by Comp Ortho | Aug 30, 2022 | pain, Spine, Wellness
When people have backaches bad enough to send them to the doctor, prompt physical therapy may be a wise choice, a new study suggests.
Researchers found that when those patients had “early” PT — within a couple weeks of seeing a doctor — they were less likely to need other, often pricey, types of medical care.
Over the next month to year, they were less likely to see a specialist or a chiropractor, land in the emergency room, need imaging tests like MRI, or receive injection pain medication into the spine.
Experts said the findings are in line with what they see in everyday practice.
“The sooner patients with acute low back pain get in to see the physical therapist, the sooner they get better and the less likely they are to need additional therapies,” said Dr. Catherine MacLean, chief value medical officer at the Hospital for Special Surgery in New York City.
MacLean, who was not involved in the study, said PT may directly ease back pain, and also give patients some peace of mind.
“My sense is that part of what’s going on is that the physical therapy is helping,” she said. “Additionally, I think reassurance that what they are experiencing is not serious and will resolve quickly is incredibly important and helpful to these patients.”
Low back pain is exceedingly common, and in general, experts recommend conservative, non-drug treatments to start. Guidelines differ on when to try PT, but some medical groups recommend that people start with “self-care,” like heating pads and gentle movement.
It’s true that low back pain often goes away “spontaneously,” said Richard Skolasky, the senior researcher on the new study.
So he and his colleagues focused on patients with a bout of back pain severe enough to send them to the doctor. That likely weeds out many people whose back pain would get better with the self-care route, according to Skolasky, director of the Johns Hopkins Spine Outcomes Research Center in Baltimore.
His team used a health insurance database to analyze claims from nearly 980,000 U.S. adults under age 65 who were diagnosed with acute lower back pain. About 11% were referred for early PT — meaning they had their first session within two weeks of their medical visit.
Over the next month, the study found, those patients were anywhere from 57% to 32% less likely to see a chiropractor or orthopedic or pain specialist, to need advanced imaging tests or pain-relieving steroid injections, or to end up in the ER.
Those differences persisted, though were smaller, over the next year. Early PT did not, however, ultimately cut people’s health care costs: The cost of two to three months of therapy may outweigh the savings from an MRI averted.
Still, Skolasky said, it’s “heartening” to see that people in early PT did not have to see other providers or have tests and procedures as often as other patients did.
Past research, he noted, has shown that prompt PT may lower the likelihood of acute back pain becoming chronic. Beyond that, patients may be better prepared the next time they have a back pain flare-up: One of the goals of PT, Skolasky said, is to teach people ways to manage the problem on their own.
That said, access remains an issue. PT is a time investment, Skolasky said, and patients can have a hard time fitting it into their lives. And in less populated areas with few providers, he noted, it may be difficult to find a facility within a reasonable distance.
In this study, patients in the Southeast and Midwest had particularly low rates of early PT. Skolasky speculated that the supply issue might partly explain that.
Despite some barriers, though, PT is worth a discussion, according to Skolasky.
“If your back pain symptoms are severe enough to see a doctor,” he said, “have a conversation about the non-drug options for treating them.”
Researchers lacked information on whether early PT helped people avoid pain medication — an important question, Skolasky noted. Guidelines on treating low back pain recommend trying non-drug options first.
The findings were recently published in the journal BMC Health Services Research.
The U.S. National Library of Medicine has more on back pain.
SOURCES: Richard Skolasky Jr., ScD, MA, director, Johns Hopkins Spine Outcomes Research Center, and professor, orthopedic surgery, Johns Hopkins School of Medicine, Baltimore; Catherine MacLean, MD, PhD, chief value medical officer, Hospital for Special Surgery, New York City; BMC Health Services Research, July 2, 2022, online
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by Comp Ortho | Mar 17, 2022 | Spine, Wellness
Sitting at your desk all day can cause back pain. Will switching to a standing desk setup help? Read on to find out.
COVID-19 has changed many aspects of American life, and one of most pronounced is how and where we work. To stop the spread of the virus, companies allowed workers to work from home or split their hours between office and home using a hybrid work model. The result was a huge surge in employees who work from home.
As people began to work from home more regularly, they quickly realized they didn’t have a proper desk setup in their houses. Instead of an office desk and chair, they crouched on their sofa with a laptop or on a stool at their kitchen table, leading to back and neck pain. Even those who had dedicated office space in their residence with a desk and chair often suffered from lower back discomfort. To alleviate back stiffness, some workers considered purchasing a standing desk, which people frequently claim can reduce some of the health risks caused by sitting for long periods of time. But can these devices actually reduce your neck and back pain? Or might they even lead to more serious pains?
