Low Back Pain, Chiropractic and Firefighters

What's the quick fix versus the long term fix?

Chiropractic can relieve low back pain quickly, but the long term fix takes a much more active roll on the part of the patient.

Isn't the jury out on whether chiropractic works for low back pain?

I'd say not. The Rand Study of the 80's proved (by placebo double blind study) that specific chiropractic adjustments work to relieve acute low back pain better than sham adjustments (i.e. nothing at all). I would hope, then, if one finds a competent chiropractor, and that chiropractor can figure out which vertebra's aberrant motion is causing the flair up of low back pain, and corrects the motion of that particular segment, relief could be had.

Motion of a segment of the spine

Imagine a bicycle chain. As you peddle, the sprocket turns, and the well oiled chain glides smoothly over both sprockets front and back. The motion is clean, and you can spin as fast or slow as you like.

The vertebrae in the spine can become affixed (sort of locked up) to the vertebra (e) above and or below. This causes a lack of motion in the joint that is supposed to move fluidly. The muscles in the area, in response, will become tight and irritated. In an effort to make the bone move again, they contract and pull on the covering (periosteum) of the bone. The periosteum is very pain sensitive. Pain becomes evident on the area. The facet joints between adjoining vertebrae are more pain sensitive, and they don't like when they cannot move, and become inflamed as well. This combination creates pain in that area- sometimes worse than others.

Envision, once again, the spine like the bike chain. If all the links move when against the adjacent links, things flow smoothly and are pain free. If these lock up, flexibility and function are lost, your rotation is impeded and your ability to perform your job is impeded. As pain levels rise, your performance suffers more.

Does this result last?

That, in my opinion, is questionable. A person's low back can have a certain pattern of dysfunction; certain vertebrae which get fixated against the ones above or below. That pattern is difficult to break. The Chiropractor may take several adjustments to restore motion. Other times, if the spine is very healthy, and if the person is hydrated and flexible, aberrant motion can be fixed with only one or two adjustments.

If a chiropractor gets this vertebra moving again, it should relieve the pain, right?

Well, this is true a lot of times. There are problems with it though. Adjusting can set things in motion again. But often they won't keep moving unless you get adjusted a whole bunch of times. And, more importantly, if you get adjusted, and don't do your homework (stretches) the motion that has been restored will not remain. The body will revert to its old way. Although the time lines are much longer, I liken this to a person who gets braces, gets their teeth straightened, and then never wears their retainer. In a few years, the teeth are right back where they started. The same will happen in your spine.

In my experience, over-adjusting is a potential problem. It can create hyper-mobile joints, and cause a person to need to be adjusted. That is why it is important to do trunk stabilization and core muscle strengthening once the acute pain episode is over. This can prevent further episodes. Besides, who wants to go get adjusted once or twice a week for the rest of their life? In my opinion, over adjusting, coupled with a lack of strengthening creates a need for adjusting...and a dependence on your chiropractor that is just not necessary.

There are, of course, exceptions, and people who need more intensive care. A second opinion is often a good idea if a lot of care is recommended.

What should the patient do?

The way to make the results of care lasting is to use exercise along with adjusting. These exercises will be different depending on what your diagnosis is, and at what stage of care you are in. They should change as you progress. You chiropractor should give you these exercises. First, they will be coupled with ice, and assist in pain relief. Then they will be used to re-create flexibility. Finally, they will strengthen.

You may have to revisit these phases regardless of whether you keep up with your strengthening exercises. In my experience, though, the long term follow through and the acceptance of responsibility for fitness helps a lot more than a learned helplessness and the search for the magical adjustment (or magic bean as I call it.)

Finding a Chiropractor

Many people find their healthcare providers in the yellow pages or advertisements. I don't recommend that. I would ask a trusted friend (or more than one) who have used a healthcare provider in the discipline being considered. Get several referrals if you think it will help you make a better choice.

There are many, many, very hard working, and well-intentioned chiropractors out there. If you find one, and you think it's a match, stick around at whatever level you feel comfortable with. They should be peaceful with helping you as much as they can without chasing you down, calling incessantly and pestering you to get care. That's your decision. Unfortunately, there are some out there who just don't seem to get it. That happens in every walk of life, though. That's why I recommend getting a referral.

Watch out for:

Beware of doctors who ask you to sign a contract that you will follow through with care. Your healthcare (and health/fitness) is completely up to you, and you should feel no pressure to perform any course of care because of some silly contract that you were pressured into signing.

Also, some chiropractors will ask that you pay in advance for care or for a year or even lifetime care for a sum of money. If anyone asks you to do this, turn and walk out. If a doctor does this, they are acting as an insurance company on your spinal health, and legally, to do this, they must have some amazingly large sum of money in the bank... like tens of millions of dollars. This money would need to be available should anything go wrong in your course of care, anything involving your spine...from cancer to accidental injury.

Conjunctive Care

In my experience, chiropractic, deep tissue massage therapy, ultrasound and therapeutic exercises are the best mix of care if properly applied. The same thing does not work for everyone.

Other joints:

Some Chiropractors adjust other joints in the body: knees, hips, wrists, even feet. I have found it extremely helpful when I have had problems with these areas. Restoring and correcting motion to just about any joint can help feel better, and perform better in your chosen sport/activity.

In Conclusion

Best wishes for you and your spinal health. Feel free to contact me and ask any questions you want answered. I will do my best to answer them, or find someone who can.

Dr. Jen Milus, DC

Author of Fire it Up! Agility Training Program
www.fireagility.com
www.backsafegolf.com

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