate use of technology.

As usual, common sense prevails. Constant and repetitive use undoubtedly leads to problems. Therefore, the most fundamental advice is to take frequent breaks, whether using a smartphone, laptop computer, iPod, etc. Even small breaks of a few seconds may be long enough to reduce the muscle fatigue that comes from using these devices, particularly if use involves a less-than-optimal body position. There is evidence from the ergonomic literature that the use of microbreaks (10 seconds every 10 minutes) may reduce muscle fatigue by as much as 20-50 percent over an eight-hour day.

Build breaks into your routine. Don’t take several phone calls back to back. Take a few minutes between calls to relax the muscles. Don’t use laptop computers for long periods. Set an alarm clock for 15 minutes and get up and walk around. The bottom line: Movement is good for you.

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