How Sitting All Day Affects Your Back
Sitting has been termed the “new smoking” due to the damage it can do to your health. While this may seem like an exaggeration, there’s no denying the health risks caused by extensive sitting. When you sit for eight hours a day at work and then more at home in front of the television, you’re not active and that can lead to serious health problems across the board.
When it comes to your back, sitting for long hours in a chair can strain the muscles in your back, neck, hips, and buttocks. Sitting can also compress the discs in your spine, leading to stiffness and pain. And if you slouch forward — as many of us do when seated — that pressure on your spine increases. In addition to simply sitting, the way you set up your desk and computer may also be causing problems. If the computer is too low or too high, you may be stressing your neck muscles in addition to your back.
How a Standing Desk Can Help
Now that you know how harmful sitting all day can be, you may want to try a standing desk or a sit-standing desk, which lets you switch between the two positions. One study found workers using a sit-standing desk reported less lower back pain. Other studies have reported standing at a desk burns more calories and results in better productivity. Generally speaking, standing may force you to improve your posture which in turn can take the pressure off your lower back.
However, a standing desk will not cure an underlying orthopedic issue, such as scoliosis or a herniated disc. And standing could exacerbate leg swelling or foot pain.
Staying Healthy When Using a Standing Desk
To avoid back pain with a standing desk, follow these tips:
Set Up Your Desk Correctly. Incorrectly setting up your standing desk or standing with poor posture could strain your back and neck more than sitting. Therefore, it’s important to rearrange your desk layout and positioning so you don’t end up with extra back pain. First, adjust your standing desk so your head, neck, and spine are aligned and your computer monitor is at eye level. As you stand, move your head slightly back and your spine in an “S” curve. Your elbows should be at a 90-degree angle, with your wrists resting flat on the desk.
Take the Pressure off Your Feet. It’s not just your back that will bear the strain of standing all day — your feet absorb most of your weight as you stand. To take the pressure off your feet, wear comfortable supportive shoes, or place a cushioned mat under your feet for extra support.
Don’t Make the Switch Overnight. Suddenly switching from a seated desk to a standing desk can be a shock to your body. Ease into your new setup by alternating between sitting and standing throughout the day until your body adapts and you find the most comfortable position.
Make a Homemade Standing Desk. Before you make a large investment in a standing desk, devise a homemade one at home. Prop up your computer on a pile of books or boxes and give it a try. You may find a standing desk isn’t helpful, or switching between standing and sitting is better for your back.
Get Moving. Whether you sit or stand all day, remember to get up and move frequently. Take a break to walk around or stretch your legs and back to unlock stiff muscles. At the end of the day, your back will feel much better if you’ve moved throughout the day.
Sit Properly. If you decide to stay seated or alternate between sitting and standing, sit properly with your lower back straight, shoulders relaxed, and feet on the floor. For more back support, insert a pillow along your lower spine.
Are You Suffering from Lower Back Pain?
For years the doctors at Comprehensive Orthopaedics have successfully treated back pain with conservative and surgical methods. We will diagnose your condition and recommend therapies so you can live pain-free. Contact us today for a consultation.
by Comp Ortho | Aug 30, 2021 | pain, Spine
THURSDAY, Aug. 26, 2021 (HealthDay News) — A new approach to spinal cord stimulation may drastically reduce chronic back pain, a small pilot study suggests.
The study, of 20 patients with stubborn low back pain, tested the effects of implanting electrodes near the spinal cord to stimulate it with “ultra-low” frequency electrical pulses.
After two weeks, 90% of the patients were reporting at least an 80% reduction in their pain ratings, the researchers found.
The improvement is striking, experts said. But they cautioned that the study was too small and short-term to draw conclusions.
“That improvement is almost too good to be true,” said Dr. Houman Danesh, who directs the division of integrative pain management at Mount Sinai Hospital in New York City.
Danesh, who was not involved in the study, said the results could be skewed because the patient group was so small. On the other hand, he said, it’s possible the researchers “have really caught onto something.”
Only larger, longer-term studies can answer that question, Danesh said.
It’s not that electrical stimulation, per se, is unproven for back pain: Pain management specialists, including Danesh, already offer the approach to some patients.
It can be done non-invasively, through transcutaneous electrical nerve stimulation (TENS) — where electrodes are placed on the skin over areas of pain, to deliver electrical pulses to the underlying nerves.
