HEALTHY LIVING RESULTS

Non-specific low back pan which persists for some time is a common presentation for various health care practitioners to deal with, representing a major reason for absence from work due to sickness. Research has moved ahead quickly over the last decade, making a scientific view of assessment and treatment recommendations possible which could lead to predictable benefits for patients with persistent low back pain. The National Institute for Clinical Excellence (NICE) has just released a new set of guidelines in May 2009.

The first requirement in the assessment of back pain is to establish a diagnosis. By definition the source is not clear in non-specific low back pain but many potential diagnoses have been ruled out such as ankylosing spondylitis, arthritic diseases, fractures, infections or tumours. Diagnosis is not a one time thing with periodic reassessment important if things change, and investigations should be requested if a specific diagnosis is suspected. Radicular symptoms in the leg, typically called sciatica, and cauda equina syndrome are neurological syndromes which cause severe and very specific symptoms and need consultation with a spinal surgeon.

Low back pain has been typically classified as acute, sub-acute and chronic. Acute back pain is said to be back pain of a duration of less than six weeks, while sub-acute back pain is said to continue between six and twelve weeks. Over twelve weeks the back pain is said to be chronic although this classification may be too rigid to reflect the reality of the incidence patterns of low back pain. Many people’s symptoms vary significantly with more and less acute episodes over a long period of time.

Low back pain is estimated to affect around 30 percent of the population of the UK every year, with about a fifth of this number consulting their general practitioner about their back pain. In the past most back pain was thought to settle by six weeks but more recent research has shown that a year after their back pain episode sixty-two percent of sufferers still have pain. In those who are off work with their back pain sixteen percent are still off work at a year. The first month shows a rapid improvement in pain and disability but this is not much improved by three months.

Contemporary figures for the costs of back pain to society are not available but are known to be very high. Patients spend a lot of money on private therapists in the UK, patronising private physiotherapists, acupuncturists, osteopaths and chiropractors. A new episode or a worsening of low back pain makes the exclusion of non-mechanical causes for the back pain vital. Infection is more common in people with immune system problems such as HIV. The incidence of the types of cancers which spread to bone is higher in older age groups. Fractures due to osteoporosis have a higher incidence in older people and anyone on steroids.

Loss of the ability to work, development of disability related to the back and loss of normal activities are the negative factors which can result from sub-acute to chronic low back pain and are the factors which must be addressed to manage this condition successfully. High pain levels, a high degree of disability and psychological distress are risk factors for a poor result and so must be targeted to improve the patient’s outcome. Back pain treatments are very numerous with many claims for effectiveness but there is little good evidence to back up the use of most therapies. NICE made the decision to look at the overall delivery of a care package for back pain rather than concentrate on particular therapeutic interventions.

The common therapies used for treatment of low back pain include:

Patient education which covers advice and explanations from professionals, written material and education sessions.

Non-invasive physical therapies such as transcutaneous electrical nerve stimulation, traction, spinal corsets, interferential, laser and ultrasound.

Land or water based exercise programmes, again either individually or as part of an exercise group.

Other physical, non-invasive therapies such as ultrasound, interferential, laser, TENS, lumbar traction and lumbar corsets.

Psychological management involves self management, mindfulness and different types of cognitive behavioural therapy.

Traction as used in chiropractic environments, is usually spinal traction. Chiropractors must treat many patients with low back problems. Applying traction to the spine is for the purpose of stretching the soft tissues between the cervical discs to assist in recovery. Traction can be applied by using a bending or pulling force to stretch the soft tissues.

Spinal traction machines have capabilities of exerting a pulling force across the entire length of the spine. These machines must secure both ends of the patient’s spine and then a pulling force is used to stretch the length of the spine. The pulling force is used in this case to stretch the soft tissues between the cervical disc.

A spinal decompression machine works on a theory of extending the disc in unison from top to bottom. The machine is exerting a force on both ends of the spine which pulls apart the cervical discs and stretches the soft tissues. This is also the more common thought of mechanical traction.

Another way to decompress the spine is inversion therapy. Inversion therapy uses the weight of your body to exert a force along the length of the spine. This is accomplished by suspending the individual upside down. Suspension can happen either with an inversion bed or with inversion boots. The boots require a little more acrobatics to get to the inverted position.

Inversion therapy uses gravity to affect the force. The patient’s own weight is used to help stretch out the spine. Since the feet are held in place, the force is applied by both the angle of tilt and the patient’s own weight.

Roller tables are commonly used to apply traction across the length of the spine. In this case, a patient is laid down on the table. The table is activated, and a roller passes up and down the length of the patient’s spine.

The way a roller table applies traction is with a bending force. The roller passes across each cervical disc. As the roller passes, it causes the cervical disc to deflect. This deflection of the cervical disc elongates the soft tissues.

Massage chairs work on the same theory as roller tables. A roller is passed across the spine. The weight of the patient and the angle of the recline determine the force exerted on the disc. Unlike a roller table, however, massage chairs are able to adjust their angle.

Mechanical traction for the spine with a massage chair uses a roller. The roller is activated to go up and down the spine of the patient. The roller passes along each cervical disc. It deflects the cervical disc which elongate the soft tissues between them.

Massage chairs are also able to provide a number of other treatments in addition to spinal traction. Massage chairs have a full array of massage treatments and programs. Additionally heating elements are placed throughout the chair soothing warmth can be applied as needed. Massage chairs also have stretching of the lower body. Massage chairs also come with MP3 players which can provide a relaxing environment for the patient.

A variety of different treatments are provided with a massage chair. Massage chairs have many different massage techniques. These massage techniques can be to target specific muscle groups. They can also be adjusted in intensity. Massage chairs provide consistent massage therapy to patients. Massage also provides patients with other treatments including lower body stretching, heating and music therapy.