Another option is spinal cord stimulation. There, doctors implant electrodes near the spinal cord, along with a pulse generator that is placed under the skin of the buttocks or abdomen. Patients can then use a remote control to send electrical pulses to the spinal cord when they are in pain.
The theory is that the stimulation interrupts the spinal cord’s transmission of pain signals to the brain.
Right now, spinal cord stimulation is reserved for certain tough cases of back pain — for example, when people continue to have pain even after back surgery, Danesh said.
The effectiveness of the approach, though, varies from person to person, and researchers have been looking at ways to refine it.
For the new study, a U.K./U.S. team tested what it’s calling ultra-low frequency spinal cord stimulation.
The researchers started with lab experiments in rats, finding that the electrical pulses blocked most transmissions of pain signals along the spinal cord — in a manner that seems distinct from current spinal cord stimulation techniques.
They then moved on to 20 patients with chronic low back pain, many of whom also had pain running down the leg (commonly known as sciatica). The researchers implanted electrodes in all 20; two patients dropped out due to infection at the surgical site.
Among the 18 patients who finished the two-week study, pain ratings improved by an average of 90%. Nearly all of the patients had improvements of at least 80%.
When the electrodes were removed, patients’ back pain came roaring back, according to findings published Aug. 25 in the journal Science Translational Medicine.
“The pain improvement is dramatic — that’s one of the features of this treatment that we find so impressive,” said senior researcher Stephen McMahon, who directs the London Pain Consortium at King’s College London in the United Kingdom.
“Other successful pain therapies more typically find 30% to 50% clinical improvement,” he added.
That said, McMahon cautioned that the study was small and short-term. Further clinical studies will be needed to define the therapy’s effectiveness and how long it lasts, he said.
One of the strengths of this early study is that it “shows directly a powerful inhibition of pain-related signals,” McMahon noted.
Having identified “such a robust mechanism,” he added, it may be possible to use the technique for a range of conditions other than back pain.
The study was funded by Presidio Medical, Inc., of South San Francisco, which is developing the technology.
Danesh said, “I think this is continuing a trend of a technological jump in the use of spinal cord stimulation.”
However, he stressed, no matter what treatments people use for low back pain, some low-tech fundamentals remain key — namely, addressing bad posture habits and muscle strength imbalances.
Sitting all day, and the resulting weakening of the gluteal muscles (in the buttocks), is a big culprit, Danesh noted.
So strengthening those muscles, along with being generally active, is a must.
“You have to be mobile, when you’re in pain and when you’re not,” Danesh said. “Movement is medicine.”
Johns Hopkins University has more on non-surgical treatments for low back pain.
SOURCES: Stephen McMahon, PhD, FMedSci, professor, physiology, and director, London Pain Consortium, King’s College London, U.K.; Houman Danesh, MD, associate professor, anesthesiology, perioperative and pain medicine, Icahn School of Medicine at Mount Sinai, and director, integrative pain management, Mount Sinai Hospital, New York City; Science Translational Medicine, Aug. 25, 2021, online
by Comp Ortho | Jan 11, 2021 | pain, Spine, Wellness
Chronic lower back pain can make the most routine tasks difficult. But a new study suggests patients can learn new, practical and less painful ways to move through individualized “motor skills training,” or MST.
A two-year study of nearly 150 patients found that MST appears to better relieve disability from lower back pain than a more common but less-tailored exercise regimen broadly focused on improving strength and flexibility.
“Our findings suggest that motor skill training in functional activities is an effective and efficient treatment that results in important short-term and long-term improvement in function in people with chronic low back pain,” said study lead author Linda Van Dillen. She’s a professor of physical therapy at Washington University in St. Louis School of Medicine.
Lower back pain is incredibly common, and the No. 1 cause of disability, according to Van Dillen. It is the most frequent cause of chronic pain among American adults.
Van Dillen notes that at least 60% to 80% of adults will experience lower back pain, and “almost half of them will have had a major episode by age 30.”
Yet there is no accepted standard of care for chronic lower back pain patients, nor a clear sense of what type of exercise intervention might work best, researchers said.
To get a better handle on the issue, Van Dillen’s team focused on a pool of patients diagnosed with what is known as “non-specific” lower back pain. That means they have tension, stiffness and/or soreness in the lower back area for which there is no clear cause.
Before the study began in December 2013, all participants had struggled with lower back pain for at least a year.
Participants, who ranged in age from 18 to 60, were randomly divided into two groups. One group received “strength and flexibility treatment for the trunk and lower limbs” — a common exercise intervention, according to Van Dillen.