Do you ever get back pain in your lower back? We depend so much on our back that sometimes we take it for granted. Statistics tell us that 80% of the population is affected by low back pain at some point in their lifetime. It is estimated that over $50 billion is spent every year in the treatment of lower back pain. Most reported back pain is due to job related injuries. There are many treatments for lower back pain including surgery and natural therapeutic methods. One interesting method being employed is with the use of massage chairs.

What is lower back pain? Lower back pain can be either acute or chronic. Acute is a short term problem lasting a few days to a few weeks. Chronic back pain can last weeks or months. Some forms are progressive and can go on for years.

The majority of cases of low back pain are treated by chiropractors. Chiropractors use only natural methods to restore the health of the spine. Chiropractors do not perform surgery. Doctors of osteopath are the type of doctors that would perform low back surgery.

A doctor of Osteopath is a specialist in musculoskeletal problems particularly the joints. A chiropractor is also specialists in musculoskeletal and problems with a specialty in the spine. Both types of doctors are specialists in spinal health and either is qualified to treat lower back pain.

There are a number of conditions that can affect the lower back such as degenerative disc disease, back injuries among others that can be more chronic in nature. For the most part massage chairs are used to treat acute back pain. For chronic conditions, massage chair therapy is used selectively.

The key to good spinal health is flexibility of the soft tissues. When the tissues have normal flexibility they can adjust to weight shifts on the spine. When they become less flexible, then the same motions can cause certain muscles to become fatigued. As a muscle fatigues it becomes stiff or which causes pain.

When people have low back pain the weight of their body has been disproportionately put on a small area. This small area is usually the lower back that takes the full weight of the body. Normally the weight of the body is distributed across the spine. This causes those muscles to become stiff which then need treatment to make them more flexible.

The focus of a natural treatment to a healthy spine is to help it redistribute the weight back across the spine. The pain is stemming from a concentration of force on a particular muscle group. These muscles become fatigued and stiff. A natural treatment seeks to improve the elasticity of the muscles. Massage chairs help to soothe and relax muscles as well as stretch them out.

There are quite a variety of treatments available in many massage chair models. Massage chairs have replicated many different massage techniques which are available at the touch of a button. Many massage chairs also have stretching of the lower body and the upper body. Also, you can find heating elements built into massage chairs for applying heat to muscles throughout the body.

The key to treating low back pain is to get the spine to take back over its own health. Natural techniques are a much clearer path than having to undergo surgery. In some cases there is no choice. If you are suffering from low back pain, then check with your medical advisor to see what options are available for you. You may find a massage chair is the clearest path to good spine health.

The early part of the year is the time for the new resolutions we have about many things, including our personal appearance and fitness. Summer will soon be here and we want to look our best. Perhaps we have already signed up for the gym and rather predictably not attended anywhere near as much as initially intended. We want to be fit but are not clear at all what that means or the significance of the typical fitness measures used to track progress. Our lack of knowledge impairs our ability to plan our training and reduces the chances of success. While physiotherapists understand more about these concepts than most people they are still not that knowledgeable in detail.

A major health focus in the community is the management and prevention of coronary heart disease, a very common health condition and responsible for a large annual death toll. We can all work at our risk factors and bring the various parameters closer towards safe limits. Fitness is not one thing but composed of various abilities, parts of each of which may need to be developed to reach an acceptable result. Allowing one of the components to be ignored can limit the potential fitness we might achieve.

To achieve aerobic fitness we need to choose an overall body activity and maintain the performance at a particular level for a particular time. e.g. swim for 30 minutes. The degree of difficulty needs to be such to engage a training effect so we must be able to continue the activity for long enough.

To achieve muscular fitness we need to acquire sufficient strength and endurance in our muscles to achieve the forces and duration needed.

Flexibility is the ability of our bodies to be extensible, for the balance of looseness and tightness in bodily structures to be optimal for functional activity.

Dynamic and functional activities demand considerable balance, maintaining the control over our postural stability as we perform complex motions under load.

To put all the previous aspects together, power, endurance, strength, balance and aerobic capacity we need to develop coordination, a dynamic control of movement.

Typical values for the measurements which are used to indicate fitness and health are a resting blood pressure of less than 140/90 (140 over 90). The higher figure, 140, is the systolic blood pressure, the pressure occurring in the main artery when the heart is in systole (sist-oley) which is the main pumping action. The lower figure, 90, is the diastolic blood pressure, the pressure in the main artery when the heart is in diastole (di-ast-oley), the resting phase when it is refilling before the next pumping action. If the diastolic, lower number is elevated it indicates that the arterial system is stiffer than it should be and so the pressure within it is higher.

High blood pressure has consequences which relate to heart disease, kidney function, peripheral blood supply and the likelihood of stroke. This is connected with total cholesterol levels which should be less than 5.0 mmol/l (five millimoles per litre), which indicates the risk for developing atherosclerosis and heart disease to some degree. Body mass is another indicator of our present and future health, with the Body Mass Index (BMI) a useful but not infallible indicator of our status in the health stakes. The BMI is often indicated on a big colourful poster, charting the relationship between our height and our bodyweight and dividing the results into underweight, healthy, overweight and obese.

From 20 to 24.9 are the recommended limits for a healthy body mass index and the chart allows the indication of a desirable weight for our size so we can plan a realistic bodyweight to aim for if we are overweight. There are some difficulties with the BMI in that some people, perhaps due to their structure or muscular bulk, seem to get unreasonable results for their predicted desirable weight. However, the body weight index does give a good indication of what a desired weight should be and can be used along with the desired body fat content of between 21 and 27%.