The other group took part in MST, which teaches patients new ways to carry out everyday tasks rendered difficult by back pain.
MST aims to zero in on each patient’s personal posture and movements throughout an entire day, and then to tailor pain-free movement strategies to their specific routines.
Both groups received six weeks of training for one hour per week. Half of each group also received three “booster” treatment sessions six months later. Disability questionnaires were completed at the outset, and at six months and one year out.
While both groups’ ability to perform daily functions without pain improved, the MST group achieved “significantly” better gains (meaning lower disability scores) over the study period.
MST patients were more satisfied with their care and less likely to use drugs for back pain. They were also less fearful of addressing work-related needs, and less likely to avoid normal daily activities, the study found.
Six months out, MST patients had fewer acute back pain flare-ups and were more likely to keep up with their exercises. And after a year, when their back pain flared up, it was less severe, researchers said.
Dr. Daniel Park, an associate professor of orthopedic surgery at Oakland University William Beaumont School of Medicine in Rochester, Mich., reviewed the findings.
He said it remains to be seen just how much better MST is compared to more common interventions.
While Park said the findings appear to be statistically significant and support the benefit of therapy on back pain, he stopped short of saying the researchers had shown “meaningful improvement.”
“I think any structured therapy can be beneficial, because you want the muscles moving and working to help with back pain,” Park said. “We used to think rest and relaxation was better. But studies show only short-term rest is beneficial, and actually if you rest too long, you can have worse outcomes.”
As a result, he added, many doctors advise patients to rest for the short term and then to begin exercising to help the muscles.
The findings were published Dec. 28 online in JAMA Neurology.
Learn more about lower back pain at the U.S. National Institute of Neurological Disorders and Stroke.
SOURCES: Linda Van Dillen, PT, PhD, professor, physical therapy and orthopedic surgery, Washington University School of Medicine in St. Louis, Mo.; Daniel Park, MD, associate professor, orthopedic spine surgery, Oakland University William Beaumont School of Medicine, Rochester, Mich., director, minimally invasive orthopedic spine surgery, William Beaumont Hospital-Royal Oak, Rochester, Mich.; JAMA Neurology, Dec. 28, 2020, online
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by Comp Ortho | Jun 23, 2020 | Spine, Wellness
FRIDAY, June 19, 2020 (HealthDay News) — If you’re working from home because of the coronavirus pandemic and expect to keep doing so, you need to be sure your work station is set up properly, an orthopedic specialist says.
You also need to take regular breaks to move around, according to Terrence McGee, a physical therapist at Johns Hopkins University School of Medicine in Baltimore.
In an office, many people have ergonomic support and opportunities for physical breaks. You might have walked to the water cooler or coffee machine, attended meetings or walked to co-workers’ desks, he noted in a university news release.
To help you adapt to working at home, McGee has some suggestions to improve the safety and comfort of your workspace.
When sitting at your desk, rest your feet flat on the floor. Use a foot rest if the desk height can’t be adjusted.
Your thighs should be parallel to the ground, with a two-finger space between the back of the knees and the chair, and 3 to 6 inches of space between your thighs and the desk/keyboard.
Place a small pillow or towel roll behind you for lower back support, he suggested. Your head should be level, facing forward, and in line with your torso.
The top of your computer screen should be at or slightly below eye level. The screen itself should be 18 to 28 inches from your eyes, or at arm’s length. If you feel you need to bring your eyes closer to your screen, consider seeing an eye doctor for an eyeglass prescription, or make your screen’s text larger, McGee said.
If you use a dual monitor, swivel your body in your chair rather than constantly turn your head to view the monitors. If you can’t adjust your chair, consider changing the orientation of the monitor from landscape to portrait.
When using the keyboard and mouse, relax your shoulders and place your forearms parallel to floor. Your wrists should rest in a neutral position (hand in line with wrist and forearm). Use soft pads or a wrist rest as needed, and keep the mouse within easy reach and next to the keyboard. Adjust mouse sensitivity for light touch. A cordless mouse is the best option, McGee noted.
Also, use a hands-free headset if you’re on the phone for more than two hours a day, and use a document holder to secure papers when typing.
It’s not good for your physical or mental health to stay seated all day. Stand and move from your chair at least once an hour, McGee advised.
Also, perform desk stretches or chair yoga in between work tasks, he added.
Boston University offers more ergonomic tips for working at home.
SOURCE: Johns Hopkins University, news release, June 16, 2020
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